J Oral Facial Pain Headache. 2021 Nov-Dec;35(4):332-345. doi: 10.11607/ofph.2953.
AIMS: To evaluate the association between clinical signs/symptoms and bone changes on CBCT images in patients with degenerative joint disease (DJD) of the temporomandibular joint (TMJ). METHODS: An electronic literature search of the MEDLINE, PubMed, EMBASE, Scopus, and Web of Science databases, as well as Google Scholar for gray literature, was conducted to identify relevant articles on February 26, 2021. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal tools. The GRADEpro (Recommendation, Assessment, Development, and Evaluation) system instrument was applied to assess the level of evidence across studies. RESULTS: Nine papers assessing clinical signs/symptoms and CBCT findings were included. TMJ pain (arthralgia) and TMJ noises carried the strongest associations with various CBCT findings, each of which were supported by four studies with significant associations. Only one study found significant associations between masticatory myalgia (muscle pain) and CBCT findings. Range of motion carried no significant associations with CBCT findings in the included studies. Based on the GRADEpro system, the certainty of evidence is low for said associations. CONCLUSION: The results suggest that TMD patients with TMJ arthralgia and joint noises may benefit from CBCT imaging. There would be less benefit in TMD patients exhibiting primarily myalgia or limited range of motion, and therefore these patients should not be prescribed routine CBCT radiographs unless indicated by other clinical findings. The heterogeneity of reporting in the included studies suggests that embracing universal clinical (DC/TMD) and radiographic diagnostic criteria for TMJ-DJD would benefit both research and clinical outcomes.
目的:评估颞下颌关节(TMJ)退行性关节病(DJD)患者的临床体征/症状与 CBCT 图像骨变化之间的关系。
方法:于 2021 年 2 月 26 日,通过 MEDLINE、PubMed、EMBASE、Scopus 和 Web of Science 数据库以及 Google Scholar 对电子文献进行检索,以确定有关 TMJ DJD 的临床体征/症状和 CBCT 发现的相关文章。使用 Joanna Briggs 研究所的关键评估工具评估偏倚风险。应用 GRADEpro(推荐、评估、发展和评价)系统工具评估研究间证据水平。
结果:纳入了 9 篇评估临床体征/症状和 CBCT 结果的研究。TMJ 疼痛(关节痛)和 TMJ 噪音与各种 CBCT 结果具有最强的关联,其中每一项均有 4 项具有显著关联的研究支持。仅有 1 项研究发现咀嚼肌痛(肌肉疼痛)与 CBCT 结果之间存在显著关联。纳入研究中,张口度与 CBCT 结果无显著关联。根据 GRADEpro 系统,这些关联的证据确定性为低。
结论:结果表明,TMJ 关节痛和关节噪音的 TMD 患者可能受益于 CBCT 成像。主要表现为肌痛或张口度受限的 TMD 患者获益较少,因此除非其他临床发现提示,否则不应常规开具 CBCT 射线照相检查。纳入研究的报告存在异质性,这表明接受 TMJ-DJD 的通用临床(DC/TMD)和放射学诊断标准将有利于研究和临床结果。
J Oral Facial Pain Headache. 2021
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