A Comparative Study Between Clinical and Instrumental Methods for the Recognition of Internal Derangements with a Clicking Sound on Condylar Movement

Aims: To compare the results of 3 methods of recognizing internal derangements with a clicking sound on condylar movement: 2 function-based methods (clinical examination and condylar move-ment recording) and 1 anatomy-based method (magnetic reso-nance imaging [MRI]). Methods: For the recognition of an ante-rior or posterior disc displacement with reduction and of hypermobility within the temporomandibular joint (TMJ), 42 par-ticipants underwent a clinical examination, an opto-electronic movement recording, and an MRI scan. The examinations were executed in a single-blind design, with different experienced exam-iners for each technique. In addition, for 10 randomly chosen par-ticipants, the condylar movement recordings and the MRI scans were carried out twice. Without the examiners’ knowledge, these second recordings were added to the other data. Results: Intraobserver reliability for the recognition of internal derange-ments was excellent for condylar movement recording (κ = 0.86) and fair to good for MRI (κ = 0.73). Intermethod agreement was fair to good (κ = 0.59) between the 2 function-based techniques. However, intermethod agreement between the anatomy-based MRI technique and either of the 2 function-based techniques was poor (for condylar movement recording, κ = 0.15; and for clinical examination, κ = 0.12). Conclusion: There is a great discrepancy between the diagnoses for internal derangements based upon anatomical TMJ characteristics and those based on functional TMJ characteristics. For a function-based diagnosis, there is prob-ably no need for the sophisticated technique of condylar move-ment recording, since that method shows fair to good agreement with a carefully performed clinical examination.

clinical criteria; condylar movement recordings; internal derangements; magnetic resonance imaging; temporomandibular joint

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