Pullinger A G, White S C
Section of Orofacial Pain, UCLA School of Dentistry, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Mar;79(3):367-74. doi: 10.1016/s1079-2104(05)80231-8.
The purpose of this study was to measure the amount of new information contributed by temporomandibular joint tomograms beyond that anticipated by the patient's clinical presentation.
The results of a clinical examination and history, including a video of patient interview, and dental casts of 105 patients with a temporomandibular disorder were presented to a panel of general dentist evaluators with some experience in temporomandibular disorders. These evaluators then described the radiographic findings they anticipated. Lastly they examined temporomandibular joint tomograms for each of the study patients and scored their findings.
The temporomandibular joint tomograms revealed unanticipated osseous changes in 61% of case judgments of condyles and 47% for the temporal bone or 34% and 22%, respectively, when subtle changes were excluded. Unexpected condyle positional findings were revealed in 31% of the patients. When stratified by clinical class, osteoarthritis and internal derangement, false-positive and false-negative interpretations were 12.1% and 25.5%, respectively, for osteoarthritis, and 12.2% and 17.3% for derangement.
The fairly high rate of unexpected new osseous and positional findings supports the need for tomograms in patients with a clinical diagnosis of derangement or osteoarthritis.
本研究的目的是测量颞下颌关节断层扫描所提供的新信息量，这些信息量超出了患者临床表现所预期的范围。
向一组具有颞下颌关节疾病相关经验的普通牙医评估人员展示了105例颞下颌关节紊乱患者的临床检查结果、病史（包括患者访谈视频）以及牙模。然后，这些评估人员描述了他们预期的影像学检查结果。最后，他们检查了每位研究患者的颞下颌关节断层扫描，并对检查结果进行评分。
颞下颌关节断层扫描显示，在髁突病例判断中，61%出现了意外的骨质改变；在颞骨病例判断中，47%出现了意外的骨质改变；若排除细微改变，则分别为34%和22%。31%的患者出现了意外的髁突位置发现。按临床分类（骨关节炎和关节内紊乱）分层时，骨关节炎的假阳性和假阴性解读分别为12.1%和25.5%，关节内紊乱的假阳性和假阴性解读分别为12.2%和17.3%。
意外的新骨质和位置发现的比例相当高，这支持了对临床诊断为关节内紊乱或骨关节炎的患者进行断层扫描的必要性。
