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Journal of Oral & Facial Pain and Headache
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J Orofac Pain 23 (2009), No. 2     15. May 2009
J Orofac Pain 23 (2009), No. 2  (15.05.2009)

Page 123-139


Relationship Between Clinical and Magnetic Resonance Imaging Diagnoses and Findings in Degenerative and Inflammatory Temporomandibular Joint Diseases: A Systematic Literature Review
Koh, Kwang-Joon / List, Thomas / Petersson, Arne / Rohlin, Madeleine
Aim: To describe evidence for a relationship between diagnoses and findings of clinical examination and diagnoses and findings of magnetic resonance imaging (MRI) examination for degenerative and inflammatory temporomandibular joint diseases.
Methods: PubMed and the Cochrane Library were searched using specific indexing terms and reference lists were hand-searched. Included publications satisfied pre-established criteria. Primary studies were interpreted using a modification of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.
Results: The literature search yielded 219 titles and abstracts. Eighty-two studies were selected and read in full-text. After data extraction and interpretation with the QUADAS tool, 23 studies remained. There was a vast heterogeneity in study design, clinical examination methods, and diagnostic criteria. No clear evidence was found for a relationship between clinical and MRI diagnoses and findings. Several studies reported a relationship between clinical pain and internal derangements diagnosed with MRI, but the calculated odds ratio (OR) for this relationship was generally low (1.54-2.04). ORs for the relationship between pain and disc displacement without reduction (4.82) or between crepitation and disc displacement without reduction (3.71) were higher.
Conclusion: This review reveals a need for studies with improved quality in reporting of samples, examination techniques, findings, and definitions and rationales for cutoffs, categories, and diagnoses. We recommend that standardized protocols such as the Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD) and the Standards for Reporting of Diagnostic Accuracy (STARD) statement be implemented in future studies.

Keywords: clinical examination, internal derangement, magnetic resonance imaging, pain, temporomandibular disorders