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 movement recording) and 1 anatomy-based method (magnetic resonance imaging [MRI]).

METHODS

For the recognition of an anterior or posterior disc displacement with reduction and of hypermobility within the temporomandibular joint (TMJ), 42 participants 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 examiners for each technique. In addition, for 10 randomly chosen participants, 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 derangements was excellent for condylar movement recording (kappa = 0.86) and fair to good for MRI (kappa = 0.73). Intermethod agreement was fair to good (kappa = 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, kappa = 0.15; and for clinical examination, kappa = 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 probably no need for the sophisticated technique of condylar movement recording, since that method shows fair to good agreement with a carefully performed clinical examination.