Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Merle Riechmann¹, Christopher Schmidt^{1

2}, M Oliver Ahlers^{3

4}, Ima Feurer⁵, Johannes Kleinheinz⁶, Andreas Kolk⁷, Christoph Pautke⁸, Andreas Schön⁹, Marcus Teschke¹⁰, Astrid Toferer¹¹, Christopher J Lux¹², Christian Kirschneck¹³, Gabriele A Krombach¹⁴, Peter Ottl^{15

16}, Ulla Vieth¹⁷, Johanna Stengel¹, Caroline Völker¹, Andreas Neff¹

Affiliations

¹ Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany.
² Department for Radiology and Nuclear Medicine, GPR Hospital Rüsselsheim, 65428 Rüsselsheim am Main, Germany.
³ Medical Practice, CMD-Centrum Hamburg-Eppendorf, 20251 Hamburg, Germany.
⁴ Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany.
⁵ Physiotherapeutic Practice & Orthopedic Manual Therapy, 78315 Radolfzell-Böhringen, Germany.
⁶ Department of Craniomaxillofacial Surgery, University Hospital Münster, Westfälische Wilhelms-University Münster, 48149 Münster, Germany.
⁷ Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria.
⁸ Medical Practice & Clinic for Oral and Craniomaxillofacial Surgery, 80333 München, Germany.
⁹ Department of Oral and Craniomaxillofacial Surgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, 53127 Bonn, Germany.
¹⁰ Medical Practice for Oral and Craniomaxillofacial Surgery, 28195 Bremen, Germany.
¹¹ Medical Practice for Oral and Craniomaxillofacial Surgery, 8301 Laßnitzhöhe, Austria.
¹² Polyclinic for Orthodontics, University Hospital Heidelberg, 69120 Heidelberg, Germany.
¹³ Polyclinic for Orthodontics, University Hospital Regensburg, 93053 Regensburg, Germany.
¹⁴ Department of Diagnostic and Interventional Radiology, University Hospital Giessen, 35392 Giessen, Germany.
¹⁵ Department of Prosthodontics and Materials Sciences, Rostock University Medical Center, 18057 Rostock, Germany.
¹⁶ Department of Life, Light and Matter, University of Rostock, 18059 Rostock, Germany.
¹⁷ Medical Practice for General Medicine, 36088 Hünfeld, Germany.

PMID: 37568349
PMCID: PMC10419428
DOI: 10.3390/jcm12154946

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Merle Riechmann et al. J Clin Med. 2023.

. 2023 Jul 27;12(15):4946.

doi: 10.3390/jcm12154946.

Authors

Affiliations

¹ Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany.
² Department for Radiology and Nuclear Medicine, GPR Hospital Rüsselsheim, 65428 Rüsselsheim am Main, Germany.
³ Medical Practice, CMD-Centrum Hamburg-Eppendorf, 20251 Hamburg, Germany.
⁴ Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany.
⁵ Physiotherapeutic Practice & Orthopedic Manual Therapy, 78315 Radolfzell-Böhringen, Germany.
⁶ Department of Craniomaxillofacial Surgery, University Hospital Münster, Westfälische Wilhelms-University Münster, 48149 Münster, Germany.
⁷ Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria.
⁸ Medical Practice & Clinic for Oral and Craniomaxillofacial Surgery, 80333 München, Germany.
⁹ Department of Oral and Craniomaxillofacial Surgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, 53127 Bonn, Germany.
¹⁰ Medical Practice for Oral and Craniomaxillofacial Surgery, 28195 Bremen, Germany.
¹¹ Medical Practice for Oral and Craniomaxillofacial Surgery, 8301 Laßnitzhöhe, Austria.
¹² Polyclinic for Orthodontics, University Hospital Heidelberg, 69120 Heidelberg, Germany.
¹³ Polyclinic for Orthodontics, University Hospital Regensburg, 93053 Regensburg, Germany.
¹⁴ Department of Diagnostic and Interventional Radiology, University Hospital Giessen, 35392 Giessen, Germany.
¹⁵ Department of Prosthodontics and Materials Sciences, Rostock University Medical Center, 18057 Rostock, Germany.
¹⁶ Department of Life, Light and Matter, University of Rostock, 18059 Rostock, Germany.
¹⁷ Medical Practice for General Medicine, 36088 Hünfeld, Germany.

PMID: 37568349
PMCID: PMC10419428
DOI: 10.3390/jcm12154946

Abstract

Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.

Keywords: Delphi method; condylar resorptions; consensus; guideline; idiopathic condylar resorption; temporomandibular joint.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Literature search—2021/2022 flow chart (last updated 12/2022).

**Figure 2**
Classification of grades of recommendations according to AWMF rules and standards.

See this image and copyright information in PMC

References

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Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Affiliations

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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