Title	CBCT Provides Accurate Diagnostic Images for the Detection of Osseous Defects in the TMJ
Clinical Question	In patients with symptoms of temporomandibular disorder, does cone beam computed tomography (CBCT) provide accurate diagnostic images for the detection of osseous defects in the temporomandibular joint (TMJ)?
Clinical Bottom Line	CBCT can be utilized in dental practice to accurately detect bony changes in the temporomandibular joint. Evidence for this conclusion is provided by a systematic review of of the literature, including meta-analysis. CBCT images aid practitioners in the prediction of temporomandibular joint disorders and facilitate proactive treatment planning.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 27708375 Ma/2016 8 studies, 976 temporomandibular joint sites Systematic review and meta-analysis of non-randomized trials Key results A literature search covering January 1990 to December 2015 was conducted, and full text review narrowed the included studies to eight (8) for this systematic review and meta-analysis. The pooled sensitivity was 0.67 (95% CI, 0.56 to 0.76) and the pooled specificity was 0.87 (95% CI, 0.78 to 0.93) with large area (0.84) under the ROC curve. Overall, evidence indicates that CBCT is an accurate modality for the detection of osseous changes in the TMJ. The meta-analysis, based on the pooled data, demonstrates that CBCT offers high image resolution and therefore high diagnostic accuracy for the TMJ.
Evidence Search	cbct [All Fields] AND ("temporomandibular joint"[MeSH Terms] OR ("temporomandibular joint "[All Fields] AND "cbct"[All Fields]) OR “temporomandibular joint osseous defects “[All Fields] [MeSH Terms])
Comments on The Evidence	Validity: In order to determine the existence and/or degree of publication bias for included studies, the researchers performed a linear regression analysis, which yielded a P-value of 0.861. The authors also assessed each study for methodological quality, revealing that studies included in this systematic review and meta-analysis did not consistently use a blinding technique. This inconsistency may indicate the possibility of confirmation bias. Moreover, some variables (size of bone defect present; scan field of view and CBCT unit) were not included in all protocols. Additionally, three of the included studies did not provide a clear description of the gold standard; this has the potential to affect the recording of true positives and true negatives (and therefore the sensitivity and specificity). Perspective: In dental practice, CBCT scans are frequently used for implant planning, endodontic and orthodontic evaluation.
Applicability	CBCT provides accurate and useful imagery for early detection of bony changes in the temporomandibular joint. These images aide practitioners in the prediction of temporomandibular joint disorders. Use of CBCT may allow dentists to proactively manage such cases before they result in severe bony deterioration.
Specialty	(Public Health) (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Prosthodontics) (Restorative Dentistry)
Keywords	CBCT, Temporomandibular joint, osseous defects, bony changes
ID#	3318
Date of submission	06/04/2018
E-mail	m.poorsattar@gmail.com
Author	Poorsattar Bejemir
Co-author(s)
Co-author(s) e-mail
Faculty mentor
Faculty mentor e-mail
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Laura Tsu (San Antonio, TX) on 10/06/2021 A recent publication by Tsai & etal. (PMID 32595895) in 2020 supports these findings. There is greater reliability, sensitivity, and specificity in detection of osseous defects with CBCT versus panoramics.