Diagnostic correlation between clinical protocols and magnetic resonance findings in temporomandibular disorders: A systematic review and meta‐analysis

Abstract

Background Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia. Methods A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS‐2. Heterogeneity was assessed using I2. Publication bias was assessed using funnel plots. For meta‐analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols. Results Fourteen studies included in the qualitative analysis and 11 studies in the meta‐analysis. None of the studies fulfilled all criteria of QUADAS‐2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion. Conclusions This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.

The influence of the COVID-19 pandemic, sex, and age on temporomandibular disorders subtypes in East Asian patients: a retrospective observational study

“…In addition to racial variations, the higher frequency of disc displacements without reduction in this study could be contributed partly by the use of supplementary MRIs for verifying this diagnosis. When compared to MRI, clinical protocols have poor-to-moderate validity for diagnosing disc displacements with and without reduction [ 28 ]. Patients who sought care during the pandemic had significantly more PT and IT conditions with higher prevalences of myalgia, headache, and degenerative joint disease than those who presented before the pandemic.…”

Novel Diagnostic and Therapeutic Approaches to Temporomandibular Dysfunction: A Narrative Review

“…Of the many diagnostic tools used by clinicians to diagnose TMD, magnetic resonance imaging (MRI) is widely considered the gold standard [ 17 ]. Not only does this imaging modality confer a high level of resolution of hard and soft tissue structures in the TMJ, but it can also produce imaging of the joint in motion.…”

Diagnostic criteria for temporomandibular disorders—INfORM recommendations: Comprehensive and short‐form adaptations for adolescents

“…CBCT and MRI with or without contrast can be very useful in the diagnosis and management of some joint‐related TMDs. A recent systematic review with meta‐analysis reported a high specificity (98%) of both RDC/TMD and DC/TMD for the diagnosis of disc displacement without reduction, however the sensitivity for the disc displacement with reduction and disc displacement without reduction were respectively 66% and 61% in adults 61 . Using the criterion standard of MRI improves diagnosis of these disc displacements, but costs and benefits of such tests needs to be assessed for each patient, particularly as this condition is common in asymptomatic patients (15%–32%) 62–64 …”

“…A recent systematic review with meta-analysis reported a high specificity (98%) of both RDC/TMD and DC/TMD for the diagnosis of disc displacement without reduction, however the sensitivity for the disc displacement with reduction and disc displacement without reduction were respectively 66% and 61% in adults. 61 Using the criterion standard of MRI improves diagnosis of these disc displacements, but costs and benefits of such tests needs to be assessed for each patient, particularly as this condition is common in asymptomatic patients (15%-32%). [62][63][64] In 2020, the distribution of doses absorbed by adult and child phantoms during panoramic radiographs and cone-beam computed tomography of the TMJ has been compared.…”