title: Diagnostic validity of clinical protocols to assess temporomandibular disk displacement disorders: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the diagnostic validity of clinical examination protocols compared with magnetic resonance imaging (MRI) in adults with temporomandibular joint disk displacement disorders.
  
  
  METHODS
  According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was undertaken using a selection process in 2 phases; 283 different references were identified, and 10 articles were included for qualitative analysis and 7 for meta-analysis. Temporomandibular joint disorders were assessed through clinical diagnosis protocols with the aid of Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or Clinical Diagnostic Criteria for Temporomandibular Disorders. The authors searched the following electronic databases: Cochrane, LILACS, PubMed, Science Direct, SCOPUS, and Web of Science. Additional search of gray literature was performed. Selected studies were evaluated by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Two subgroups were analyzed: Disk displacement with reduction (DDwR) and disk displacement without reduction (DDwoR).
  
  
  RESULTS
  The validity of clinical protocols compared with MRI performed in studies evaluating only DDwR presented sensitivity of 44% (39%-49%) and specificity 51% (46%-57%). In studies evaluating only DDwoR, sensitivity was 22% (16%-30%) and specificity 93% (85%-98%). The area under the curve value for validity of clinical protocols in all studies was 0.63, 0.56 for studies evaluating DDwR and 0.64 for studies evaluating DDwoR. Area under the curve values were considered poor.
  
  
  CONCLUSIONS
  Clinical examination protocols have poor validity to diagnose DDwR and DDwoR compared with MRI. MRI should be used to increase the diagnostic accuracy when the information provided can influence clinical decisions.
authors.affiliation: Department of Restorative Dentistry, Federal University of Parana, Curitiba, Paraná, Brazil.
authors.forename: Yasmine Mendes
authors.initials: YM
authors.lastname: Pupo
authors.affiliation: Brazilian Centre for Evidence Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
authors.forename: Leticia Lopes Quirino
authors.initials: LL
authors.lastname: Pantoja
authors.affiliation: Brazilian Centre for Evidence Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
authors.forename: Flavia Fusco
authors.initials: FF
authors.lastname: Veiga
authors.affiliation: Department of Dentistry and Post Graduate Program Communication Disorders - Tuiuti University of Parana, Curitiba, Paraná, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Stechman-Neto
authors.affiliation: Department of Pediatrics, Federal University of Sao Paulo, São Paulo, Brazil.
authors.forename: Liete Figueiredo
authors.initials: LF
authors.lastname: Zwir
authors.affiliation: Department of Pharmaceutical Sciences, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.
authors.forename: Paulo Vitor
authors.initials: PV
authors.lastname: Farago
authors.affiliation: School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Graziela
authors.initials: G
authors.lastname: De Luca Canto
authors.affiliation: Brazilian Centre for Evidence Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil. Electronic address: andreporporatti@yahoo.com.br.
authors.forename: André Luís
authors.initials: AL
authors.lastname: Porporatti
mesh_terms: D002985:Clinical Protocols; D006801:Humans; D008279:Magnetic Resonance Imaging; D012680:Sensitivity and Specificity; D000078202:Systematic Reviews as Topic; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis*