What is idiopathic condylar resorption?
INTRODUCTION Idiopathic condylar resorption (ICR) of the temporomandibular joint (TMJ) is a condition that is often esthetically and functionally altering, characterized by progressive resorption of the TMJ condylar heads, without a known cause.
What are the modern treatments for Condylar resorption?
Modern treatments for condylar resorption almost exclusively focus on the surgical resection of the diseased joint and replacing it with an artificial joint prosthesis. Our approach however follows the successful medical protocols seen in the fields of rheumatology and orthopedics.
Does orthognathic orthodontic treatment cause condylar resorption?
Orthodontic treatment may coincide with idiopathic condylar resorption; however, it has not been demonstrated that this pathology occurs due to active therapy [12]. On the contrary, condylar resorption after orthognathic surgery has been observed [13].
Can you have condylar resorption without any cause?
Some people develop condylar resorption without an obvious cause, known as idiopathic condylar resorption. Idiopathic condylar resorption is rare. What are the symptoms of condylar resorption?
How do you treat idiopathic condylar resorption?
How is condylar resorption treated?Anti-inflammatory medications, which can help slow the condition's progress.Bite splints or night guards to protect your teeth from damage due to bruxism (grinding and clenching).Condylectomy, which is surgery to remove your mandibular condyles.More items...•
When does idiopathic condylar resorption stop?
Since ICR tends to occur in the teens and twenties, the most relevant inflammatory arthritis is JIA, which occurs from 0 to 16 years of age. [29] It affects the growth of the mandible, which normally can continue until the third decade[30] and cause condylar hypoplasia and anterior open bites.
Is idiopathic condylar resorption rare?
Purpose: Idiopathic condylar resorption (ICR) is a relatively uncommon condition. Its diagnosis, etiology, and management options are controversial. Furthermore, it is difficult for 1 provider to collect a large cohort of ICR patients to develop a statistically significant study of these concerns.
How do you know if you have idiopathic condylar resorption?
The signs of condylar resorption are: Facial imbalance (receding chin), Smaller airway (snoring, apnea) and. Bite disturbances (anterior open bite, posterior tooth wear and muscle pain).
What causes idiopathic condylar resorption?
Systemic connective tissue or autoimmune diseases that can cause condylar resorption include rheumatoid arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, Sjögren syndrome, ankylosing spondylitis, and others. ICR is a specific disease entity different from these other disease processes.
Is idiopathic condylar resorption genetic?
Condylar resorption, also called idiopathic condylar resorption, ICR, and condylysis, is a temporomandibular joint disorder in which one or both of the mandibular condyles are broken down in a bone resorption process....Condylar resorptionAn anatomical diagram of the condyloid process.SpecialtyOrthopedic2 more rows
Does TMJ cause condylar resorption?
Condylar resorption (CR) is a common sequela of some temporomandibular joint (TMJ) abnormalities. CR can result in jaw deformities and dysfunction, malocclusion, pain, headaches, and airway obstruction.
What is a BSSO surgery?
A Bilateral Sagittal Split Osteotomy (or BSSO) is a type of jaw surgery where the lower jaw is separated from the face and repositioned. This repositioning is also called orthognathic surgery.
Can a jaw joint be replaced?
Temporomandibular joint (TMJ) implants are intended to be surgically implanted in the jaw to replace the temporomandibular joint. A variety of artificial materials have been used to partially or totally replace the TMJ, including plastics, Teflon, silicone, metals, and a combination of these materials.
Evaluation and Treatment
In patients with the condition of uncertain etiology that is commonly referred to as idiopathic condylar resorption (ICR) *, the condyles of the mandible partially resorb, thereby causing a loss of condylar height with secondary alterations of the maxillofacial morphology, occlusion, and head and neck function.
Theories of Etiology
The current dominant theory holds that the etiology of ICR is hormonally mitigated, immunologically controlled and may arise in genetically susceptible individuals in conjunction with environmental factors. * Sex hormones are thought to modulate biochemical changes within the TMJ, which may then result in condylar resorption.
Clinical Perspectives
The foregoing theories remain unproven, but the effects of estrogen on condylar resorption and repair with or without an autoimmune component seem indisputable.
Current Clinical Approach to Correction of the Secondary Jaw Deformities
After the diagnosis of ICR is made, non-invasive measures (e.g., splint therapy, muscle relaxants, medications, and diet modification) to “unload” and “stabilize” the condyles or at least to relieve masticatory muscle hyperactivity and discomfort are initiated.
Case Presentations
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What is idiopathic condylar resorption?
Idiopathic condylar resorption is a poorly understood progressive disease that affects the TMJ and that can result in malocclusion, facial disfigurement, TMJ dysfunction, and pain. This article presents the diagnostic criteria for idiopathic condylar resorption and a new treatment protocol for management of this pathologic condition. Idiopathic condylar resorption most often occurs in teenage girls but can occur at any age, although rarely over the age of 40 years. These patients have a common facial morphology including: (1) high occlusal and mandibular plane angles, (2) progressively retruding mandible, and (3) Class II occlusion with or without open bite. Imaging usually demonstrates small resorbing condyles and TMJ articular disk dislocations. A specific treatment protocol has been developed to treat this condition that includes: (1) removal of hyperplastic synovial and bilaminar tissue; (2) disk repositioning and ligament repair; and (3) indicated orthognathic surgery to correct the functional and esthetic facial deformity. Patients with this condition respond well to the treatment protocol presented herein with elimination of the disease process. Two cases are presented to demonstrate this treatment protocol and outcomes that can be achieved. Idiopathic condylar resorption is a progressive disease that can be eliminated with the appropriate treatment protocol. (Am J Orthod Dentofacial Orthop 1999;116:667-77)
What age can condylar resorption occur?
Idiopathic condylar resorption most often occurs in teenage girls but can occur at any age, although rarely over the age of 40 years . These patients have a common facial morphology including: (1) high occlusal and mandibular plane angles, (2) progressively retruding mandible, and (3) Class II occlusion with or without open bite.
What are the characteristics of ICR?
People with the following specific facial morphologic characteristics appear to be most susceptible to ICR: (1) females (approximately 9:1 female to male ratio); (2) age range from 10 to 40 years old with a strong predominance for teenagers in their pubertal growth phase; (3) high occlusal plane angle and mandibular plane angle; and (4) predominance of Class II skeletal and occlusal relationship with or without open bite. ICR rarely occurs in low occlusal and mandibular plane angle facial types or in Class III skeletal relationships.
Is ICR a disease?
ICR is a poorly understood disease process, but it can be treated effectively with the specific treatment protocol described herein provided that the articular disks and condyles are still salvageable. Other pathologic TMJ conditions must be ruled out because they may not respond to this treatment protocol.
Dr. Bradford Edgren illustrates a patient with dysfunctional remodeling of the condyle
A healthy 16-year 10-month-old female presented for a clinical evaluation of her temporomandibular joints with chief complaints of headaches (tension 2-to-3 times per week and migrainous once a week), perceived reduced opening, right temporomandibular joint (TMJ) clicking, history of closed lock, nocturnal clenching and bruxism, and jaw pain of 5 months’ duration.
Discussion
A number of factors can result in dysfunctional remodeling of the condyle, including hormonal influences, systemic illnesses such as autoimmune and endocrine disorders, trauma, parafunction, unstable occlusion, and genetic predisposition.
Acknowledgments
The author thanks Seuss Kassisieh, DDS, MS, for reviewing the manuscript and George Holling DDS, MS, for reviewing the manuscript and providing the implant radiographs.
