Diagnostic validity of clinical protocols to assess temporomandibular disk displacement disorders: a meta-analysis

To evaluate the diagnostic validity of clinical examination protocols compared with magnetic resonance imaging (MRI) in adults with temporomandibular joint disk displacement disorders.

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was undertaken using a selection process in 2 phases; 283 different references were identified, and 10 articles were included for qualitative analysis and 7 for meta-analysis. Temporomandibular joint disorders were assessed through clinical diagnosis protocols with the aid of Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or Clinical Diagnostic Criteria for Temporomandibular Disorders. The authors searched the following electronic databases: Cochrane, LILACS, PubMed, Science Direct, SCOPUS, and Web of Science. Additional search of gray literature was performed. Selected studies were evaluated by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Two subgroups were analyzed: Disk displacement with reduction (DDwR) and disk displacement without reduction (DDwoR).

The validity of clinical protocols compared with MRI performed in studies evaluating only DDwR presented sensitivity of 44% (39%-49%) and specificity 51% (46%-57%). In studies evaluating only DDwoR, sensitivity was 22% (16%-30%) and specificity 93% (85%-98%). The area under the curve value for validity of clinical protocols in all studies was 0.63, 0.56 for studies evaluating DDwR and 0.64 for studies evaluating DDwoR. Area under the curve values were considered poor.

Clinical examination protocols have poor validity to diagnose DDwR and DDwoR compared with MRI. MRI should be used to increase the diagnostic accuracy when the information provided can influence clinical decisions.