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Dr. Dr. Georg-Friedemann Rust
Specialist in Radiology & Neuroradiology
Physicist and radiologist – combining medical and technical expertise for precise imaging and personal care.
Choose a check – an idea of possible examinations, in a few minutes, anonymously.
“A doctor and physicist who combines the highest professional competence with a very pleasant manner – the patient is at the centre, and the findings are explained in an understandable way.”
Experience diagnostics with calm assurance. Radiology and cardiology hand in hand in the centre of Munich.
MRI of the temporomandibular joint.
The temporomandibular joint is the most-used joint in the body – and at the same time one of the most heavily loaded: when you bite down firmly, the load concentrates on the tiny cusps of a single tooth into pressures approaching one tonne per square centimetre. Inconspicuous as it may seem, a disorder of this joint can cause far more than most people suspect – from clicking and chewing pain through severe headache and facial pain to tinnitus and persistent neck and shoulder tension. And yet the cartilage disc within the joint measures only a few millimetres. That is precisely why details matter here: high resolution – and examining the joint not only at rest but also in motion.
The articular disc – the cartilage disc between the condyle and the joint socket – is the most common source of clicking, pain and locking. On X-ray and CBCT it is invisible: both show bone, not cartilage. It becomes visible on MRI alone. And whether it snaps back when the mouth opens or stays displaced – the distinction on which the treatment depends – only shows when both positions are examined.
With jaw joint pain, clicking or restricted mouth opening, MRI shows the disc and joint structures of the temporomandibular joint without radiation.
Many of these complaints originate in the temporomandibular joint – and remain unexplained for years, because no one ever looked there specifically. Headache and facial pain in particular, tinnitus and a feeling of pressure in the ear, or persistent neck and shoulder tension are first attributed to the ENT, neurological or orthopaedic field – even though the cause may lie in the masticatory system.
Small as the temporomandibular joint is, its mechanics are remarkably sophisticated: it does not merely rotate but at the same time glides forwards and backwards – a combined hinge and sliding joint (technically “ginglymoarthrodial”) that makes the grinding motion of chewing possible in the first place. At its heart is the cartilage disc (articular disc). If this interplay falls out of step – for example due to night-time teeth grinding (bruxism) – chewing problems, clicking and pain result.⁷
Position and shape of the cartilage disc in closed and open mouth position – displacement with or without reduction.
Joint effusion, synovitis and bone marrow oedema as signs of active strain – depicted on MRI without radiation.
Flattening, marginal outgrowths and changes in the shape of the condyle – assessed in side-by-side comparison.
Masseter and pterygoid muscles: thickening and irritation, often with nocturnal grinding.
Online or by phone – appointments usually at short notice; emergencies accommodated. Call us.
About 25 minutes, without radiation, in closed and open mouth position – both joints in the same appointment.
Explained clearly, on request sent directly to your dentist, orthodontist or oral and maxillofacial surgeon.
Structured TMD imaging following a clear protocol – both joints, two positions, read by a specialist and physicist. Short-notice appointments, images sent directly into your system on request.
Physicist and radiologist – combining medical and technical expertise for precise imaging and personal care.
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About 5 to 12 percent of adults have complaints of the masticatory system¹ – women considerably more often than men. And the temporomandibular joint is among the most heavily loaded joints of all: in the molar region the maximum bite force reaches several hundred newtons – on average around 700 N, in men up to about 1000 N⁷ –, which, distributed onto the tiny cusp contacts, concentrate into point pressures on the order of about one tonne per square centimetre. Disc displacement is the most common structural cause.² For its assessment, magnetic resonance imaging is regarded internationally as the reference method: it depicts the cartilage disc, joint effusion and soft tissue that remain invisible on X-ray and cone-beam CT (CBCT).³ ⁴ Decisive here is the examination in both mouth positions – only this allows a distinction between displacement with and without reduction, which largely determines further treatment.⁵ The German guideline recommends imaging specifically when a therapeutic consequence follows from the finding⁶ – which examination makes sense in your case is something we clarify together with your treating dentist. The symptoms of a temporomandibular disorder often reach far beyond the jaw – headache and facial pain, tinnitus and aural pressure as well as neck and shoulder complaints can arise from it and are initially often attributed to other specialties.⁸