A Prognostic Nomogram for Postoperative Bone Remodeling in Patients with ADDWoR

Area of Science:

• Temporomandibular Joint (TMJ) Disorders
• Orthodontics
• Oral and Maxillofacial Surgery

Background:

• Anterior disc displacement without reduction (ADDWoR) is a common temporomandibular joint disorder.
• Predicting postoperative bone remodeling is crucial for managing ADDWoR outcomes.
• Current prediction methods for bone remodeling lack precision.

Purpose of the Study:

• To develop and validate a prognostic nomogram for predicting postoperative bone remodeling in ADDWoR patients.
• To identify key prognostic factors influencing bone remodeling after surgical intervention for ADDWoR.
• To provide a tool for individualized risk assessment of bone remodeling.

Main Methods:

• Retrospective study of 1110 patients with ADDWoR undergoing arthroscopy surgery (January 2007-January 2017).
• Multivariate logistic regression analysis to identify independent prognostic factors.
• Development of a nomogram integrating age of onset, nocturnal bruxism, disc morphology, BMD, Wilkes' classification, and splint therapy.
• Validation using ROC (AUC-index) and calibration curves with bootstrap resampling.

Main Results:

• The overall probability of postoperative bone remodeling in ADDWoR was 0.51.
• Six independent prognostic factors were identified and integrated into the nomogram.
• The nomogram demonstrated good predictive discrimination (AUC-index = 0.84) in internal and external validation.
• Calibration curves indicated optimal agreement between predicted and observed probabilities of bone remodeling.

Conclusions:

• A validated prognostic nomogram effectively predicts postoperative bone remodeling in ADDWoR patients treated with arthroscopy.
• The nomogram facilitates individualized prediction of bone remodeling, aiding clinical decision-making.
• This tool enhances the management of temporomandibular joint disorders by offering personalized prognostic insights.