Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
Primary Health Care, Ministry of Health, Jazan, Saudi Arabia.
Eur Radiol. 2024 May;34(5):3126-3140. doi: 10.1007/s00330-023-10248-4. Epub 2023 Oct 25.
This systematic review aimed to appraise the reliability and comprehensiveness of imaging methods in studies that used three-dimensional assessment of the temporomandibular joint (TMJ) in order to propose a standardized imaging method.
Six databases/search engines were searched up until September 2022. The outcomes of interest included measurements of the mandibular condyle, glenoid fossa, joint spaces, or the entire TMJ. Two checklists were utilized: one to assess the risk of bias, with a maximum score of 37, and the other, a pre-designed checklist consisting of 22 items to evaluate the comprehensiveness of the methods used, with a maximum score of 33.
Out of the 2567 records retrieved, only 14 studies, which used cone bean computed tomography (CBCT), were deemed eligible and thus included in the qualitative analysis. Three studies were deemed of low risk of bias, while the remaining studies were rated as moderate to high risk of bias, primarily due to improper reporting of inter-observer agreement, varying reliability values, and a limited number of cases included in the reliability analysis. Regarding the comprehensiveness of the methods used, only four studies achieved relatively high scores. The deficiencies observed were related to the reporting of variables such as slice thickness and voxel size, absence of or improper reporting of intra- and inter-examiner reliability analyses, and failure to assess all osseous components of the TMJ.
CBCT-based methods used to assess the positions and morphology of TMJ bony structures appear to be imperfect and lacking in comprehensiveness. Hence, criteria for a standardized assessment method of these TMJ structures are proposed.
Accurately, comprehensively, and reliably assessing the osseous structures of the temporomandibular joint will provide valid and valuable diagnostic features of the normal temporomandibular joint, and help establish potential associations between these osseous features and temporomandibular disorders.
The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199792).
•Although many methods have been introduced to assess the osseous structure of the temporomandibular joint, they yielded inconsistent findings. •None of the published studies comprehensively assessed the temporomandibular joint. •Recommendations for a comprehensive temporomandibular joint osseous assessment method were suggested for better validity and reliability of future research.
本系统评价旨在评估使用三维评估颞下颌关节（TMJ）的研究中影像学方法的可靠性和全面性，以便提出标准化的影像学方法。
截至 2022 年 9 月，检索了 6 个数据库/搜索引擎。感兴趣的结局包括下颌髁、关节窝、关节间隙或整个 TMJ 的测量值。使用了两个检查表：一个用于评估偏倚风险，最高得分为 37 分，另一个是预先设计的检查表，包含 22 个项目，用于评估使用方法的全面性，最高得分为 33 分。
在检索到的 2567 条记录中，只有 14 项研究使用锥形束 CT（CBCT）被认为符合条件并纳入定性分析。其中 3 项研究被认为偏倚风险较低，而其余研究则被评为中至高偏倚风险，主要原因是对观察者间一致性的报告不恰当、可靠性值差异较大，以及可靠性分析中纳入的病例数量有限。关于所使用方法的全面性，只有 4 项研究得分相对较高。观察到的缺陷与变量的报告有关，例如切片厚度和体素大小、缺乏或不正确的观察者内和观察者间可靠性分析报告，以及未能评估 TMJ 的所有骨性成分。
用于评估 TMJ 骨性结构位置和形态的基于 CBCT 的方法似乎并不完善且缺乏全面性。因此，提出了这些 TMJ 结构标准化评估方法的标准。
准确、全面、可靠地评估颞下颌关节的骨性结构将为正常颞下颌关节提供有效的、有价值的诊断特征，并有助于确定这些骨性特征与颞下颌关节紊乱之间的潜在关联。
本系统评价的方案在国际前瞻性系统评价登记库（PROSPERO，编号：CRD42020199792）中进行了登记。
尽管已经引入了许多方法来评估颞下颌关节的骨性结构，但它们得出的结果不一致。
没有一项发表的研究全面评估了颞下颌关节。
建议使用更全面的颞下颌关节骨性评估方法，以提高未来研究的有效性和可靠性。
