Comparing these two CBCT scans year apart, what differences do you see?

Does the right condyle look like it has had some repair at all (Is there now a cortical outline? )…

Comparing these two CBCT scans year apart, what differences do you see?
Does the right condyle look like it has had some repair at all (Is there now a cortical outline?).
What is the position my joints are now in called?
1st CBCT is J. Morita from 2006 (1 year into TMJ dysfunction & parafunction)
2nd is i-CAT from 2015 (no more pain or dysfunction, but occlusion problems and lower jaw receding)
Someone mentioned my condyle shape look strange from the start – what do you think?

Discussion

Lisa Berner-Schmidt
They do look deteriorated Bianca. Does it show discs anywhere?

Bianca Esposito
Lisa how are you doing? I have not had good luck with imaging centres to be honest – the i-CAT did not give me close up shots of my condyle without the 3d render like everyone else gets, and they did not provide a 3d render of skull. With the MRI they did not give me digital copies only hard copy which won’t scan properly. However, the report said poor visualization of discs.

Lisa Berner-Schmidt
Oh no. I would talk to a dr about what you could do to save your joints. Anything to get the discs functioning. I had a friend who had vitek and she was able to live with her osteoporotic joints and the scar tissue that formed prevented more breakdown. I am having lots of pain. I do good and then when it comes near being due I feel I need the meds the pain gets worse. I am awake because they had to jimmy rig an inhaler mouthpiece for me. Nebulizer aren’t good long term so the respiratory therapist got creative.
LOL I should be leaving the hospital tomorrow. I will be more comfy at the hotel. Being wired with this big splint is no fun!!

Bianca Esposito
Lisa Berner-Schmidt I feel that my joints are improving. I tried to get the radiology place to compare both CBCTs to see if there has been some repair, but they never did it. I read in many articles that if the coritical white outline re-appears, it means there has been bone repair. I’m not in pain anymore, I just want to know if they are now stable, so that I can correct my bite. I can’t imagine what you are going through! 🙁 Has the screw-turning process begun?

Lisa Berner-Schmidt
Bianca Esposito no we start that on Wed at the dr’s office.i am glad to hear your joints have improved!!did the dr talk about orthognathic bite surgery? thats what they did with my upper a 3 piece le forte and the distraction on the bottom. Sorry for typos… Pain meds and middle of the night.

Bianca Esposito
Lisa Berner-Schmidt Thinking of you ❤ Yes, I want to do BSSO but they warned me that I could relapse if the degeneration continues after the surgery. They have mentioned resorption, but I don’t know if that’s right. I don’t understand the difference between ‘degeneration’ and ‘resorption’?

Bianca Esposito
If any professionals out there can help me with my questions it would be very much appreciated. Clayton A. Chan, Bjørn Hogstad Nick Yiannios, Rick Coker, Curtis Westersund, Jeffrey Brown, Asif Saba, Rajesh Raveendranathan. And anyone else. My questions are:

1. Do you see major differences between the two CBCTs?
2. Is there repair seen on the right condyle – it has still reduced in size I think BUT there is now a ‘top’ covering white outline to it, whereas in 2006 it looks to be just exposed bone.
3. What is the position term for how my condyles now sit in 2015?
4. Back in 2001 pano xray did my condyles look strange or problematic from the beginning at all? The film quality isn’t too good unfortunately.
   Thank you for any information that you can provide. Can’t get the tags to work for some reason!
   

Jeffrey Brown
Hello Bianca Esposito – best I can tell you is that the condyles appear quite worn down in these shots. Xrays done at different dates on different machines are deceiving to say the least – also angulation, exposure, etc will vary. So I guess I can say the condyles are worn down a lot.

Bianca Esposito
Jeffery Brown, thank you for your opinion. Yep, I was told I should always try and get the same type of machine and person to do the report, for best results, but doesn’t always work out like that unfortunately 🙁 Do you know if the terms degeneration and resorption mean the thing? I’ve had docs mention both.

Asif Saba
Bianca Esposito typically the outer surface of bone is cortical ,which is more dense than inner one and the inner layers are called cancellous bone,which are less dense than outer layer. Your early image shows no or very little cortical bone and also changes in bone shape ( flatening) . while in later image we do see some radiopaque boundary over your condyle head..ie some formation or healing of cortical bone. Usually in my opinion such changes happens in degenerative joint disease,where rapid destruction leads to loss of cortical bone with less repair…but after a period of rapid destruction the process slow down and bone gets chance to repair itself..I don’t know your clinical condition so its not very easy for me to tell you the exact thing going on with you..but its what seems to me in just first look

Bianca Esposito
Asif Saba thanks so much for your explanation on bone layers and especially for confirming that there is some evidence of healing of the cortical bone. That makes me VERY pleased to know.
I also had a MRI, but don’t have the films to post. This was the report:
“Severe osteoarthritis of both temporomandibular joints seen bilaterally, with poor visualization over the biconcave disc on both sides, compatible with complex degeneration, tearing and resorption. On the right side the mandibular condyle has flattened irregular morphology with subchonral sclerosis. On the left, the mandibular condyle has irregular, flattened morphology with subchondral cyst formation and bone marrow oedema. Despite the severe osteoarthritis in both temporomandibular articulations there is anterior translation of the mandibular condyle in open mouth position”
The Oral Medicine Specialist that I was seeing to asses my TMJs before getting braces, said based on this MRI he ordered, I had Condylar Resorption.
Then I had a surgeons opinion, and he said Osteoarthritis, and I asked ‘with condylar resorption too?’ to see if he agreed with the other specialist, and he said yes.
A different surgeon said it doesn’t look like Condylar Resorption – it only looks like Osteoarthrits.
Is it all basically just the same thing??
Would you say the condyle has diminished in size enough for it to be considered resorption?

Asif Saba
Osteoarthritis is inflammation of of bone and joint which leads to irregular surface..bone destruction and formation occurs simultaneously, but with different speed. While bone resorption is destruction of bone ,not getting any chance to repair itself or the bone formation doesn’t cope up with the destruction. Bone resorption might be due to many cause…its true that destruction do occurred in your joint rapidly previously.. Osteoarthritis slow down on its own after some period of time and then bone gets chance to repair and adapts itself to function…though not to normal level…irregularities remains in repair all the time. While if resorption do slow down or stop on its own ,then it has little chance of bone repair without treatment..