Diagnosis of TMJ degenerative diseases by panoramic radiography: is it possible? A systematic review and meta-analysis.

ABSTRACT

OBJECTIVE: The objective of this work was to determine the diagnostic accuracy of panoramic radiography in detecting degenerative diseases of the temporomandibular joint. METHOD: The protocol was registered at the PROSPERO website. To consider the eligibility of studies to be included/excluded from this review, the acronym "PIRDS" was used and appropriate word combinations and truncations were adapted in the following electronic databases PubMed/Medline, EMBASE, Latin American and Caribbean Literature on Health Sciences, Web of Science, Scopus, and Cochrane Library. RESULTS: A total of 2572 references, after the removal of duplicates, were retrieved from the eight electronic databases. After reading the titles and abstracts, a total of 26 articles were selected for full reading, of which ten were excluded, resulting in 16 articles included for qualitative synthesis. All in vivo studies were classified as having a low risk of bias. Regarding in vitro studies none of the included studies scored below 80% in the overall evaluation. CONCLUSIONS: Both in vitro and in vivo studies consistently report a low accuracy in detecting degenerative diseases of the temporomandibular joint using panoramic radiography. CLINICAL RELEVANCE Cone-beam computed tomography offers a superior image quality without overlapping structures and a higher accuracy compared to panoramic radiography. However, panoramic radiography can still serve as an initial examination when combined with a clinical assessment. CBCT should be reserved for cases where there are evident clinical and/or radiographic alterations that recommend its use. This approach ensures a judicious and cost-effective use of CBCT resources.