Improved Interaction Models of Temporomandibular Joint Anatomic Relationships in Asymptomatic Subjects and Patientswith Disc Displacement with or without Reduction

Aims: To consider temporomandibular joint (TMJ) anatomic inter-actions in order to refine hard tissue models differentiating (1) joints diagnosed with disc displacement with reduction (DDwR) or without reduction (DDw/oR) from asymptomatic joints (Normals), and (2) DDwR joints from DDw/oR joints. Methods:TMJ tomograms of 84 women with unilateral DDwR and 78 with unilateral DDw/oR were compared against each other and against those of 42 female Normal joints through the use of 14 linear and angular measurements, 8 ratios, and 34 interactions. A classification tree model for each comparison was tested for fit with sensitivity, specificity, accuracy, and log likelihood and com-pared to logistic regression models. Results: In the classification tree model comparison, the DDwR model versus the Normal model realized 35.9% log likelihood (88.0% sensitivity, 66.7%specificity); the DDw/oR model versus the Normal model realized 38.8% log likelihood (69.6% sensitivity, 85.7% specificity). The DDwR model versus the DDw/oR model realized 33.3% log like-lihood (76.0% sensitivity, 73.1% specificity). In the logistic regres-sion model comparison, the DDwR model versus the Normal model realized 40.8% log likelihood (82.1% sensitivity, 78.6%specificity) and the DDw/oR model versus the Normal model real-ized 61.1% log likelihood (85.9% sensitivity, 90.5% specificity). The DDwR model versus the DDw/oR model realized 21.5% log likelihood (60.3% sensitivity, 79.8% specificity). The addition of interactions to the logistic regression models improved the previ-ously published log likelihood from 99% to 149%. Conclusion: The interactions improved logistic regression models and the data suggest that anatomic characteristics influence joint functional sta-tus. Because the models incorporated nearly all considered anatomic measurements, no anatomic factor is redundant in the closed TMJ biological system.

disc displacement with reduction; disc displacement without reduction; multifactorial analysis; temporo-mandibular joint anatomy

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