Panoramic imaging may detect morphologically abnormal temporomandibular joints in children with juvenile idiopathic arthritis

Objective

To investigate the reliability of panoramic imaging (PAN) with cone beam computed tomography (CBCT) as gold standard to distinguish between normal and abnormal temporomandibular joint (TMJ) morphology in a sample of children with juvenile idiopathic arthritis (JIA).

Material and method

In this prospective cohort study, 106 PAN and 108 CBCT examinations from 54 children were obtained. A classification system with reference images was developed and used to discriminate between normal and abnormal TMJ morphology. The severity of abnormality and additional findings were registered. Three experienced and calibrated maxillofacial radiologists evaluated the images and intra- and inter-reader agreement was calculated.

Results

Consensus diagnosis of abnormal TMJ morphology on PAN and on CBCT was registered in 27.6% and 28.1% of the joints, respectively. There were differences between the two imaging modalities regarding severity grading of abnormality and registration of additional findings. With CBCT abnormal TMJ morphology was frequently graded as more severe and additional findings such as erosions and osteophytes more frequently found.

Conclusion

With trained readers, PAN was found to distinguish between morphologically normal and abnormal TMJs equally often as CBCT. Thus, the method seems valuable for assessing TMJ involvement in children with JIA. However, CBCT was found to be superior for assessing severity of abnormality and additional diagnostic information.