Tomo report.

Last summer, I had a tomogram taken of my TMJs.  It's a very interesting experience!  It's not like an MRI or a CT scan (you don't go through a tube or anything), but it does make the magnetic banging noises and it is a HUGE machine.  You sit in a chair in the middle, and around you swing the arms of the x-ray that takes pictures of you jaw.  I sort of laughed to myself, though, as I was sitting there.  Any of you who have undergone the dreaded face bow, or even just the ear rod things from the ceph x-rays will understand.  So, I am sitting in the middle of this enormous, sophisticated equipment, and then they tell me to place my chin on the chin rest and they proceed to swing around a contraption that looks like some sort of medieval torture device.  It's like 1200s meets the 21st century.  Anyway, there were ear-rods and clamps.  It was somewhat uncomfortable, but not too bad considering.  It only took about ten minutes to do both sides.

Here is the report, again in dentist-speak, which I will leave untranslated and to your imagination.

The left condyle was very small.  The reduction in size occured from the superior surface of the left condyle.  The superior surface of the left condyle showed signs of flattening, erosions and sclerosis while the superior surface of the right condyle had a thick cortex.  The superior slope of the left articular eminence showed signs of flattening, sclerosis, and erosions.  When the mandible was in the closed position the consyles were located superior to the center of their fossa and the resultant superior joint spaces were thin.  In the mandibular open position the condyles translated to a point short of the summit of the adjacent eminence.

The structure and morphology of the osseous components of the TMJs were evaluated and the findings noted above were consistent with active degenerative joint disease (DJD) in the left TMJ and remodeling in the right TMJ.  DJD involves the destruction of the articular tissues and occurs when the remodeling capcity of those tissues has been exceeded by the functional demands.  I could not rule out the possibility of active DJD in the left TMJ therefore this joint may be vulnerable to biomechanical forces.  The presence of the DJD increases the probability of a displaced disc in the left TMJ, has reduced the size of the left condyle, may be associated with a change in occlusion and mandibular posture and may predispose the TMJs to dysfunction.  In addition, the narrowed superior joint space increases the probability of displaced discs and/or thinning of the soft tissues separating the superior and inferior joint compartments.  The condyles demonstrated a radiographically subnormal anterior range of motion.

What this boils down to is that surgery is necessary to prevent any further damage, but it can't un-do the damage that has already been done.  My surgeon said that my bite will always have some "wiggle" because the joint is small and this will allow my bite to shift around.  This really increases the chance of relapse, but if I don't have the surgery at all, things would be much worse.  So I am moving forward...  Top braces go on next week!