CBCT Evaluation of the effects of loss of posterior teeth on the mandibular condyle

2. Special Thanks to
Prof. Dr. Ahmed Yehia Ashour
• B.D.S, M.S, Ph.D.
• Dean of Faculty of Dentistry P.U.A
• Professor of Restorative Dentistry

3. Special Thanks to
Prof. Dr. Fayza Mahmoud El-Daly
• B.D.S, Ph.D.
• Vice Dean of Faculty of Dentistry
P.U.A

4. Great Thanks to
Prof. Dr. Magda Mohamed Saleh
• B.D.S, Ph.D.
• Head of DEPARTMENT OF ORAL
AND MAXILLOFACIAL SURGERY

5. Particular Appreciation to
• Dr. Haitham Sakr
Lecturer At PUA

6. Presented By
• Abdullah Mohamed
• Abd-ElRahman Hassan Gouda
• Atia Ahmed Shamseldin

7. Welcome

8. CBCT evaluation
of the effects of loss of posterior teeth on
the mandibular condyle

9. Introductio
n
• TMJ
• Condyle
• CBCT
• AIM of study
Patients and methods
• Patient selection
• Methods Used
• Statistical analysis
Results
• What we observed
• Tables
Conclusion
• And recommendation
References

10. Introduction
TMJ & Condyle The Teeth CBCT

11. TMJ
• The functions of the temporomandibular joint, is to provide smooth,
efficient movement of the mandible during mastication, swallowing and
speech and to provide stability of mandibular position and prevent
dislocation from external or unusual forces.
• The temporomandibular joint is a unique joint that can be affected by
different kinds of hard and soft tissue abnormalities.
• The bony components of TMJ need a careful study since the changes in
these components may imply functional disorders and pain.
• Temporomandibular joint disorders are a subdivision of musculoskeletal
pathologies which act as a source of orofacial pain of non dental origin .
• These temporomandibular joint disorders are frequently associated with
certain degenerative bony changes that include; Flattening, Erosion,
Osteophytes etc, all of which involve the bony components of TMJ.
Condyle
• The mandible is composed of the body, the ramus and condyle at
the most superior part and is located inferior to the maxilla. they
join the body at the angle of the mandible.
• The mandibular condyle (or head), besides joint function, acts as
a site of regional adaptive growth even under functional load
supported by its cartilage.
• Mandibular condyle morphology is characterized by a rounded
bone projection with an upper biconvex and oval surface in axial
plane.
• The condyle presents an articular surface for articulation
with the articular disk of the temporomandibular joint.
• The condyle is a very special part of the TMJ, It expresses the
center of mandibular growth.

12. Teeth
• Teeth are the main functional component of the oral cavity.
• Teeth provide a variety of function including mastication, speech and esthetics .
Tooth loss occurs in the oral cavity by various causes such as dental caries,
periodontal diseases, trauma, pulpal and periapical diseases and various systemic
diseases.
• The teeth provide a stable vertical and horizontal relation of mandible to maxilla
and provide guiding planes for movement of the mandible anteriorly and laterally
in the range of the mandibular movement during which the teeth are in contact.
• Loss of posterior teeth followed by loss of occlusal curve may tip the balance from
adaptation with functional harmony towards disordered function .
• The absence of posterior teeth has been described as an etiological factor of high
prevalence in the functional alterations of the stomatognathic system

13. CBCT
• Cone-beam computed tomography systems (CBCT) are a variation of
traditional computed tomography (CT) systems.
• The CBCT systems used by dental professionals rotate around the patient,
capturing data using a cone-shaped X-ray beam.
• These data are used to reconstruct a three-dimensional (3D) image of the
following regions of the patient’s anatomy: dental (teeth); oral and
maxillofacial region (mouth, jaw, and neck); and ears, nose, and throat
• X-ray imaging, including dental CBCT, provides a fast, non-invasive way of
answering a number of clinical questions.
• Dental CBCT images provide three-dimensional (3-D) information, rather
than the two-dimensional (2-D) information provided by a conventional X-
ray image.
• This may help with the diagnosis, treatment planning and evaluation of
certain conditions..

14. The present study was designed to investigate
the effect of bilateral loss of mandibular
posterior teeth on the mandibular condyle
dimensions and volume using CBCT.
Aim of study

15. Introductio
n
• TMJ
• Condyle
• CBCT
• AIM of study
Patients and methods
• Patient selection
• Methods Used
• Statistical analysis

16. Patient Selection
5
10
14
5
3
4
0
2
4
6
8
10
12
14
16
18
20
Control Group Study Group Excluded
Male Female
• This study was performed on 23 patients.
• Age Range 30-60 Years.
13
10
Kennedy Class I Patients
Fully Dentate Patients
• All CBCTS were taken in Pharos University Radiology Center
• The study was approved by the Faculty’s research ethics committee..
• The control group had a complete set of teeth
• The study group had bilateral loss of mandibular teeth (all lower molars and
second premolar at least)
• All patients were Class I skeletal pattern, This was determined by measuring the
ANB angle.
No.
of
Cases
Exclusion criteria
• Persons below 18 years of age,
• Patients with Temporo-mandibular Diseases, patients with maxillofacial
trauma and history of condylar fracture,
• Patients with degenerative bone diseases,
• Patient with oral malignancy,
• Patients with severe malocclusion,
• Patients with a history of orthodontic treatment having with skeletal
deformity,
• And persons whose radiographs do not reveal the condylar anatomy
clearly were excluded from the study group.

17. • All variables were described by the mean, standard deviation (SD).
• Data were explored for normality by checking the distribution of data and
using Kolmogorov–Smirnov test of normality.
• Significance level was considered at P<0.05.

18. Introductio
n
• TMJ
• Condyle
• CBCT
• AIM of study
Patients and methods
• Patient selection
• Methods Used
• Statistical analysis
Results
• What we observed
• Tables

19. Results
• All parameters were assessed separately on right and left
TMJs of the study and control groups.
• Kennedy class I patients showed statistically significant
higher mean condyle width than control group.
• No statistically significant difference was found
between the study group and the control group regarding
condyle Antero-Posterior dimension.
Observations and Tables
Right Left Sum of both
Mean 9.395 10.064 19.459
Standard Deviation 2.6892 3.2722 5.9614
Standard Error of The mean 0.8504 1.0348 1.8852
9.395
10.064
19.459
2.6892
3.2722
5.9614
0.8504 1.0348
1.8852
0
5
10
15
20
25
mm
Saggital View
Normal Patients
Mean Standard Deviation Standard Error of The mean
Width of Condyle In Normal Patients
( Sagittal View )
Right Coronal and Sagittal View in a patient 1 of Control Group
Left Coronal and Sagittal View in a patient 1 of Control Group
Right Coronal and Sagittal View in a patient 2 of Control Group
Left Coronal and Sagittal View in a patient 2 of Control Group
Width of Condyle In Normal Patients
( Coronal View )
Right Left Sum of both
Mean 17.586 18.776 36.362
Standard Deviation 1.7907 3.0427 4.8334
Standard Error of The mean 0.5663 0.9622 1.5285
17.586
18.776
36.362
1.7907
3.0427
4.8334
0.5663 0.9622 1.5285
0
5
10
15
20
25
30
35
40
mm
Coronal View width of Condyle
in Normal patients
Mean Standard Deviation Standard Error of The mean
Right
Left
Study group Patient 1
( coronal and sagittal view )
Right
Left
Study group Patient 2
( coronal and sagittal view )
Right
Left
Right Left
Left
Right Left Sum of both
Mean 8.73 9.06 17.79
Standard Deviation 0.8995 1.5154 2.4149
Standard Error of The mean 0.2712 0.4569 0.7281
8.73
9.06
17.79
0.8995
1.5154
2.4149
0.2712 0.4569 0.7281
0
2
4
6
8
10
12
14
16
18
20
mm
Sagittal View in Study Group
Mean Standard Deviation Standard Error of The mean
Condyle width of sagittal View
( Study Group )
Condyle width of Coronal View
( Study Group )
Right Left Sum of both
Mean 18.5055 16.43 34.9355
Standard Deviation 1.9472 2.4154 4.3626
Standard Error of The mean 0.5871 0.7283 1.3154
18.5055
16.43
34.9355
1.9472 2.4154
4.3626
0.5871 0.7283 1.3154
0
5
10
15
20
25
30
35
40
mm
Coronal View of Study Group
Mean Standard Deviation Standard Error of The mean

20. Introductio
n
• TMJ
• Condyle
• CBCT
• AIM of study
Patients and methods
• Patient selection
• Methods Used
• Statistical analysis
Results
• What we observed
• Tables
Conclusion
• And Recommendation

21. Conclusion
Loss of posterior teeth is accompanied
by significant decrease in condyle
height and increase in condyle width
with no change in the total condyle
volume or antero-posterior
dimensions.
Condyle mediolateral width in the study group
showed 18.52 mean and 2.06 standard deviation
while the control group showed 17.21 mean and 2.39
SD. The P value was lower than 0.05 so that condyle
mediolateral width was significantly higher in the
study group than the control group.
Condyle antero-posterior dimension in the study
group showed lower mean in the study group (8.27)
than the control group (8.43) but the P value was
higher than 0.05 so that there was no significant
change in condyle antero-posterior dimension.

22. Further investigations has to be done in this matter, with more
advanced scanning and measurement systems
Recommendation

23. Thank You!