AJR 2002; 178:1557-1562
© American Roentgen Ray Society
Disk Displacement of the Temporomandibular Joint: Sonography Versus MR Imaging
Rüdiger Emshoff1,
Siegfried Jank1,
Stefan Bertram1,
Ansgar Rudisch2 and
Gerd Bodner2
1 Department of Oral and Maxillo-Facial Surgery, University of Innsbruck,
Maximilianstr. 10, A-6020 Innsbruck, Austria.
2 Department of Radiology, University of Innsbruck, Anichstr. 35, A-6020
Innsbruck, Austria.
Received July 3, 2001;
accepted after revision December 17, 2001.
Address correspondence to R. Emshoff.
Abstract
OBJECTIVE. The purpose of this study was to determine the value of
dynamic sonography in the evaluation of internal derangements of a
temporomandibular joint (TMJ) during maximal mandibular range of motion.
SUBJECTS AND METHODS. Maximal mandibular range of motion was
performed during high-resolution sonography of the TMJ in 64 consecutive
patients (128 joints; nine males and 55 females; age range, 17-65 years; mean
age, 35 years 6 months), all of whom subsequently underwent MR imaging. MR
imaging confirmed disk displacement with reduction in 27 joints and disk
displacement without reduction in 60 joints of the 128 examined. The
high-resolution sonography and MR imaging findings for these 27 and 60 TMJs,
respectively, were analyzed.
RESULTS. Dynamic high-resolution sonography performed during the
maximal range of motion helped to detect 81 instances (93%) of internal
derangement, 22 instances (82%) of disk displacement with reduction, and 50
instances (83%) of disk displacement without reduction. There was one
false-positive finding for internal derangement. The accuracy of prospective
interpretation of high-resolution sonograms of internal derangement, disk
displacement with reduction, and disk displacement without reduction was 95%,
92%, and 90%, respectively.
CONCLUSION. When real-time images are interpreted by expert
radiologists, dynamic sonography performed during maximal mandibular range of
motion may provide valuable information about disk displacement of the
TMJ.
Introduction
Internal derangements of the temporomandibular joint (TMJ) are one of the
most common forms of temporomandibular disorders. The term "internal
derangement" refers to clinical criteria for classifying TMJ disorders
but is generally used to denote an abnormal position of the articular disk
relative to the mandibular condyle and the articular eminence. The disorders
have been associated with characteristic clinical findings such as pain, joint
sounds, and irregular or deviating jaw function
[1,
2].
Arthrography and MR imaging are common diagnostic methods for the
evaluation of disk displacement. Arthrography as a dynamic investigation
technique for the disk—condyle relationship has been shown to provide a
diagnostic accuracy of 83% when combined with videofluoroscopy
[3], whereas MR imaging has a
diagnostic accuracy of 95% when coronal and sagittal imaging techniques are
combined [4]. However,
arthrography is invasive and may be complicated by pain, disk perforation, and
allergic reactions; MR imaging poses a problem in terms of clinical
availability and cost.
Sonography allows dynamic visualization of the soft-tissue structures of
the TMJ. Although some reports in the literature discuss the use of sonography
in the diagnosis of disk displacements
[5,6,7],
little attention has been directed toward the types of internal derangements.
The purpose of this study was to describe the technique of high-resolution
sonographic evaluation of an internal derangement and to discuss the
reliability of the sonographic findings.
Subjects and Methods
From June 2000 to March 2001, 64 consecutive patients with symptoms of TMJ
internal derangement were referred for MR imaging of the TMJ. There were 55
females and nine males whose ages ranged from 17 to 65 years (mean age, 35
years 6 months). High-resolution sonography was performed immediately after MR
imaging. The findings on sonography and MR imaging in these 64 patients (128
joints) were analyzed.
All sonograms were obtained and interpreted prospectively by a radiologist
who had no knowledge of the results of the MR imaging. Sonography was
performed using a 12-MHz linear array transducer on an HDI 5000 scanner
(Advanced Technology Laboratories, Bothell, WA). Dynamic imaging for the full
range of motion in the mandibular opening was used to evaluate the presence or
absence of disk displacement at closed-mouth and maximal open-mouth
positions.
The orientation of the scanning was based on a standardized protocol to
obtain cross-sections intersecting the anterosuperior joint compartment in a
sagittal-to-frontal plane. With the patient in a supine position, we placed
the transducer over the TMJ, parallel to the long axis of mandibular ramus.
The transducer was tilted until the optimal visualization was obtained (Fig.
1A,1B,1C).
On the sonograms, the disk is visualized as a thin homogeneous,
hypoto-isoechoic band lying adjacent to the inferior relation (overlying the
mandibular condyle). The bony landmarks of the mandibular condyle and the
articular eminence are visualized as hyperdense lines. We identified the
course of the disk's motion by having the patient slightly move the mandible.
We found that during the dynamic evaluation, the sonographic beam must be kept
in exactly the same orientation to the diskal surface to avoid artifactual
changes in diskal echogenicity. Scanning 60° or more off the plane
perpendicular to the long axis of the disk leads to nonvisualization of the
disk. Scanning parallel to the joint space is of limited use because a lack of
bony landmarks makes orientation difficult. However, once the disk is
localized in a sagittal or coronal direction, the transducer is tilted
perpendicular to the joint to determine the position of the disk in the
sagittal direction.
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Fig. 1A. —Drawings illustrate examination and analysis of
temporomandibular joint (TMJ) disk position using high-resolution sonography.
Drawing shows technique of examining TMJ region with sonographic transducer
positioned against patient's face overlying zygomatic arch and TMJ.
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Fig. 1B. —Drawings illustrate examination and analysis of
temporomandibular joint (TMJ) disk position using high-resolution sonography.
Depiction of location of disk intermediate zone relative to condyle (C) and
articular eminence (E) at closed-mouth position. Top = anterior, left =
superior.
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Fig. 1C. —Drawings illustrate examination and analysis of
temporomandibular joint (TMJ) disk position using high-resolution sonography.
Depiction of location of disk intermediate zone relative to condyle (C) and
articular eminence (E) at maximal open-mouth position. Top = anterior, left =
superior.
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In evaluating findings of the closed mouth, we considered the position of
the disk to be normal if the intermediate zone of the disk was located between
the anterosuperior aspect of the condyle and the posteroinferior aspect of the
articular eminence. Disks with the intermediate zone located anterior to this
position were considered displaced. In evaluating findings of the open mouth,
the position of the disk was considered normal if the intermediate zone of the
disk was located between the condyle and the articular eminence of the condyle
(Fig.
1A,1B,1C).
At the time of MR imaging, the diagnosis of disk displacement was made by a
second radiologist. MR imaging was performed with a 1.5-T MR scanner (Vision;
Siemens, Erlangen, Germany) and a dedicated circular polarized
transmit—receive TMJ coil. The data were collected on a 252 x 256
matrix with a field of view of 145 mm, giving a pixel size of 0.60 x
0.57 mm. With the patient in a supine position, 15 coronal slices and eight
parasagittal slices were obtained of the TMJs in each patient using a turbo
spin-echo proton density—weighted sequence (TR/TE, 2800/15) with thin
slices of 3 mm. MR images were corrected to the horizontal angulation of the
long axis of the condyle.
Each patient received an individual nonferromagnetic intermaxillary device
to help in obtaining the different open-mouth positions. Sequential bilateral
images were obtained of the closed-mouth and the maximal open-mouth
positions.
The MR images selected for analysis of the disk—condyle relationship
depicted the disk, condyle, articular eminence, and glenoid fossa. The disk
position was considered normal if the posterior band of the disk was located
at the 12-o'clock or superior position relative to the condyle. Disk
displacement was diagnosed in patients in whom the posterior band of the disk
was in an anterior, anteromedial, anterolateral, medial, or lateral position
relative to the superior part of the condyle
[4]. The MR images were
interpreted without knowledge of the findings of the other study.
Diagnosis of the functional disk—condyle relationship was categorized
as normal (absence of internal derangement) or as disk displacement with or
without reduction. The categorization was based on whether disk displacement
was evident in the closed-mouth position and whether the displacement was or
was not associated with an interposition of the disk between the condyle and
the articular eminence in the open-mouth position
[4] (Figs.
2A,2B,2C,2D
and
3A,3B,3C,3D).
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Fig. 2A. —Temporomandibular joint (TMJ) of 32-year-old woman. Diagnosis
of disk displacement with reduction was based on MR imaging findings.
Longitudinal high-resolution sonogram obtained in closed-mouth position shows
anterosuperior TMJ compartment and disk (arrows) anterior to condyle
(arrowheads). E = articular eminence, D = disk, C = condyle.
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Fig. 2B. —Temporomandibular joint (TMJ) of 32-year-old woman. Diagnosis
of disk displacement with reduction was based on MR imaging findings. Sagittal
MR image obtained in closed-mouth position shows anterosuperior TMJ
compartment and disk (arrows) anterior to condyle.
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Fig. 2C. —Temporomandibular joint (TMJ) of 32-year-old woman. Diagnosis
of disk displacement with reduction was based on MR imaging findings.
Longitudinal high-resolution sonogram obtained in maximal open-mouth position
shows anterosuperior TMJ compartment and disk (arrows) superior to
condyle (arrowheads). E = articular eminence, D = disk, C =
condyle.
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Fig. 2D. —Temporomandibular joint (TMJ) of 32-year-old woman. Diagnosis
of disk displacement with reduction was based on MR imaging findings. Sagittal
MR image obtained in maximal open-mouth position shows anterosuperior TMJ
compartment and disk (arrows) superior to condyle.
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Fig. 3A. —Temporomandibular joint (TMJ) in 27-year-old woman. Diagnosis
of disk displacement without reduction was based on MR imaging findings.
Longitudinal high-resolution sonogram shows anterosuperior TMJ compartment in
closed-mouth position and disk (arrows) anterior to condyle
(arrowheads). E = articular eminence, D = disk, C = condyle.
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Fig. 3B. —Temporomandibular joint (TMJ) in 27-year-old woman. Diagnosis
of disk displacement without reduction was based on MR imaging findings.
Sagittal MR image shows anterosuperior TMJ compartment in closed-mouth
position and disk (arrows) anterior to condyle.
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Fig. 3C. —Temporomandibular joint (TMJ) in 27-year-old woman. Diagnosis
of disk displacement without reduction was based on MR imaging findings.
Longitudinal high-resolution sonogram shows anterosuperior TMJ compartment in
maximal open-mouth position and disk (arrows) anterior to condyle
(arrowheads). E = articular eminence, D = disk, C = condyle.
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Fig. 3D. —Temporomandibular joint (TMJ) in 27-year-old woman. Diagnosis
of disk displacement without reduction was based on MR imaging findings.
Sagittal MR image shows anterosuperior TMJ compartment in maximal open-mouth
position and disk (arrows) anterior to condyle.
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Results
Dynamic high-resolution sonography revealed 81 internal derangements, all
of which were verified on MR imaging. In these 81 TMJs, MR imaging confirmed
disk displacement with reduction in 22 cases and disk displacement without
reduction in 50 cases. In the six cases in which sonography produced
false-negative results, MR imaging revealed a medially displaced disk in the
closed-mouth position (Table
1).
MR imaging revealed 87 cases of internal derangement: 22 true-positive
findings of disk displacement with reduction, five false-negative findings of
disk displacement with reduction, 50 true-positive findings of disk
displacement without reduction, and 10 false-negative findings of disk
displacement without reduction. The sensitivity of MR imaging for detecting
disk displacement with reduction in the presence of a disk displacement with
reduction was 82%; in the presence of a normal disk position, sensitivity was
95%. For disk displacement without reduction, sensitivity was 83% in the
presence of a disk displacement and 96% in the presence of a normal disk
position (Tables 1 and
2).
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TABLE 2 Reliability of Prospective Diagnoses Based on High-Resolution
Sonographic Findings in 64 Patients (128 Temporomandibular Joints)
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Of TMJ positions diagnosed as disk displacement on high-resolution
sonography, MR imaging showed 22 disk displacements with reduction (82%) and
50 disk displacements without reduction (83%). Of the TMJ positions shown on
high-resolution sonography as normal disk positions, MR imaging showed that
five were disk displacements with reduction (95%) and 10 were disk
displacements without reduction (87%) (Tables
1 and
2).
The accuracy of prospective interpretation of high-resolution sonograms of
internal derangement, disk displacement with reduction, and disk displacement
without reduction was 95%, 92%, and 90%, respectively
(Table 2).
Discussion
The close association between symptoms of TMJ internal derangements and
disk displacement has been emphasized in the literature. Symptoms of TMJ
internal derangements may resolve spontaneously, and conservative treatment
with occulusal splints has been successful
[8]. However, the disorder is
frequently accompanied by severe, persistent pain, and in such cases, surgical
repair is advocated. The techniques of arthroscopic lysis and lavage
[9], repositioning the
displaced disk [10], and
diskectomy [11] have been
previously described.
Arthrography and MR imaging of the soft-tissue components of the TMJ may
not be always available. Arthrography is an invasive technique; cost and
availability concerns limit the use of MR imaging. Thus, most management
approaches for patients with TMJ disorder are symptom-based. For this reason,
several studies have been conducted to determine the accuracy of clinical and
adjunctive diagnostic tests; the accuracy rates of the tests for TMJ internal
derangements have ranged from 43% to 90%
[6,
12,13,14,15].
Although sonography has been advocated for diagnosis
[5], its reliability as an aid
in diagnosing disk displacement has not been critically studied. A recent
study using static sonography concluded that interpretation by an experienced
clinician of properly obtained sonograms has a diagnostic accuracy of 55%.
Differences in interpretations occurred when disk displacements were evaluated
separately at different open-mouth positions
[6]. Patients in the study who
had a prospective diagnosis of TMJ internal derangement then underwent dynamic
high-resolution sonographic evaluation (with a 12-MHz probe) during maximal
mandibular range of motion. Accuracy for diagnosis of internal derangement,
disk displacement with reduction, and disk displacement without reduction
based on prospective interpretation of high-resolution sonograms was 95%, 92%,
and 90%, respectively. High-resolution sonography allowed greatly improved
diagnostic efficacy because of a more defined tissue differentiation and
enhanced near-field clarity. Furthermore, the advantage of dynamic
high-resolution sonography in investigating the disk—condyle
relationship during repeated motion at the respective open-mouth positions
probably made the structures involved more clearly distinguishable.
There are pitfalls in diagnosing disk displacements on the basis of the
dynamic high-resolution sonographic findings during maximal mandibular range
of motion. If the transducer is not tilted to obtain cross-sections
appropriately intersecting the disk in the frontal plane, the disk may become
hypoechoic, resulting in a false-negative diagnosis of displacement.
Degeneration or partial rupture of the disk may cause errors in interpretation
while the disk is being located and maximal mandibular range of motion is
being performed. It is important to scan the entire length of the upper joint
compartment both transversely and especially longitudinally to look for the
fibrillar pattern of a degenerated disk
(Fig. 4). Most disk
displacements that were missed on high-resolution sonography were positioned
laterally or medially. Sideways and rotational components are difficult to
completely evaluate with the current high-resolution sonographic techniques
(Fig. 5). The upper TMJ
compartment may be filled with fluid or fibrous tissue, especially if the disk
has been displaced for a long time. Nearly all false-positive interpretations
of disk displacements in our study were caused by synovial effusion simulating
anterior disk displacement (Fig.
6). Differentiation on high-resolution sonography between disk
displacement and fibrous structures sometimes was impossible
(Fig. 7).
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Fig. 4. —Temporomandibular joint (TMJ) in 39-year-old man. Diagnosis
of disk displacement and degeneration was based on findings on MR imaging.
Interpretation of sonographic findings resulted in false-negative diagnosis.
Longitudinal high-resolution sonogram shows anterosuperior TMJ compartment
with disk disrupted in posterior (large arrows) and anterior
(small arrows) parts. Anterior part of disk (small arrows)
is displaced anteriorly to condyle (arrowheads). E = articular
eminence, D = disk, C = condyle.
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Fig. 5. —Temporomandibular joint (TMJ) in 21-year-old woman. Diagnosis
of medial disk displacement was based on findings on MR imaging.
Interpretation of sonographic findings resulted in false-negative diagnosis.
Longitudinal high-resolution sonogram shows anterosuperior TMJ compartment and
disk (arrows) superior to condyle (arrowheads). E =
articular eminence, D = disk, C = condyle.
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Fig. 6. —Temporomandibular joint (TMJ) in 35-year-old woman. MR
imaging showed normal disk position with effusion. Interpretation of
sonographic findings resulted in false-positive diagnosis. Longitudinal
high-resolution sonogram shows anterosuperior TMJ compartment with disk
(large arrows) superior to condyle (arrowheads) and presence
of effusion (small arrows). E = articular eminence, D = disk, C =
condyle, EF = effusion.
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Fig. 7. —Temporomandibular joint (TMJ) in 51-year-old woman. MR
imaging showed normal disk position and degeneration. Interpretation of
sonographic findings resulted in false-positive diagnosis. Longitudinal
high-resolution sonogram shows anterosuperior TMJ compartment with disk
(large arrows) superior to condyle (arrowheads) and presence
of fibrous structures (small arrows). E = articular eminence, D =
disk, C = condyle, F = fibrous structures.
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It is possible that some of the disk displacements diagnosed with
high-resolution sonography were not visible to the radiologist on the MR
images and that MR imaging is an imperfect standard of reference. In our
study, judgments about disk position were made using the sagittal and coronal
views. Arthroscopic or surgical confirmation of imaging results was not
available for our patients. False-negative and false-positive imaging findings
may not be reliably excluded in the absence of surgical confirmation. Studies
in which MR imaging findings of the TMJ have been correlated to cryosectional
morphology have shown high sensitivity, specificity, and diagnostic accuracy
[4]. In addition, surgical
confirmation of imaging findings may not be as precise as cryosectional
observations because surgery does not provide a cross-sectional view. For
these reasons, it seems justifiable to use the MR imaging findings as the gold
standard.
Observer variations are known to be present in any clinical experience and
could substantially influence the process of diagnosis. It seems that, for our
institution, the learning curve has leveled off. Although the issue was not a
focus of our study, we found little variability among the error rates of the
respective 5-month study periods. This finding implies that the radiologist
involved in the sonographic evaluation is at an even level of the learning
curve in experience, formal training, and continuing education.
Preoperative or intraoperative recognition of an abnormality of the TMJ
disk is essential to ensure a beneficial outcome
[9,
16]. The results of therapy
may be disappointing if disk displacements are overlooked
[17,18,19].
The findings of high-resolution sonography could play an important part in
determining patient care. The sonographic findings obtained before surgery may
help in the selection of the optimal therapeutic approach.
Sonography, despite its limitations, may provide valuable information about
disk displacement of the TMJ. The disk may be most clearly seen on coronal
images, but obtaining sagittal images can increase the examiner's confidence
that the disk is located in a normal position on the condyle.
References
-
Truelove EL, Sommers EE, LeResche L, Dworkin SF, Von Korff M.
Clinical diagnostic criteria for TMD: new classification permits multiple
diagnosis. J Am Dent Assoc
1992;123:47
-54[Abstract]
-
Katzberg RW, Westesson PL, Tallents RH, Drake CM. Anatomic
disorders of the temporomandibular joint disc in asymptomatic subjects.
J Oral Maxillofac Surg
1996;54:147
-153[Medline]
-
Westesson PL, Bronstein SL. Temporomandibular joint: comparison of
single- and double-contrast arthrography. Radiology
1987;164:65
-70[Abstract/Free Full Text]
-
Tasaki MM, Westesson PL. Temporomandibular joint: diagnostic
accuracy with sagittal and coronal MR imaging.
Radiology
1993;186:723
-729[Abstract/Free Full Text]
-
Stefanoff V, Hausamen JE, van den Berghe P. Ultrasound imaging of
the TMJ disk in asymptomatic volunteers: preliminary report. J
Craniomaxillofac Surg
1992;20:337
-340[Medline]
-
Emshoff R, Bertram S, Rudisch A, Gaßner R. The diagnostic
value of ultrasonography to determine the temporomandibular disk position.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1997;84:688
-696[Medline]
-
Hayashi T, Ito J, Koyoma J, Yamada K. The accuracy of sonography
for evaluation of internal derangement of the temporomandibular joint in
asymptomatic elementary school children: comparison with MR and CT.
AJNR
2001;22:728
-734[Abstract/Free Full Text]
-
Okeson JP. Long-term treatment of disk-interference disorders of
the temporomandibular joint with anterior repositioning occlusal splints.
J Prosthet Dent
1988;60:611
-615[Medline]
-
Clark GT, Moody DG, Sanders B. Arthroscopic treatment of
temporomandibular joint locking resulting from disc derangement: two-year
results. J Oral Maxillofac Surg
1991;49:157
-164[Medline]
-
Montgomery MT, Gordon SM, Van Sickels JE, Harms SE. Changes in
signs and symptoms following temporomandibular joint disk repositioning
surgery. J Oral Maxillofac Surg
1992;50:320
-328[Medline]
-
Eriksson L, Westesson PL. Temporomandibular joint diskectomy.
Oral Surg Oral Med Oral Pathol
1992;74:259
-272[Medline]
-
Anderson GC, Schiffman EL, Schellhas KP, Fricton JR. Clinical vs.
arthrographic diagnosis of TMJ internal derangement. J Dent
Res 1989;68:826
-829[Abstract/Free Full Text]
-
Roberts C, Katzberg RW, Tallents RH, Espeland MA, Handelman SL. The
clinical predictability of internal derangements of the temporomandibular
joint. Oral Surg Oral Med Oral Pathol
1991;66:32
-36
-
Paesani D, Westesson PL, Hatala MP, Tallents RH, Brooks SL.
Accuracy of clinical diagnosis for TMJ internal derangement and arthrosis.
Oral Surg Oral Med Oral Pathol
1992;73:360
-363[Medline]
-
Parlett K, Paesani D, Tallents RH, Hatala MA. Temporomandibular
joint axiography and MRI findings: a comparative study. J Prosthet
Dent 1993;70:521
-531[Medline]
-
Tasaki MM, Westesson PL, Isberg AM, Ren YF, Tallents RH.
Classification and prevalence of temporomandibular joint disc displacement in
patients and asymptomatic volunteers. Am J Orthod Dentofacial
Orthop 1996;109:249
-262[Medline]
-
Kurita K, Westesson PL, Yuasa H, Toyoma M, Machida J, Ogi N.
Natural course of untreated symptomatic temporomandibular joint disk
displacement without reduction. J Dent Res
1998;72:968
-979[Abstract/Free Full Text]
-
Orsini MG, Kuboki T, Terada S, Matsuka Y, Yatani H, Yamashita A.
Clinical predictability of temporomandibular joint disc displacement.
J Dent Res
1999;78:650
-660[Abstract/Free Full Text]
-
Emshoff R, Rudisch A. Validity of clinical diagnostic criteria for
temporomandibular disorders: clinical versus magnetic resonance imaging
diagnosis of temporomandibular joint internal derangement and osteoarthrosis.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2001;91:50
-55[Medline]
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Abstract
Introduction
