Assessment of dentofacial growth deviation in juvenile idiopathic arthritis: Reliability and validity of three-dimensional morphometric measures

• Authors: Peter Stoustrup, Aarhus University; Christian Kerting Iversen, Aarhus University; Kasper Dahl Kristensen, Aarhus University; Cory M. Resnick, Harvard School of Dental Medicine; Carlalberta Verna, University of Basel; Sven Erik Norholt, Aarhus University Hospital; Shelly Abramowicz, Emory University; Annelise Kuseler, Aarhus University; Paolo Maria Cattaneo, Aarhus University; Troels Herlin, Aarhus University Hospital; Thomas Klit Pedersen, Aarhus University
• Journal Title: PLoS ONE
• Volume: Volume 13, Number 3
• Publisher: Public Library of Science | 2018-03-13, Pages e0194177-e0194177
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0194177
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; TEMPOROMANDIBULAR-JOINT ARTHRITIS; COMPUTED-TOMOGRAPHY; FACIAL ASYMMETRY; FOLLOW-UP; CRANIOFACIAL MORPHOLOGY; MANDIBULAR ASYMMETRY; CHILDREN; INVOLVEMENT; CT; CLASSIFICATION

Abstract

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction: Patients with juvenile idiopathic arthritis (JIA) and involvement of the temporomandibular joint (TMJ) often experience abnormal facial growth. Three-dimensional (3D) assessment of dentofacial growth deviation has become more common with advancement and commercialization of imaging technologies. However, no standardized guidelines exist for interpretation of 3D imaging in patients with JIA. The aim of this study was to propose and validate morphometric measures for the 3D radiographic assessment of dentofacial growth deviation in patients with JIA to enhance: 1) Description of dentofacial growth deviation; 2) Treatment planning; 3) Longitudinal follow-up. Methods: The study was conducted in a standardized sequential-phased approach involving: 1) Preliminary decision-making; 2) Item generation; 3) Test of content-validity; 4) Test of reliability; 5) Test of construct validity; 6) Establishment of final recommendations. Results: Twenty-one morphometric measures were evaluated. Based on results of reliability and validity-testing including subjects with JIA (n = 70) and non-JIA controls (n = 19), seven measures received a "high recommendation" score. Those measures were associated with posterior mandibular height, occlusal cant, mandibular asymmetry, mandibular inclination, and anterior/posterior lower face height. Nine other measures were "moderately recommended" and five received a "somewhat recommendation" score. Conclusion: Seven morphometric measures were considered very useful in the 3D assessment of growth deviation in patients with TMJ disease associated with JIA. These variables can be used to standardize the description of dentofacial deformities and to plan corrective interventions.