|Baltic Dental and Maxillofacial Journal|
September, 2004, Vol. 6, No. 3
© 2004 Stomatologija
Stomatologija 2004; 6 (3): 91-3 170 KB
Accuracy of Traditional Clinical Examination in Combination with 3-D Computerized Axiography for Diagnosing Anterior Disk Displacement with Reduction
Giedre Kobs, Olaf Bernhardt, Thomas Kocher, Georg Meyer
Statement of problem. Magnetic resonance imaging (MRI) was reported to be a non-invasive and useful tool for diagnosing disk displacement. However, cost and availability often limit the use of MRI. The clinician must often rely on the patients history and clinical examination findings to establish the diagnosis.
Purpose. The objective of this study was to evaluate the diagnostic accuracy of a clinical examination in combination with computerized axiography for diagnosing anterior disk displacement with reduction.
Material and methods. 464 joints with no disk displacement (NDD), 114 joints with reducible displaced disk (RDD), and 36 joints with permanently displaced disk (PDD) confirmed on magnetic resonance imaging (MRI) were examined by traditional clinical approach and 3-D computerized axiography.
Results. Pathological TMJ states such as RDD could be separated from healthy joints with an clinical examination sensitivity of approximately 52,8% on the right side and 59,0% on the left side. The overall accuracy for the Clicking test combined with 3-D computerized axiography was about 77,8% on the right side and 72,1% on the left side.
Conclusion. Our results suggest that anterior disk displacement with reduction can’t be diagnosed with considerable accuracy though the use of a clinical examination only.
Although the predictability of identifying anterior disk displacement with reduction by clicking was relatively low, it increased to an acceptable level when additional 3-D computerized axiography were used. Within the limitation of this study we suggest, that clinical examination in combination with jaw-tracking devices is an accurate evaluation method for determination of TMJ dysfunction.
Key words: temporomandibular disorders; temporomandibular joint dysfunction; internal derangement; clinical examination; computerized axiography; magnetic resonance imaging; sensitivity; specificity
Received: 22 06 2004
Accepted for publishing: 20 09 2004
Giedre Kobs - D.D.S., PhD., Institute of `Odontology, Faculty of Medicine, Vilnius University, Lithuania.
Olaf Bernhardt - D.D.S., PhD., assist. Professor, Assistant medical director at the Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Greifswald, Germany.
Thomas Kocher - D.D.S., PhD., Hab. Dr., Professor and Head of the Department of Periodontology, University of Greifswald, Germany.
Georg Meyer - D.D.S., PhD., Hab. Dr., Professor and Head of the Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Greifswald, Germany.
Address correspondence to G. Kobs: Department of Prosthodontics, Institute of Odontology Faculty of Medicine, Vilnius University, Zalgirio str. 117, Vilnius, Lithuania.