Thapar Prem R, Nadgere Jyoti B, Iyer Janani, Salvi Neelam A
Post graduate student, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India.
Professor and Head, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India.
J Prosthet Dent. 2025 Feb;133(2):446-454. doi: 10.1016/j.prosdent.2023.03.012. Epub 2023 Apr 17.
Diagnosing temporomandibular disorders without an adjunctive chairside diagnostic tool has made the management of temporomandibular disorders challenging and subjective. The use of magnetic resonance imaging, considered the standard imaging modality, is hindered because of high cost, a long learning curve, availability, and a longer examination time.
The purpose of this systematic review and meta-analysis was to determine whether ultrasonography could be a chairside tool to help clinicians diagnose disc displacement in temporomandibular disorders.
An electronic search was conducted of the PubMed (including MEDLINE) and Cochrane Central database and the Google Scholar search engine for articles published from January 2000 to July 2020. Studies were chosen based on the inclusion criteria, which included the diagnostic technique's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with respect to imaging the displacement of the articular disc. The quality assessment of diagnostic accuracy studies (QUADAS- 2) tool was applied to assess the risk of bias for the included studies. The Meta-Disc 1.4 and RevMan 5.3 software program were used to conduct the meta-analysis.
Seventeen articles were included in this systematic review, and a meta-analysis of 14 articles was done after applying the inclusion and exclusion criteria. None of the included articles were considered to have applicability concerns; however, 2 articles had a high risk of bias. The sensitivities and specificities for the different selected studies vary substantially from 21% to 95% with a good pooled sensitivity estimate of 71% while the specificities varied from 15% to 96% with a good pooled specificity estimate of 76%.
This systematic review and meta-analysis suggested that ultrasonography may have clinically acceptable diagnostic accuracy in diagnosing disc displacement of the temporomandibular joint, allowing the treatment of patients with temporomandibular disorders with greater assurance and success. Additional training in the operation and interpretation of ultrasonography is required to reduce the learning curve and make the use of ultrasonography relevant, straightforward, and routine in dentistry to supplement clinical examination and diagnosis in patients with suspected disc displacement of the temporomandibular joint. The evidence acquired needs to be standardized, and further research is required to provide stronger evidence.
在没有辅助的椅旁诊断工具的情况下诊断颞下颌关节紊乱症，使得颞下颌关节紊乱症的治疗具有挑战性且主观。磁共振成像虽被视为标准成像方式，但因其成本高、学习曲线长、可用性以及检查时间长而受到限制。
本系统评价和荟萃分析的目的是确定超声检查是否可以作为一种椅旁工具，帮助临床医生诊断颞下颌关节紊乱症中的盘状移位。
对PubMed（包括MEDLINE）、Cochrane中心数据库以及谷歌学术搜索引擎进行电子检索，以查找2000年1月至2020年7月发表的文章。根据纳入标准选择研究，纳入标准包括诊断技术在关节盘移位成像方面的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。应用诊断准确性研究的质量评估（QUADAS - 2）工具来评估纳入研究的偏倚风险。使用Meta - Disc 1.4和RevMan 5.3软件程序进行荟萃分析。
本系统评价纳入了17篇文章，在应用纳入和排除标准后，对14篇文章进行了荟萃分析。纳入的文章均未被认为存在适用性问题；然而，有2篇文章存在高偏倚风险。不同所选研究的敏感性和特异性差异很大，从21%到95%不等，合并敏感性估计值良好，为71%，而特异性从15%到96%不等，合并特异性估计值良好，为76%。
本系统评价和荟萃分析表明，超声检查在诊断颞下颌关节盘移位方面可能具有临床可接受的诊断准确性，从而使颞下颌关节紊乱症患者的治疗更有把握且更成功。需要对超声检查的操作和解读进行额外培训，以缩短学习曲线，并使超声检查在牙科中成为相关、直接且常规的检查手段，以补充对疑似颞下颌关节盘移位患者的临床检查和诊断。所获得的证据需要标准化，还需要进一步研究以提供更有力的证据。
