Coronal joint spaces of the Temporomandibular joint: Systematic review and meta-analysis

E Martins,Jd Lopes,Jc Silva,Mjf Ponces-Ramalhao,Ca Pires

doi:10.4317/jced.52439

Abstract

Introduction The joint space measurements of the temporomandibular joint have been used to determine the condyle position variation. Therefore, the aim of this study is to perform a systematic review and meta-analysis on the coronal joint spaces measurements of the temporomandibular joint. Material and Methods An electronic database search was performed with the terms “condylar position”; “joint space”AND”TMJ”. Inclusionary criteria included: tomographic 3D imaging of the TMJ, presentation of at least two joint space measurements on the coronal plane. Exclusionary criteria were: mandibular fractures, animal studies, surgery, presence of genetic or chronic diseases, case reports, opinion or debate articles or unpublished material. The risk of bias of each study was judged as high, moderate or low according to the “Cochrane risk of bias tool”. The values used in the meta-analysis were the medial, superior and lateral joint space measurements and their differences between the right and left joint. Results From the initial search 2706 articles were retrieved. After excluding the duplicates and all the studies that did not match the eligibility criteria 4 articles classified for final review. All the retrieved articles were judged as low level of evidence. All of the reviewed studies were included in the meta-analysis concluding that the mean coronal joint space values were: medial joint space 2.94 mm, superior 2.55 mm and lateral 2.16 mm. Conclusions the analysis also showed high levels of heterogeneity. Right and left comparison did not show statistically significant differences. Key words:Temporomandibular joint, systematic review, meta-analysis.

Highlights

IntroductionOne of the main components of the TMJ is the mandibular condyle as it connects the mandible, the only bone of the craniomandibular complex that moves, to the temporal bone by the TMJ
The joint space measurements of the temporomandibular joint have been used to determine the condyle position variation
Many studies have been performed to determine condyle position, both on the sagittal and coronal plane, using mainly computed tomography (CT) and cone-beam computed tomography (CBCT) as these exams are more common in dental practice

Summary

Introduction

One of the main components of the TMJ is the mandibular condyle as it connects the mandible, the only bone of the craniomandibular complex that moves, to the temporal bone by the TMJ. Eligibility of the retrieved articles was determined by applying the following inclusion criteria: [1] tomographic examination of the TMJ [2] determination of coronal joint space measurements at least on two different points. The main reasons for exclusion were: mandible fractures, studies not performed in living humans, surgical interventions, studies with patients with syndromes or chronic diseases (including degenerative pathology of the TMJ), examination of the condylar position only with clinical methods, 2D radiographs or magnetic resonance imaging, orthodontic or splint therapy, samples containing only patients in the primary or mixed/ early permanent dentition, case reports, discussion or debate articles. As not all the included articles presented the values for all the spaces from the right and left joints, the analysis were performed including all the data presented in each selected study. The mean medial, lateral and superior joint space values assessed with this meta-analysis were 2.94 mm, 2.16 mm and 2.55 mm respectively The heterogeneity analysis shows that the difference values are homogeneous both to the medial and lateral joint space

Discussion

Findings

Conclusions