The Clinical Research Of The Idiopathic Condylar Resorption

The idiopathic condylar resorption is an uncommon degenerative disease of TMJ of an aggressive nature that is seen mostly in female adolescents and young women.In general,ICR has the following features: Class II open bite,Mandibular retropositioning with clockwise rotation(high angle).Condyle plays an important role in the growth of the mandible.It is closely related to the formation of the malocclusion.And at the same time the loss of condylar mass and the malocclusion will accelerate the reconstruction of the condyle.Recently,many researchers had studied the etiology and the treatment of the ICR.As the idiopathic morphology,most of the studies focused on the two dimensions.This study,which is using the CBCT technique and three-dimensional measurement to measure and analyze the condylar bony structures of ICR,aims to be referred to clinic.Experiment One:Evidence-based medical research of the ICRObjective: To evaluate and analyze the efficacy of various treatment methods from the trials involved.Methods: The main database: Cochrane Library,Embase,PubMed,Medline,SinoMed,WanFang,full text database of Chinese periodicals topic(CNKI),VIP Chinese Science and other databases(such as the Chinese scientific papers online).The Search term: “idiopathic AND condylar AND resorption”,“progressive AND condylar AND resorption”,“aggressive AND condylar AND resorption”,“idiopathic AND condylysis”,“idiopathic AND condylar AND atrophy”.Then we use the NoteExpress to determine the documents included in the study and extract relevant information.Results: Twelve studies(131cases)were identified.84 cases of them are from the USA,33 cases from the Netherlands,10 cases from France,4 cases from Britain.The treatment methods include Wolford protocol(14cases),Orthognathic surgery(12cases),Condylectomy and CCG(23cases),Occlusal splint and orthodontic treatment(13cases),BSSO(20cases),Mandibular osteotomy(5cases),Bibasilar osteotomy(3cases),Maxillary osteotomy(1case),Alloplastic TMJ reconstruction(36cases).Among them,the orthognathic surgery and BSSO were reported to relapse.Conclusion: Because of the small number,low quality,selection bias,publication bias and the implementation of the possibility of bias,and there are many limitations,so the results of the system reliability is low,but for the future of ICR clinical research points the way of treatment.The future there is a need for high quality,large sample randomized controlled trial.Experiment Two:The clinical research of the idiopathic condylar resorptionObjective: The aim of this study was to explore the clinical onset characteristics of ICR patients,analyze the profile related characteristics to provide a reference for clinic.Methods: Fifty-two cases(26 normal control group;26 ICR patients group)were collected.To analyze the ICR patients’ age,sex,single or double side,joint symptoms and occlusal conditions.Then we measure and analyze the X-ray films to find the differences between the two groups.Results: ICR is seen mostly in female adolescents and young women.ICR has the following features: Class II open bite,Mandibular retropositioning with clockwise rotation(high angle),mandibular ramus decreased.Conclusions: ICR has certain clinical disease characteristics and its unique profile characteristics,provide reference for clinical diagnosis and treatment.Experiment Three:The CBCT imaging studies of the ICR Objective: Using CBCT to measure the structure of the TMJ in three-dimension,then we explore the morphological characteristics of them,so as to provide reference for clinic.Methods: Fifty-two CBCT films(26 normal control group;26 ICR patients group)were collected.Use Mimics 17.0 software to measure the positions and forms of condyle,forms of fossa and joint spaces.Results: The condylar volume,the condylar surface,anteroposterior distance,medial-lateral distance,condylar height,superior joint space,the inclined angle in axial plane,articular eminence inclination of the ICR patients are smaller than the control group,but the inclined angle in sagittal plane is bigger.Conclusions: The three-dimensional characteristics of the mandibular condyle are changed when the ICR patients compared with the healthy,these are good indicators for assessing ICR development and its treatment effect and prognosis.