Is panoramic radiography sufficient enough for the evaluation of mandibular condyle osseous changes and cortication types?

Introduction:
Temporomandibular disorders (TMDs) are identified by cranio-facial pain that affects the temporomandibular joint or masticatory muscles, along with symptoms, such as limited mouth opening, clicking, and crepitus.

Objectives:
The aim of this study was to investigate the accuracy of panoramic radiography (PR) in detecting mandibular condyle osseous changes and mandibular condyle-articular eminence cortication types in patients with TMDs, using cone beam computed tomography (CBCT) as a gold standard.

Material and methods:
Osseous changes in the mandibular condyle head and cortication types in both articular eminence and mandibular condyle head were examined using PR and CBCT images of patients with TMD symptoms.

Results:
The most occurrences of flattening were detected in the mandibular condyle heads using PRs, and the most of erosions were found in CBCT images. In both imaging methods, cortication of both the mandibular condyle head and articular eminence was the same or higher than that of the surrounding structures. PR showed high specificity and negative predictive values in detecting mandibular condyle osseous changes. PR revealed greater sensitivity and positive predictive values if the cortication of the mandibular condyle head and articular eminence was the same or higher than that of the surrounding structures.

Conclusions:
TMDs often result in the flattening and erosion of the mandibular condyle. PR and CBCT images demonstrate that the cortication of the mandibular condyle and articular eminence in patients with TMDs indicates the same or higher intensity than that of the surrounding structures. PR alone may be insufficient to evaluate osseous changes in the mandibular condyle and cortication of the temporomandibular joint. Three-dimensional imaging methods, such as CBCT, may be required for a more comprehensive evaluation.