Prevalence of Posterior Disc Displacement of theTemporomandibular Joint in Patients with Temporomandibular Disorders: Systematic Review and Meta-Analyses

Aims: To assess the prevalence of posterior disc displacement (PDD) in patients with temporomandibular disorders (TMD) through a systematic review of the literature and meta-analysis, as well as to assess features associated with PDD such as chief complaint, signs and symptoms, morphologic condyle and disc alterations, and PDD management. Methods: A systematic literature search was performed in the US National Library of Medicine’s PubMed/MEDLINE and Cochrane Library databases to identify all peer-reviewed, English-language manuscripts related to PDD. A critical appraisal checklist provided by the Joanna Briggs Institute for studies reporting prevalence data was used to assess the quality of the included manuscripts. A meta-analysis was conducted using software MetaXL 5.3 (EpiGear International Pty Ltd) add-in for Microsoft Excel. Pooled prevalence and 95% confidence intervals (CIs) were calculated using the software. Heterogeneity of the included studies was assessed using the Higgins I2 test and Cochran’s Q (with P value; < .05 was considered significant). Results: A total of 21 articles were selected for qualitative data synthesis: 2 case reports, 14 observational studies, and 5 studies that reported PDD in various conditions. Quantitative data analysis was performed for the 14 observational studies, of which 13 reported prevalence with respect to the number of joints affected and 9 reported prevalence with respect to the number of patients affected. The overall pooled prevalence of PDD for the number of joints affected was 0.7% (95% CI: 0.005 to 0.008). The pooled prevalence of PDD for the number of patients was 0.9% (95% CI: 0.007 to 0.011). PDD was found to be associated with osseous changes, including changes in the morphology of the condyle, disc, and articular eminence; osseous abnormalities (erosion, osteophytes); and joint effusion. Conclusion: This meta-analysis showed a very low prevalence rate of PDD in TMD patients. The limited literature did not allow conclusions to be drawn about the PDD-related features.

arthrography;magnetic resonance imaging;musculoskeletal disease;posterior disc displacement;prevalence;temporomandibular joint disc;temporomandibular joint disorders

1.Dias IM, Cordeiro PC, Devito KL, Tavares ML, Leite IC, Tesch Rde S. Evaluation of temporomandibular joint disc displace-ment as a risk factor for osteoarthrosis. Int J Oral Maxillofac Surg 2016;45:313–317.

2.Roh HS, Kim W, Kim YK, Lee JY. Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings. J Craniomaxillofac Surg 2012;40:283–286.

3.Westesson PL, Larheim TA, Tanaka H. Posterior disc displace-ment in the temporomandibular joint. J Oral Maxillofac Surg 1998;56:1266–1273.

4.Paesani D, Westesson PL, Hatala M, Tallents RH, Kurita K. Prevalence of temporomandibular joint internal derangement in patients with craniomandibular disorders. Am J Orthod Dentofacial Orthop 1992;101:41–47.

5.Tasaki MM, Westesson PL, Isberg AM, Ren YF, Tallents RH. Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers. Am J Orthod Dentofacial Orthop 1996;109:249–262.

6.Okochi K, Ida M, Honda E, Kobayashi K, Kurabayashi T. MRI and clinical findings of posterior disk displacement in the tem-poromandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:644–648.

7.Chossegros C, Cheynet F, Guyot L, Bellot-Samson V, Blanc JL. Posterior disk displacement of the TMJ: MRI evidence in two cases. Cranio 2001;19:289–293.

8.Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

9.Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-anal-yses: The PRISMA statement. PLoS Med 2009;6:e1000097.

10.Ikeda R, Ikeda K. Directional characteristics of incipient tem-poromandibular joint disc displacements: A magnetic reso-nance imaging study. Am J Orthod Dentofacial Orthop 2016; 149:39–45

11.Paesani D, Salas E, Martinez A, Isberg A. Prevalence of tem-poromandibular joint disk displacement in infants and young children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:15–19.

12.The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual 2014: The Systematic Review of Prevalence and Incidence Data. https://joannabriggs.org/assets/docs/sumari/ReviewersManual_2014-The-Systematic-Review-of-Prevalence-and-Incidence-Data_v2.pdf. Accessed 21 February 2018.

13.Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health 2013; 67:974–978.

14.Vogl TJ, Lauer HC, Lehnert T, et al. The value of MRI in patients with temporomandibular joint dysfunction: Correlation of MRI and clinical findings. Eur J Radiol 2016;85:714–719.

15.de Farias JF, Melo SL, Bento PM, Oliveira LS, Campos PS, de Melo DP. Correlation between temporomandibular joint morphology and disc displacement by MRI. Dentomaxillofac Radiol 2015;44:20150023.

16.Kumar R, Pallagatti S, Sheikh S, Mittal A, Gupta D, Gupta S. Correlation between clinical findings of temporomandibular disorders and MRI characteristics of disc displacement. Open Dent J 2015;9:273–281.

17.Deregibus A, Castroflorio T, De Giorgi I, Burzio C, Debernardi C.Could different TMJ disc positions observed in MRI cause different sounds? Analysis on a group of subjects with ADD with reduction: A pilot study. Cranio 2014;32:265–274.

18.Santos KC, Dutra ME, Warmling LV, Oliveira JX. Correlation among the changes observed in temporomandibular joint inter-nal derangements assessed by magnetic resonance in symp-tomatic patients. J Oral Maxillofac Surg 2013;71:1504–1512.

19.Alkhader M, Kuribayashi A, Ohbayashi N, Nakamura S, Kurabayashi T. Usefulness of cone beam computed tomog-raphy in temporomandibular joints with soft tissue pathology. Dentomaxillofac Radiol 2010;39:343–348.

20.Ottl P, Hohmann A, Piwowarczyk A, Hardenacke F, Lauer HC, Zanella F. Retrospective study on the evaluation of the TMJ by MRI using a newly developed standardized evaluation form. Cranio 2008;26:33–43.

21.Larheim TA, Smith HJ, Aspestrand F. Temporomandibular joint abnormalities associated with rheumatic disease: Comparison between MR imaging and arthrotomography. Radiology 1992; 183:221–226.

22.Crusoé-Rebello IM, Campos PS, Rubira IR, Panella J, Mendes CM. Evaluation of the relation between the horizon-tal condylar angle and the internal derangement of the TMJ-A magnetic resonance imaging study. Pesqui Odontol Bras 2003;17:176–182.

23.Larheim TA, Westesson P, Sano T. Temporomandibular joint disk displacement: Comparison in asymptomatic volunteers and patients. Radiology 2001;218:428–432.

24.Milano V, Desiate A, Bellino R, Garofalo T. Magnetic resonance imaging of temporomandibular disorders: Classification, prev-alence and interpretation of disc displacement and deforma-tion. Dentomaxillofac Radiol 2000;29:352–361.

25.Chiba M, Watanabe N, Echigo S. Longitudinal MRI follow-up of non-reducible posterior disc displacement accompa-nied by bone marrow oedema in the mandibular condyle. Dentomaxillofac Radiol 2007;36:304–307.

26.Ueki K, Nakagawa K, Takatsuka S, et al. Temporomandibular joint morphology and disc position in skeletal class III patients. J Craniomaxillofac Surg 2000;28:362–368.

27.Ueki K, Yoshizawa K, Moroi A, et al. Changes in computed tomography values of mandibular condyle and temporoman-dibular joint disc position after sagittal split ramus osteotomy. J Craniomaxillofac Surg 2015;43:1208–1217.

28.Pressman BD, Shellock FG, Schames J, Schames M. MR imaging of temporomandibular joint abnormalities associated with cervical hyperextension/hyperflexion (whiplash) injuries. J Magn Reson Imaging 1992;2:569–574.

29.Williamson EH. Treatment of internal derangement and closure of posterior open bite in the adult. Facial Orthop Temporomandibular Arthrol 1986;3:3–5.

30.Schellhas KP, Wilkes CH, Omlie MR, et al. The diagnosis of temporomandibular joint disease: Two-compartment arthrog-raphy and MR. AJR Am J Roentgenol 1988;151:341–350.

31.Honda T, Shimoda T, Moses JJ, Harada H. Traumatically in-duced posterior disk displacement without reduction of the TMJ—A case report. Cranio 1994;12:128–132.

32.Nitzan DW. Temporomandibular joint “open lock” versus con-dylar dislocation: Signs and symptoms, imaging, treatment, and pathogenesis. J Oral Maxillofac Surg 2002;60:506–511.

33.Hoglund LT, Scott BW. Automobilization intervention and exer-cise for temporomandibular joint open lock. J Man Manip Ther 2012;20:182–191.

34.Huddleston Slater JJ, Lobbezoo F, Chen YJ, Naeije M. A com-parative study between clinical and instrumental methods for the recognition of internal derangements with a clicking sound on condylar movement. J Orofac Pain 2004;18:138–147.

35.Huddleston Slater JJ, Lobbezoo F, Hofman N, Naeije M. Case report of a posterior disc displacement without and with re-duction. J Orofac Pain 2005;19:337–342.

36.Kalaykova S, Naeije M, Huddleston Slater JJ, Lobbezoo F. Is condylar position a predictor for functional signs of TMJ hyper-mobility? J Oral Rehabil 2006;33:349–355.

37.Montagnani G, Manfredini D, Tognini F, Zampa V, Bosco M. Magnetic resonance of the temporomandibular joint: Experience at an Italian university center. Minerva Stomatol 2005;54: 429–440.

38.Rao VM, Liem MD, Farole A, Razek AA. Elusive “stuck” disk in the temporomandibular joint: Diagnosis with MR imaging. Radiology 1993;189:823–827.

39.Mupparapu M, Parisi E, DeRossi SS. Temporomandibular joint disc disfigurement and abnormal thickening of the posterior band. Gen Dent 2003;51:256–258.

40.Blankestijn J, Boering G. Posterior dislocation of the temporo-mandibular disc. Int J Oral Surg 1985;14:437–443.

41.Limchaichana N, Nilsson H, Ekberg EC, Nilner M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil 2007;34:237–245.

42.Melis M, Di Giosia M, Secci S. Temporomandibular joint disk fracture: A case report. Cranio 2011;29:227–231.

43.Ueki K, Nakagawa K, Marukawa K, Takatsuka S, Yamamoto E. The relationship between temporomandibular joint disc mor-phology and stress angulation in skeletal Class III patients. Eur J Orthod 2005;27:501–506.

44.Gil C, Santos KC, Dutra ME, Kodaira SK, Oliveira JX. MRI analysis of the relationship between bone changes in the tem-poromandibular joint and articular disc position in symptomatic patients. Dentomaxillofac Radiol 2012;41:367–372.

45.Kretapirom K, Okochi K, Nakamura S, et al. MRI character-istics of rheumatoid arthritis in the temporomandibular joint. Dentomaxillofac Radiol 2013;42:31627230.

46.Laurent F, Cuffel P. Stenosis of the external ear canal due to meniscus intrusion [in French]. Rev Stomatol Chir Maxillofac 1984;85:276–279.

47.Avrahami E, Schreiber R, Benmair J, Paltiel Z, Machtey J, Horowitz I. Magnetic resonance imaging of the temporo-mandibular joint and meniscus dislocation. Br J Radiol 1986;59:1153–1158.

48.Porto VC, Salvador MC, Conti PC, Rotta RR. Evaluation of disc position in edentulous patients with complete dentures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97:116–121.

49.Yoda T, Imai H, Shinjyo Y, Sakamoto I, Abe M, Enomoto S. Effect of arthrocentesis on TMJ disturbance of mouth closure with loud clicking: A preliminary study. Cranio 2002;20:18–22.

50.Gallagher DM. Posterior dislocation of the temporomandibu-lar joint meniscus: Report of three cases. J Am Dent Assoc 1986;113:411–415.

51.Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofacial Sci 2006;1:9–14.

52.Katzberg RW, Westesson PL, Tallents RH, Drake CM. Anatomic disorders of the temporomandibular joint disc in asymptomatic subjects. J Oral Maxillofac Surg 1996;54: 147–153.

53.Drace JE, Enzmann DR. Defining the normal temporomandibu-lar joint: Closed-, partially open-, and open-mouth MR imaging of asymptomatic subjects. Radiology 1990;177:67–71.

54.Heffez LB. Posterior disc displacement in the temporoman-dibular joint [discussion]. J Oral Maxillofac Surg 1998;56: 1273–1274.

55.Larheim TA. Role of magnetic resonance imaging in the clin-ical diagnosis of the temporomandibular joint. Cells Tissues Organs 2005;180:6–21.

56.Katzberg RW, Tallents RH. Normal and abnormal temporo-mandibular joint disc and posterior attachment as depicted by magnetic resonance imaging in symptomatic and asymptomat-ic subjects. J Oral Maxillofac Surg 2005;63:1155–1161.