Condylar Morphological Changes in Juvenile Idiophatic Arthritis : Cone Beam CT

Aim: To examine the relationship between the clinical signs and symptoms of temporomandibular joint disorders and Cone Beam Computed Tomography (CBCT) evidence of destruction of these joints in children afflicted with Juvenile Idiopathic Arthritis (JIA). It has been evaluated from a statistical stand point the temporal, metric and clinical variables of the disease, also measuring condylar and mandibular real volumes in order to plan an effective therapy. Materials and Methods: This study enrolled 30 patients with JIA. CBCT has been performed. 3D quantitative measures of the mid-lateral and anterior-posterior diameters and angles of the condyles were taken. The mandible was isolated from others craniofacial structures; the whole mandibular volume and its components’ volumes (condyle, ramus, emibody, emisymphysis on right side and on left side) has been calculated by a 3D volume rendering technique. Results: The analysis of the condylar changes showed that the most apparent signs were the erosion (44%), the flattening (24.5%) and the presence of osteophytes (15%). Only 2% of the study subjects had no damage. There was a very significant difference in the linear and angular measurements between healthy and affected condyles (p<0.01). The results show a highly significant statistical difference between affected side volumetric values versus normal side volumetric values above all on condyle region (P<0.01), while they doesn’t show any statistical differences between right side versus left side. Conclusions: CBCT represents an improvement in quantifying the morphological changes of the condyle and mandible, gives an accurate picture of these structures in JIA and allows the acquisition of true measurements of the mandibular components even in the early stages of JIA. Early initiation and optimal adjustment of aggressive therapy with disease-modifying anti-rheumatic drugs have been extremely successful in preventing irreversible joint damage.