Desordens degenerativas da articulação temporomandibular: impacto do exame por imagem e parâmetros técnicos no diagnóstico

• Ano de defesa: 2025
• Autor(a) principal: Maracci, Lucas Machado
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Santa Maria; Brasil; UFSM; Programa de Pós-Graduação em Ciências Odontológicas; Centro de Ciências da Saúde
• Palavras-chave em Português: Transtornos da articulação temporomandibular; Doença articular degenerativa; Tomografia computadorizada de feixe cônico; Exames bidimensionais; Temporomandibular joint disorders; Degenerative joint disease; Cone beam computed tomography; Two-dimensional exams; CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA
• Link de acesso: http://repositorio.ufsm.br/handle/1/36787

Cone beam computed tomography (CBCT) is considered the reference examination for the evaluation of hard tissues of the temporomandibular joint (TMJ), especially in cases of suspected degenerative joint disease (DJD). However, acquisition and assessment parameters may influence TMJ evaluation. Furthermore, CBCT has limitations related to cost, availability, and, mainly, to higher radiation dose compared with radiographic exams such as panoramic radiography (PR) and planigraphy (PL). The present thesis aimed to map the parameters related to CBCT acquisition, examiner calibration, and assessment criteria and their impact on DJD detection (Article 1), and to evaluate the diagnostic performance of PR and PL for DJD detection, compared with CBCT, as well as the impact of the examination on disease classification (Article 2). Article 1 consisted of a scoping review including 24 in vivo studies with adult individuals that used CBCT to evaluate degenerative changes and discriminated technical acquisition parameters and assessment criteria. Wide variation in CBCT acquisition parameters was verified (voxel: 0.076 mm to 0.3 mm; kV: 70 to 120; mA: 3 to 38), with voxel size apparently not influencing DJD detection. Ahmad et al.’s criteria (2009) were the most frequently used for TMJ assessment (n=10). The most frequently assessed condylar changes were erosion, flattening, sclerosis, osteophyte, and subcortical cyst. Only five studies provided calibration data (kappa), with values ranging from 0.30 to 0.79 (interexaminer) and 0.69 to 0.88 (intraexaminer). Article 2 was a diagnostic efficacy study with imaging examinations (CBCT and PR and/or PL) of 83 symptomatic adult patients. Three calibrated examiners evaluated the exams, using the criteria of Ahmad et al. (2009). Specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC) were calculated for each exam; Friedman and Wilcoxon tests were used to compare the exams regarding DJD classification. Interexaminer reproducibility ranged from low to substantial across all exams. Radiographic examinations showed high sensitivity (68%–98%) and low specificity (2%–32%) for condylar flattening and erosion and temporal sclerosis, while other changes presented intermediate and similar values among the exams. PPV (77%), NPV (91%), and AUC (0.75) were adequate only for osteophyte in PL. PR and PL confirmed approximately 73% of the classification results obtained with CBCT, with no significant difference (p>0.05). The results of this thesis indicate a lack of calibration and inconsistencies in the standardization of TMJ assessment criteria. Regarding the diagnostic performance of imaging exams, PR and PL show low diagnostic accuracy in identifying alterations individually, although a diagnostic thinking process similar to CBCT in DJD classification.