Progressive/Idiopathic Condylar Resorption: An Orthodontic Perspective

This article opens with a definition of progressive/idiopathic condylar resorption (PCR/ICR), which is a severe form of degenerative joint disease that selectively affects the temporomandibular joint. The demographics of this relatively rare condition have been reported, and it is clear that female adolescents are the main affected group. Some cases occur spontaneously, whereas others appear during orthodontic therapy or as sequelae to orthognathic surgical procedures. Whereas the condylar cartilage and bone are the main tissues involved, the role of the articular disk remains controversial. The authors report the results of a survey of orthodontists regarding their experience with PCR/ICR, and based on those results, an estimate of 1 case per 5000 orthodontic patients was reached. The next section of this article discusses practical aspects of recognizing and managing PCR/ICR in the orthodontic practice. It is essential for orthodontists to recognize the onset of this condition in their own patients as early as possible, and if cases are referred from outside the practice, they may not present with an established diagnosis. Imaging techniques such as tomograms and cone beam computed tomography scans have been shown to have value in the initial diagnostic process as well as in monitoring the condition over time. Management of PCR/ICR patients with oral appliances and surgical procedures requires continuous collaboration between the orthodontist and other professional colleagues. The final section includes 2 case reports of patients treated by a combination of orthodontic treatment and orthognathic surgery. These are followed by an in-depth discussion of the medico-legal aspects of managing PCR/ICR in the orthodontic practice.