UCLA School of Dentistry, Los Angeles, CA 90024-1668, USA.
J Oral Rehabil. 2013 Apr;40(4):296-318. doi: 10.1111/joor.12032.
Belief in and rejection of a relationship of occlusion and temporomandibular joint (TMJ) condyle-fossa position with normal and abnormal function are still contentious issues. Clinical opinions can be strong, but support in most published data (mostly univariate) is problematic. Distribution overlap, low sensitivity and specificity are a common basis to reject any useful prediction value. Notwithstanding, a relationship of form with function is a basic tenet of biology. These are multifactor problems, but the questions mostly have not been analysed as such. This review moves the question forward by focusing on TM joint anatomic organisation as the multifactor system it is expected to be in a closed system like a synovial joint. Multifactor analysis allows the data to speak for itself and reduces bias. Classification tree analysis revealed useful prediction values and usable clinical models which are illustrated, backed up by stepwise logistic regression. Explained variance, R(2), predicting normals from pooled TMJ patients was 32·6%, sensitivity 67·9%, specificity 85·7%; 37% versus disc displacement with reduction; and 28·8% versus disc displacement without reduction. Significant osseous organisational differences between TM joints with clicking and locking suggest that this is not necessarily a single disease continuum. However, a subset of joints with clicking contained characteristics of joints with locking that might contribute to symptom progression versus resistance. Moderately strong models confirm there is a relationship between TMJ osseous organisation and function, but it should not be overstated. More than one model of normals and of TM derangement organisation is revealed. The implications to clinical decision-making are discussed.
对颞下颌关节（TMJ）髁突窝位置与正常和异常功能之间存在闭塞关系的相信和拒绝仍然是有争议的问题。临床观点可能很强，但大多数已发表数据（主要是单变量）的支持存在问题。分布重叠、低敏感性和特异性是拒绝任何有用预测值的常见基础。尽管如此，形态与功能的关系是生物学的基本原则。这些是多因素问题，但这些问题大多没有被如此分析。通过关注 TM 关节解剖结构作为预期在类似于滑膜关节的封闭系统中应该存在的多因素系统，本综述将问题向前推进。多因素分析允许数据自行说明问题，并减少偏差。分类树分析显示了有用的预测值和可用的临床模型，并用逐步逻辑回归进行了说明和支持。解释方差、R(2)，从 pooled TMJ 患者中预测正常情况的准确率为 32.6%，敏感性为 67.9%，特异性为 85.7%；37%与可复性盘前移位相比；28.8%与不可复性盘前移位相比。具有弹响和锁定的 TM 关节之间存在显著的骨质组织差异表明，这不一定是单一的疾病连续体。然而，具有弹响的关节亚组具有锁定关节的特征，这可能导致症状进展与抵抗。中度强模型证实 TMJ 骨质组织与功能之间存在关系，但不应夸大其词。揭示了正常和 TM 紊乱组织的多个模型。讨论了对临床决策的影响。
