1810 HOW TO DIAGNOSE IDIOPATHIC CONDYLAR RESORPTIONS IN THE ABSENCE OF CONSENSUS-BASE
HOW TO DIAGNOSE IDIOPATHIC
CONDYLAR RESORPTIONS IN THE
ABSENCE OF CONSENSUS-BASED
CRITERIA?
The etiology of idiopathic condylar resorptions (ICR)
remains controversial and current management prin-
ciples rest more on empirical conviction and tradition
than science.1,2 Considerable overlap is seen between
adolescent ICR, juvenile idiopathic arthritis (JIA) of
the temporomandibular joint (TMJ) and other TMJ
conditions. Any new knowledge aiding diagnostic
discrimination between these conditions seems
warranted.
We therefore welcome the critique of our recent
publication3 by Drs Posnick and Kaban because it
allows us to raise the pertinent, highly relevant and
more general question of how to diagnose adolescent
ICR in the absence of consensus-based guidelines.
Without diagnostic criteria, we must assume that the
use of the ICR diagnosis differs between healthcare
providers. Any comparison of studies of ICR should
therefore be made with caution (e.g. comparison of
boy/girl ratio)
Traditionally, ICR is a diagnosis of exclusion. In our
retrospective study, ICR patients (n=19) were
included following meticulous diagnostic work-up
involving the concerted effort of experts of orthodon-
tics, oral and maxillofacial surgery, radiology and
pediatric rheumatology; all affiliated to a regional cra-
niofacial team. Patients were seen due to signs/symp-
toms and radiological findings; not because they
needed orthodontic treatment. Patients with JIA and
ICR underwent standardized examination, monitoring
and assessment following international consensus-
based recommendations.4,5 In patients with ICR, stan-
dard diagnostic work-up included examination for
presence of autoimmune disease by a pediatric rheu-
matologist as clearly stated in the inclusion criteria.
Drs Posnick and Kaban’s doubts about the patients’
rheumatologic status therefore hardly seem war-
ranted. Patients were categorized as having adoles-
cent ICR only if they were without signs of
autoimmune disorder, previous facial trauma, TMJ
compression or other clinical conditions potentially
causing TMJ conditions. This group of patients was
hence characterised by having TMJ deformity of
unknown origin − which may rightly be coined idio-
pathic condylar resorption. We acknowledge that the
demographics of the ICR group may challenge the tra-
ditional perception of adolescent ICR; however, this
group may represent an earlier stage of the ICR spec-
trum than the surgical candidates described by Drs
Posnick and Kaban (e.g., bilateral cases, age at onset
14-30, severe dentofacial deformity)
Another critique by Drs Posnick and Kaban con-
cerns the assessment of dentofacial deformity. This
critique is partly warranted. However, we wish to set
right 2 important misunderstandings: 1) Radiological
examinations were performed to assess the extent of
dentofacial deformity at the time of diagnosis. It is
therefore incorrect to claim that we postulate the
presence of a general disease-specific difference
between the ICR and the JIA group. Actually, we are
stating the opposite: The difference in dentofacial
deformity (between ICR and JIA TMJ groups) is
rooted in differences in diagnostic timing rather than
disease-related characteristics.3 This is a critical issue
since it implies that the JIA group underwent timely
diagnosis and treatment, unlike the ICR group (see
discussion section).3 2) Our evaluation of dentofacial
deformity comprised more than assessment of
”maxillo-mandibular asymmetry”. In fact, the only sig-
nificant difference in dentofacial deformity in the ICR
group at time of diagnosis pertained to parameters
associated with symmetric clockwise mandibular
rotation (Table 4).3 No difference in facial asymmetry
was observed between ICR and JIA groups despite
inclusion of comparable numbers of uni-/bilateral
cases in both groups (Table 4).3
For more than 2 decades, the overlap between ICR
and TMJ JIA has been the subject of scholarly atten-
tion.6,7 No previous study has offered a relevant com-
parison of these conditions. We believe that our study
is, indeed, relevant in spite of its apparent limitations,
inherently applying to any retrospective study, and
the absence of consensus criteria for ICR work-up.
We wish to thank Drs Posnick and Kaban for
highlighting these limitations in our study and in the
ICR literature, which mainly consists of low-evidence
retrospective case series.2
Now would be the right time to start interdisciplin-
ary collaboration to develop consensus-based criteria
for ICR diagnostic work-up. We welcome any effort
to this end and any initiative that may help improve
conditions for our primary stakeholders − our
patients.
THOMAS KLIT PEDERSEN, DDS, PHD
PETER STOUSTRUP, DDS, PHD
Aarhus, Denmark
References
1. Alsabban L, Amarista FJ, Mercuri LG, Perez D: Idiopathic Condy-
lar Resorption: A Survey and Review of the Literature. J Oral
Maxillofac Surg 76, 2018. 2316.e2311-2316.e2313
2. Ji YD, Resnick CM, Peacock ZS: Idiopathic condylar resorption:
A systematic review of etiology and management. Oral Surg Oral
Med Oral Pathol Oral Radiol 130:632-639, 2020
3. Alimanovic D, Pedersen TK, Matzen LH, Stoustrup P: Comparing
Clinical and Radiological Manifestations of Adolescent Idio-
pathic Condylar Resorption and Juvenile Idiopathic Arthritis in
PEDERSEN AND STOUSTRUP
the Temporomandibular Joint. J Oral Maxillofac Surg 79:774-
785, 2021
4. Stoustrup P, Resnick CM, Pedersen TK, et al. Standardizing Ter-
minology and Assessment for Orofacial Conditions in Juvenile
Idiopathic Arthritis: International, Multidisciplinary Consensus-
based Recommendations. J Rheumatol 46:518-522, 2019
5. Stoustrup P, Twilt M, Spiegel L, et al. Clinical Orofacial Examina-
tion in Juvenile Idiopathic Arthritis: International Consensus-
based Recommendations for Monitoring Patients in Clinical
Practice and Research Studies. J Rheumatol 44:326-333, 2017
1811
6. Arnett GW, Milam SB, Gottesman L: Progressive mandibular ret-
rusion−idiopathic condylar resorption. Part I. Am J Orthod Den-
tofacial Orthop 110:8-15, 1996
7. Arnett GW, Milam SB, Gottesman L: Progressive mandibular ret-
rusion-idiopathic condylar resorption. Part II. Am J Orthod Den-
tofacial Orthop 110:117-127, 1996
https://doi.org/10.1016/j.joms.2021.04.025