Tmj findings in cbct & mri

TMJ findings
in CBCT & MRI
Judy H. Oh, D.D.S.
UCLA School of Dentistry, 1992
Preceptorship for OMFR at Rutgers School of Dental Medicine, 2016
3D Oral & Maxillofacial Imaging Center, N. Bethesda, MD
3DOMI.net

TMJ capsule and Adjacent structures
web.duke.edu

TMJ capsule and Adjacent structures

CBCT: TMJ bone morphology
3DOMI.net
Carestream 9300
Anatomage

CBCT: TMJ bone morphology
3DOMI.net, Carestream 9300, Anatomage

CBCT: Frontal, Axial & Sagittal views of TMJ
3D Oral & Maxillofacial Imaging Center, North Bethesda, MD

CBCT: Sagittal views of the right TMJ

CBCT: Frontal views of the right TMJ

MRI: TMJ Anatomy
MRI shows soft & hard tissues of the joint
Clayton A. Chan, DDS, Las Vegas, NV

www.drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX
MRI

Abnormal findings in TMJ
Developmental
Soft tissue related
Remodeling & Arthritis
Trauma
Tumors

Abnormal findings in TMJ: Developmental
Hemifacial Microsomia
Condylar Aplasia
Condylar Hypoplasia
Condylar Hyperplasia
Juvenile Arthrosis
Coronoid Hyperplasia
Bifid Condyle

Underdeveloped mandible without condyle
Congenital ~1 of 4000 births
Possible cause: poor blood
supply to face in 1st trimester
Facial asymmetry
Chaudhari SY. Craniofacial microsomia: A rare case
report. J Oral Maxillofac Radiol 2013;1:70-4

Chaudhari SY. Craniofacial microsomia: A rare case report. J Oral Maxillofac Radiol 2013;1:70-4

Condylar Aplasia
Absence of one or both condyles; Rare
Peeyush Shivhare, Lata Shankarnarayan, Usha, Mahesh Kumar, and Malliger Basavaraju Sowbhagya, “Condylar
Aplasia and Hypoplasia: A Rare Case,” Case Reports in Dentistry, vol. 2013, Article ID 745602, 5 pages, 2013.
doi:10.1155/2013/745602

Condylar Hypoplasia
Micrognathia
‘Treacher Collins Syndrome’
Congenital, Developmental or Acquired(radiation, infection)
Causes Degenerative Joint Disease, Osteoarthrosis
Tx: Orthognathic surgery
Bone graft
Orthodontic therapy
Differential: Degenerative Joint Disease(DJD) in older pts
Juvenile Rheumatoid Arthritis if other joints involved

Condylar Hypoplasia
HORN, Danieli de Souza Gomes et al . Hipoplasia condylar of probable otologic origin.Rev. CEFAC, São Paulo , v. 18, n. 3,
p. 801-806, June 2016

Increased cortical thickness but normal trabecular pattern
Common in male, early 20’s
Ipsilateral hyperplasia of mandible
Ends with cessation of skeletal growth
Tx: Orthodontia, Orthognathic surgery
Differential: Osteoarthrosis: older pts with large osteophyte
Condylar Osteoma
Breaking of condyle
Osteochondroma: irregular growth continues
after skeletal growth

Eurorad.org
Radiopaedia.org

Juvenile Arthrosis, ‘Boering’s Arthrosis’
Idiopathic
Condylar hypoplasia
Female > Male
Marked flattening & elongated A-P dimension
Condylar neck is short or absent
Flattening of Glenoid fossa
Tx: Orthognathic surgery &/or Orthodontia
Differential: Developmental condylar hypoplasia
Rheumatoid arthritis
DJD
Condylar degeneration after surgery

Researchgate.net
16 yr, Female

3D Oral & Maxillofacial Imaging Center
21 yr, F

Developmental or Acquired
Secondary to Ankylosis
Male > Female
Evident at puberty
Inability to open mouth
Extends >1 cm above the inferior rim of Zygomatic arch
Tx: Surgical removal & physiotherapy
Differential: Osteochondroma, Osteoma

Torenek K, Duman SB, Bayrakdar IS, Miloglu O. Clinical and radiological findings of a bilateral coronoid hyperplasia case.
Eur J Dent 2015;9:149-52

Torenek K, Duman SB, Bayrakdar IS, Miloglu O.
Clinical and radiological findings of a bilateral
coronoid hyperplasia case. Eur J Dent
2015;9:149-52

Bifid Condyle
Notch in the condylar head
Possibly due to trauma to condylar growth center
May cause pain or ankylosis
Tx: only if it is symptomatic
Differential: Vertical fracture
Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony
changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66

Bifid Condyle

Abnormal findings in TMJ: Soft Tissue
Internal derangements with disc displacement
Caused by parafunctional habits or jaw injury
Disc - deformed, thickened, fibrotic, perforated
Disc displaces anteriorly, anterolaterally or anteromedially
*Rarely posteriorly or medially
Disc displacement with reduction
Disc displacement without reduction

Disc resumes to normal position during opening & click
www.dentalsynergy.it

drlarrywolford.com, Dr. Larry M. Wolford, Dallas, TX
Closed Open

Disc Displacement with Reduction
occlusionconnections.com

Disc displacement without reduction
Disc lies anteriorly to the condyle throughout movements
Causes closed or open lock
Alkhader, M et al. “Usefulness of Cone Beam Computed Tomography in Temporomandibular Joints with Soft Tissue
Pathology.” Dentomaxillofacial Radiology 39.6 (2010): 343–348.
Closed Open Osteophyte

Non-Reducing
Disc Displacement &
Arthritic Condyle
www.drlarrywolford.com
Dr. Larry M. Wolford, Dallas, TX

Abnormal findings in TMJ: Remodeling/Arthritis
Remodeling
Degenerative Joint Disease(DJD)
Degenerative Arthritis, Osteoarthrosis
Rheumatoid Arthritis
Juvenile Arthritis; Chronic(Still’s Disease) or Rheumatoid
Psoriatic Arthritis
Septic Arthritis
Synovial Chondromatosis
Chondrocarcinosis(Pseudogout)

Remodeling
Adaptive response to excessive force applied to joint
Flattening
Erosion
Cortical thickening
Subchondral sclerosis
Subchondral cyst
Osteophytes
Precursor to Degenerative Joint Disease(DJD)

Remodeling
A. Normal B. Flattening C. Sclerosis D. Osteophytes E. Erosion
Lee DY, Kim YJ, Song YH, Lee NH, Lim YK, Kang ST, Ahn SJ.; Comparison of bony changes between panoramic radiograph and
cone beam computed tomographic images in patients with temporomandibular joint disorders; Korean J Orthod. 2010
Dec;40(6):364-372. Published online 2010 December

Remodeling
A. Normal B. Flattening C. Erosion D. Osteophytes E. Bone remodel
mand. fossa
ALVES, N et al. Morphological Characteristics of the Temporomandibular Joint Articular Surfaces in Patients with
Temporomandibular Disorders. Int. J. Morphol. [online]. 2013, vol.31, n.4 [citado 2016-11-13], pp.1317-1321.

Remodeling: Flattening of the right condyle

Remodeling: Erosion in both condyles

Remodeling: Erosion

Remodeling: Osteophyte

Remodeling: Osteophyte
3D Oral & Maxillofacial Imaging Center, N. Bethesda, MD
33yr, F

Remodeling: Sclerosis

Remodeling: Subchondral cyst, ‘Ely cyst’

Remodeling: Subchondral cyst

Remodeling: Osteophyte with ‘joint mice’

Etiology: Acute trauma
Hypermobility of joint
Parafunction
Internal disc derangement
Not inflammatory
Female>Male
Adolescent Internal Condylar Resorption (AICR): Female:Male(8:1)
Tx: Splint therapy, anti-inflammatory and/or physiotherapy
Differential: Erosive- Rheumatoid arthritis with severe erosion;
Proliferative - osteochondroma, osteoma

Deterioration of articular cartilage
Flattening
Surface erosion
Cortical thickening or thinning
Osteophyte
Osteophyte with loose joint bodies: ‘Joint mice’
Sclerosis of articular surface
Subchondral sclerosis
Subchondral cyst(Ely cyst)
Reduced joint space
Long-term non-reducing disc displacement
Anterior open bite

TMJ:
Perforation
drlarrywolford.com, Dr. Larry
M. Wolford, Dallas, TX

Sagittal T1 MRI images of resorbed condyles and anteriorly displaced discs
AICR: 19 yr old female, onset at 14 yr

CBCT showing advanced arthritis with severe condylar resorption
AICR:
22 yr Female,
Onset at 14 yr

MRI showing the arthritic changes in the joints and the severely
degenerated articular discs
AICR:
22 yr Female
Onset at 14 yr

Degenerative Arthritis, Osteoarthrosis
Age related; avg age 35, most prominent 40’s, 50’s
Female:Male(7:1)
Unilateral
Pain, Dysfunction, Disability
Non-inflammatory
Etiology: Parafunction, Occlusion, Psychosocial
Macrotrauma, Genetics
Yount, K, Osteoarthritis of TMJ, Practical Pain Management Dec, 2011

Degenerative Arthritis: etiology
Parafunction: clenching
increases intra-articular pressure
destroys lubricant27(phospholipids, hyaluronic acid)
causes stickiness, pulling, tearing of elastin & lateral ligament
Occlusion:
lack of anterior guidance, class II occlusion
lateral interference on posterior teeth, cross bite
loss of posterior teeth, bite discrepancy

Degenerative Arthritis: etiology cont’d
Psychosocial:
poor sleep, stress, anxiety, depression
Macrotrauma:
stretching & tears of the lateral ligament & elastin
caused by jaw bracing during impact
muscle tension from stress or clenching
hypercontraction of the lateral pterygoid
Genetic:
hypermobility of joint increases damage to ligaments & elastin

Degenerative Arthritis: clinical & radiographic
Pain/Tenderness in joint & masticatory muscles
Reduced range of motion or deviation
Crepitus during mandibular movements
Flattening of condyle
Irregular cortical outlines
Erosions
Resorption of condylar head, mandibular fossa
Subchondral cyst
Osteophyte
Reduced joint space
Sclerosis

Remodeling: Erosion of the left condyle
Prasannasrinivas Deshpande et al. Diagnostic Imaging in TMJ Osteoarthritis: A Case Report and Overview. International
Journal of Dental Sciences and Research, 2015, Vol. 3, No. 3, 56-59. doi:10.12691/ijdsr-3-3-4
70 yr
Female

Remodeling: Reduced joint space, Erosion,
Osteophyte, Sclerosis of AE, Ely’s Cyst
70 yr
Female

Remodeling: Right TMJ
Flattening
Reduced joint space
Osteophyte with ‘joint mice’
Sclerosis of condylar head
Remodeling: Left TMJ
Flattening of the lateral pole

Remodeling: ‘Joint Mice’
70 yr Female

Rheumatoid Arthritis
Chronic inflammation, Autoimmune disease, 40-60 yr(F>M)
Affects hands & feet: 70% involves TMJ (Synovial membrane,
Tendon sheaths, Ligaments)
Bitemporal headache/pain, Hypomobility, Crepitus
Anterior open bite, Ankylosis
Flattening, Erosion, Resorption, Sclerosis
Reduced joint space, Osteophyte
Shortened posterior ramus causing premature
posterior occlusion & anterior open bite

Rheumatoid Arthritis:
22 yr. Female: Pain in the left TMJ
Limited mouth opening
Joint space narrowing
Coronal view of open mouth a. Normal b. Narrowing of articular space & Erosion
R L
Sodhi A, Naik S, Pai A, Anuradha A. Rheumatoid arthritis affecting temporomandibular joint. Contemporary Clinical Dentistry. 2015;6(1):124-127.
doi:10.4103/0976-237X.149308.

Rheumatoid Arthritis:
22 yr. Female: Pain in the left TMJ, Limited mouth opening
Sagittal view of open mouth a. Normal b. Narrowing of articular space & Erosion
Sodhi A, Naik S, Pai A, Anuradha A. Rheumatoid arthritis affecting temporomandibular joint. Contemporary Clinical Dentistry. 2015;6(1):124-127.
doi:10.4103/0976-237X.149308.
R L

Connective Tissue, Auto-Immune Disease
www.drlarrywolford.com/
Dr. Larry M. Wolford,
Dallas, TX

Juvenile Arthritis; Chronic(Still’s Disease) or Rheumatoid
Chronic inflammation
<16 yrs, 40% involves TMJ
Synovial hypertrophy, Joint effusion, Swollen & Painful joints
Affects Cartilage & Bone
Micrognathia(bird face), Anterior open bite
Osteopenia, Impaired mandibular growth, Erosions
Flattening, Abnormal disc
Small condyle, Fibrous ankylosis
Deepening of antegonial notch

Psoriatic Arthritis
Skin lesions, 7% involves TMJ
Radiographic similarity to rheumatoid arthritis

Septic Arthritis
Rare infection & inflammation
Cause: Parotid, Otic, Mastoid Osteomyelitis; Middle ear infection
Common in Rheumatoid arthritis, Diabetes, Immunosuppressed
Children after blunt trauma with hematoma;
Unilateral mandibular deviation to unaffected side
due to joint effusion
Joint space widened with erosion & thinning of cortex
Osteopenia, Sequestra formation
Osseous ankylosis
Inhibited mandibular growth

Septic Arthritis
24 yr. male presents with
Periauricular(L) swelling & pain
Erythema
Fever
Myalgia
Joint pain, generalized, for 2-3 wks
Limited mouth opening, deviation to R
Treated with antibiotics
MRI:
left TMJ joint with effusion circled
2ml of turbid fluid withdrawn
via needle aspiration & cultured
Al-Khalisy HM, Nikiforov I, Mansoora Q, Goldman J, Cheriyath
P. Septic Arthritis in the Temporomandibular Joint. North
American Journal of Medical Sciences. 2015;7(10):480-482.
doi:10.4103/1947-2714.168678.

Chondrometaplasia, Osteochontromatosis
Rare in TMJ, mostly affects large joints
Benign synovial metaplasia: cartilaginous nodules
Female:Male(4:1)
Mainly affects superior joint space
Fragments of cartilage,
Loose bodies in synovial membrane
Joint swelling/pain, Clicking/Crepitus, Limited joint movement
Multiple, loose calcified nodules in joint space
Sclerosis of mandibular fossa & condylar head
Widened joint space
Irregularity of osseous cortical surface

http://roentgenrayreader.blogspot.com/2011/07/synovial-chondromatosis-of.html

49 yr. Male:
Pain in the R joint for several years
Swelling
Clicking
Limited opening
Panoramic:
Calcified nodular lesions (arrows)
Lim SW, Jeon SJ, Choi SS, Choi KH. Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings.
The British Journal of Radiology. 2011;84(1007):e215-e218. doi:10.1259/bjr/69067316.

(a)Axial CT: multifocal calcified loose bodies (arrow) (b) Coronal CT image: loose bodies (arrow). bony erosion of glenoid fossa
(arrowhead), widening of joint space but no extra-articular extension (c) Follow-up CT obtained after 10 months: complete removal of intra-
articular mass and calcifications and the absence of recurrence.

MRI: multiple loose bodies in soft tissue mass(a)
soft tissue mass expanding with thickened synovium(b)

(a) Numerous small calcified nodules (b) Histopathological (×40) analysis: small,
metaplastic cartilaginous nodules of varying size with calcifications.

Acute or Chronic Synovitis
Deposition of Calcium Pyrophosphate Dehydrate
Rare in TMJ
Unilateral
Male>Female
Fine radiopacities with uniform distribution in joint space
Bone erosion with increased condylar bone density
Swelling & edema of muscles

Calcified mass in the glenoid fossa, bulging into the epitympanum & middle cranial
fossa floor.
E. Gatti, I. Montermini, A. Marconi, E. Botturi, R. Maroldi. Department of Radiology, University of Brescia,
Brescia, Italy., ECR 2009-CASE OF THE DAY

Abnormal findings in TMJ: Trauma
Effusion
Dislocation
Fractures
Neofractures
Ankylosis

Effusion
Influx of fluid into a joint due to hemorrhage or inflammation
Causes: internal derangement
trauma
arthritis
rheumatic disease
Symptoms: Swelling, Pain
Limited opening
Hearing difficulties
Difficulty occluding posterior teeth due to fluid in joint

Effusion
Closed: ( ) deformed,
anteriorly displaced disc
( )Temporal posterior
attachment
Alkhader, M et al. “Usefulness of Cone Beam Computed Tomography in Temporomandibular Joints with Soft Tissue
Reduced on open Superior joint space
Effusion
CBCT: no osseous
abnormality

Dislocation
Condyle outside the mandibular fossa but inside the capsule
Bilateral
Displaced condyle anteriorly & superiorly
Condylar fracture may be a cause
Inability to close the mouth with pain
Muscle spasm

Dislocation
Exodontia.info
blogs.brown.edu

Dislocation
Bilateral TMJ dislocation
blogs.brown.edu

Fractures
Condylar fracture: intra- or extra-capsular
Condylar neck fracture:
dislocation of condylar head to forward-medial direction
Irregular cortical outline
Unilateral
Look for parasymphyseal or body fracture of opposite
Ankylosis, Radiolucent or radiopaque lines, Step defects
Condylar head fracture with vertical or compressive patterns
Remodeling: Flattening, DJD, Hemarthrosis

Fractures
Radiopaedia.org
High neck fracture

Fractures
Guardsman fracture:
a tripartite fracture of
the parasymphyseal
region and both
condylar necks
Radiopaedia.org
High neck fracture

Neofractures
Forcep injury causing condylar fracture
Severe mandibular hypoplasia
Lack of development of Glenoid fossa/eminence

Ankylosis
Fibrous or Bony in the joint
Unilateral: Trauma or Infection
Bilateral: Rheumatoid arthritis
Fibrous: Irregular erosions on articular surfaces
Reduced joint space, Jigsaw puzzle appearance
Bony: Osseous bridges
Large bony masses
Differential: muscle spasm
myositis ossificans
coronoid process hyperplasia

Ankylosis
Bilateral TMJ ankylosis:
bony fusion of mandibular
condyle to the glenoid fossa
on the left side.
AO Surgery Reference

Ankylosis
Unilateral bony ankylosis causing
Hypoplastic mandible
Facial asymmetry
Hegde RJ, Devrukhkar VN, Khare SS, Saraf TA.
Temporomandibular joint ankylosis in child: A case report. J
Indian Soc Pedod Prev Dent 2015;33:166-9

Ankylosis
Alkhader, M et al. “Usefulness of Cone Beam Computed Tomography in Temporomandibular Joints with Soft Tissue Pathology.”
Dentomaxillofacial Radiology 39.6 (2010): 343–348.
Closed: Deformed articular disc
Anteriorly displaced
Temporal posterior attachment( )
Open: not reduced No sign of joint effusion CBCT: Ankylosis

Abnormal findings in TMJ: Tumors
Benign: Osteochondroma
Osteocartilaginous Exostosis
Malignant: Osteosarcomas
Chondrosarcomas
Metastatic tumors

Benign Tumors
Osteochondroma, Osteocartilaginous exostosis
Affects 20-30 yr old
Limited mouth opening, jaw deviation to contralateral side
Facial asymmetry, Malocclusion
CBCT - Enlarged condyle with irregular outline
Abnormal pedunculated mass attached to condyle
Altered trabecular pattern
Radiopacity, Radiolucency
Less common: Osteoma, Osteoblastoma, Chondroblastoma
Fibromyxoma, Giant Cell lesions
Aneurysmal bone cysts
Langerhans cell histiocytosis

Benign Tumors: Osteochondroma
62 yr. Male complains of snoring.
No pain, no dysfunction, no hx of jaw fracture or trauma
Rheumatology Network

Benign Tumors: Giant Cell Tumor
Marius Bredella, et al, Tenosynovial, Diffuse Type Giant Cell Tumor of the
Temporomandibular Joint, Diagnosis and Management of a Rare Tumor, Journal of
Clinical Medicine Research, Vol. 7, No. 4, Apr 2015

Malignant Tumors
Osteosarcomas, Chondrosarcomas, Metastatic tumors
Pain, Unilateral swelling in preauricular region
Reduced joint mobility
Mandibular deviation
CBCT: Bone destruction with poorly defined borders
Irregular margins
Erosion of cortical plates
Minimal expansion
Pathologic calcification
Condylar deformity
Less common: Synovial sarcoma, Fibrosarcoma
Parotid salivary gland tumor, Rhabdomyosarcoma

Malignant Tumors: Osteosarcoma
SlideShare: Nour-Eldin A.
Nour-Eldin Mohammed

References:
1. Chaudhari SY. Craniofacial microsomia: A rare case report. J Oral Maxillofac Radiol 2013;1:70-4
2. HORN, Danieli de Souza Gomes et al . Hipoplasia condylar of probable otologic origin.Rev. CEFAC, São Paulo , v. 18, n. 3,
p. 801-806, June 2016
3. Peeyush Shivhare, Lata Shankarnarayan, Usha, Mahesh Kumar, and Malliger Basavaraju Sowbhagya, “Condylar Aplasia and
Hypoplasia: A Rare Case,” Case Reports in Dentistry, vol. 2013, Article ID 745602, 5 pages, 2013. doi:10.1155/2013/745602
4. Shawneen Gonzalez, DDS, MS; Interpretation Basics of CBCT,
5. Pande SP, Kumbhare SP, Parate AR. Incidental findings on cone beam computed tomography: Relate and relay. J Indian
Acad Oral Med Radiol 2015;27:48-54
6. 3D Oral & Maxillofacial Imaging Center, North Bethesda, MD
7. drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX
8. Dentalsynergy.it
9. Occlusionconnections.com
10. Eurorad.org
11. Radiopaedia.org
12. Researchgate.net
13. Torenek K, Duman SB, Bayrakdar IS, Miloglu O. Clinical and radiological findings of a bilateral coronoid hyperplasia case. Eur
J Dent 2015;9:149-52
14. Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony
15. Hu, Y.K. et al. Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint:
a longitudinal retrospective study. Sci. Rep. 6, 34253; doi: 10.1038/ srep34253 (2016).

References:
16. Alkhader, M et al. “Usefulness of Cone Beam Computed Tomography in Temporomandibular Joints with Soft Tissue
17. Lee DY, Kim YJ, Song YH, Lee NH, Lim YK, Kang ST, Ahn SJ.; Comparison of bony changes between panoramic
radiograph and cone beam computed tomographic images in patients with temporomandibular joint disorders;
Korean J Orthod. 2010 Dec;40(6):364-372. Published online 2010 December
18. ALVES, N et al. Morphological Characteristics of the Temporomandibular Joint Articular Surfaces in Patients with
19. Sodhi A, Naik S, Pai A, Anuradha A. Rheumatoid arthritis affecting temporomandibular joint. Contemporary Clinical Dentistry.
2015;6(1):124-127. doi:10.4103/0976-237X.149308.
20. Al-Khalisy HM, Nikiforov I, Mansoora Q, Goldman J, Cheriyath P. Septic Arthritis in the Temporomandibular Joint. North
American Journal of Medical Sciences. 2015;7(10):480-482. doi:10.4103/1947-2714.168678.
21. http://roentgenrayreader.blogspot.com/2011/07/synovial-chondromatosis-of.html
22. Lim SW, Jeon SJ, Choi SS, Choi KH. Synovial chondromatosis in the temporomandibular joint: a case with typical imaging
features and pathological findings. The British Journal of Radiology. 2011;84(1007):e215-e218. doi:10.1259/bjr/69067316.
23. Hegde RJ, Devrukhkar VN, Khare SS, Saraf TA. Temporomandibular joint ankylosis in child: A case report. J Indian Soc
Pedod Prev Dent 2015;33:166-9
24. Rheumatology Network
25. Marius Bredella, et al, Tenosynovial, Diffuse Type Giant Cell Tumor of the Temporomandibular Joint, Diagnosis and
Management of a Rare Tumor, Journal of Clinical Medicine Research, Vol. 7, No. 4, Apr 2015
26. Slide share: Nour-Eldin A., Nour-Eldin Mohammed
27. Dorrit W. Nitzan, The process of lubrication impairment and its involvement in temporomandibular joint disc displacement:
A theoretical concept, Journal of Oral and Maxillofacial Surgery, Volume 59, Issue 1, Pages 36-45
28. Yount, K, Osteoarthritis of TMJ, Practical Pain Management Dec, 2011

with gratitude for your generous support!
Dr. S. Singer
Dr. A. Creanga
Dr. M. Strickland
Oral & Maxillofacial Radiology Department
Rutgers School of Dental Medicine

Tmj findings in cbct & mri

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