Cone-beam computed tomography or computed tomography as an alternative diagnostic tool for temporomandibular joint disc displacement when magnetic resonance imaging is unavailable: a systematic review and meta-analysis.

While magnetic resonance imaging (MRI) is the reference standard for diagnosing temporomandibular joint disc displacement, limited accessibility necessitates alternative approaches. This systematic review and meta-analysis evaluated whether osseous markers on conventional or cone-beam computed tomography (CT/CBCT) accurately detect disc displacement compared to MRI. PubMed, Cochrane Library, and Google Scholar were searched through May 31, 2025. Study quality was assessed using QUADAS-2. Twenty studies were included, categorized into pathological changes, morphology, and joint space measurements. Bivariate random-effects meta-analyses showed the pathological changes group (seven studies) had a pooled sensitivity of 74%, specificity of 83%, and diagnostic odds ratio (DOR) of 7.77. The morphology subgroup (10 studies) demonstrated sensitivity of 73%, specificity of 79%, and DOR of 9.77. The joint space subgroup (eight studies) revealed sensitivity of 72%, specificity of 81%, and DOR of 11.41. Limitations include heterogeneity and varying imaging protocols. Findings support CBCT or CT as a valuable alternative diagnostic tool when MRI is unavailable. A clinical decision-making algorithm was developed to guide diagnostic confidence.