Short communicationInter- and intra-rater reliability of 3D kinematics during maximum mouth opening of asymptomatic subjects
Introduction
Mouth opening requires a complex combination of rotation and translation in the temporomandibular joint (TMJ) (Ferrario et al., 2005). Subjects with temporomandibular dysfunctions (TMD) often present clicking noises, deviation and altered muscle activation during mouth opening (Dworkin et al., 1990). Patients with TMD showed lower relative rotation of the TMJ at the end of mouth opening and biomechanical alterations during chewing when compared to healthy subjects (De Felício et al., 2013). Despite the high prevalence of TMD in adults (Gonçalves et al., 2010), the complexity of human jaw movements, and the mechanical problems associated with TMD, there is a lack of information about how jaw movement occurs in people with and without TMD.
In order to evaluate tridimensional human jaw movements, several studies using different kinematic analysis systems evaluated head, trunk and jaw movement during mouth opening and chewing (Eriksson et al., 2000, Hansdottir and Bakke, 2004, Kalaykova et al., 2011, Mapelli et al., 2009, Tanaka et al., 2016, Visscher et al., 2000, Zafar et al., 2000). Nevertheless, since Ferrario et al. (2005), that reported between-session reliability for kinematic measurements in five subjects, no other study has proven the reliability of TMJ movements using different systems and more complex kinematic analysis. Also, there is a lack of information about standard error of measurement (SEM) and minimum detectable change (MDC).
The reproducibility of kinematic measurements during maximum mouth opening (MMO) can be influenced by the discrepancy on palpation of anatomic spots, the experience of raters and the clinical, anatomical and anthropometrical variations across subjects (Hopkins, 2000). This type of analysis provides information about the consistency and cause of normal and changed motor patterns. Furthermore, the MDC can help to interpret the results of future biomechanical studies or clinical trials in people with and without TMD and consequently, to improve the quality of the evidence for primary studies on the treatment of patients with TMD.
Thus, considering the need of a reliable method to further investigate the jaw movements in clinical studies, the purpose of this study was to analyze within- and between-session reliabilities, inter-rater reliability, SEM, MDC and consistency of agreement across raters and sessions of 3D kinematic variables during MMO.
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Subjects
Data were collected from 19 males and 17 females (23.92 ± 2.8 years old, BMI of 24.3 ± 2.9 kg/m2). Inclusion criteria were no history of TMJ trauma or pain and absence of TMD signs and symptoms and MMO of at least 35 mm. Exclusion criteria were history of jaw fracture, TMJ luxation, systemic ligament laxity, rheumatic or neurologic systemic diseases, orthodontic treatment in the last six months and previous cervical or oral surgery.
The study was approved by Ethics Committee for Human Investigations
Intra-rater reliability
Tables demonstrating ICC, SEM, and MDC90 values for all comparisons are in supplementary online material. Within-day ICCs (Table 1) ranged from 0.57 to 0.88, while tridimensional mandibular motion during MMO presented larger 95% confidence interval (95%CI). Jaw radius and width, as well as incisor displacement, presented smaller ICC values. SEM values ranged from 2.26 mm to 3.48 mm, or 0.66° to 2.48°. MDC90 values ranged from 5.24 mm to 8.08 mm, or from 1.53° to 5.76°, depending on the variable.
Discussion
This is the first methodological study to provide evidence of the reproducibility of kinematic variables during MMO as well as SEM, MDC calculations and limit of agreement. According to our results, the reliability of TMJ kinematic evaluation in asymptomatic subjects depends on the data analysis and outcomes. Jaw radius and width, as static measures, were the most reproducible variables. Furthermore, the incisor displacement during MMO and the angular movements in the sagittal plane presented
Acknowledgments
Authors are grateful to Cláudia Maria de Felício for supporting the kinematic analysis and to Fundação de Amparo à Pesquisa do Estado de São Paulo for financial support (grant #2014/05276-7). All authors disclose any financial and personal relationships with other people or organizations that could inappropriately bias our work.
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