Silent Disc Displacements vs. Noisy Normal Joints: Reassessing Clicking as a Marker of ADDwR

Year 2025, Volume: 3 Issue: 3, 49 - 52, 31.12.2025

İsmet Ersalıcı , Elif Meltem Aslan , Gürkan Ünsal

https://doi.org/10.62243/edr.1831766

Abstract

Aim To evaluate the diagnostic value of temporomandibular joint (TMJ) clicking as a clinical marker of anterior disc displacement with reduction (ADDwR) by comparing clinical findings with magnetic resonance imaging (MRI).
Material and method This retrospective study included 128 TMJ sides from adult patients referred for TMJ symptoms between January 2021 and December 2024. All patients underwent standardized clinical TMJ examination documenting the presence or absence of clicking, and bilateral 1.5T MRI with closed- and open-mouth sequences.
Results Clinical examinations identified clicking in 114 of 128 joints (89.1%), while 14 joints (10.9%) were clinically silent. MRI demonstrated ADDwR in 112 joints (87.5%) and normal disc position in 16 joints (12.5%). Among ADDwR joints, 98 (87.5%) presented with clicking and 14 (12.5%) represented silent ADDwR. Of the 114 clicking joints, 98 (86.0%) had ADDwR and 16 (14.0%) had normal disc position, constituting clicking without displacement. Clicking showed high sensitivity for ADDwR (87.5%) but occurred in joints with normal disc position as well.
Conclusion TMJ clicking is strongly associated with ADDwR but is neither exclusive to displaced discs nor universally present in reducible disc displacements. The coexistence of silent ADDwR and clicking in nondisplaced joints underscores the limitations of relying solely on auscultation or palpation and supports MRI as an important adjunct in diagnostically ambiguous cases.

Keywords

ADDwR , Joint sounds , Magnetic resonance imaging , Temporomandibular Joint , Temporomandibular Joint Disorders

Ethical Statement

The study protocol was approved by the Lokman Hekim University Scientific Research Ethics Committee (No: 2024160)

References

• Rozylo-Kalinowska, I., & Orhan, K. (Eds.). (2019). Imaging of the temporomandibular joint (1st ed.). Springer.
• Tamimi, D. (2025). Understanding the internal derangement and degenerative joint disease process through radiographic imaging. Neuroimaging Clinics of North America, 35(4), 449–465.
• Sang, S., Ameli, N., Almeida, F. T., & Friesen, R. (2024). Association between clinical symptoms and MRI image findings in symptomatic temporomandibular joint (TMJ) disease: A systematic review. Journal of Cranio-Maxillofacial Surgery, 52(7), 835–842.
• Özel, Ş., Tunç, S., & Şenol, A. U. (2025). Association between clinical findings and 3T MRI features in temporomandibular joint disorders. BMC Oral Health, 25(1), 921.
• Mehndiratta, A., Kumar, J., Manchanda, A., Singh, I., Mohanty, S., Seth, N., & Gautam, R. (2019). Painful clicking jaw: A pictorial review of internal derangement of the temporomandibular joint. Polish Journal of Radiology, 84, e598–e615.
• Vogl, T. J., Lauer, H. C., Lehnert, T., Naguib, N. N., Ottl, P., Filmann, N., Soekamto, H., & Nour-Eldin, N. E. (2016). The value of MRI in patients with temporomandibular joint dysfunction: Correlation of MRI and clinical findings. European Journal of Radiology, 85(4), 714–719.
• Loan, H. K., Anh, N. T. V., Duy, T. V., Hoa, N. T., Chien, D. Q., & Au, H. D. (2025). Correlation between clicking sound symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement. Medical Archives, 79(2), 155–158.
• Sancar, E., Yılmaz, D., Parlak, S., Bulut, E. G., Ozer, G., & Hersek, N. E. (2025). Exploring the relationship between clinical symptoms and MRI findings in temporomandibular joint disorders: A preliminary study. Journal of Oral & Facial Pain and Headache, 39(3), 172–182.
• Schiffman, E., Ohrbach, R., Truelove, E., et al. (2014). Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal of Oral & Facial Pain and Headache, 28(1), 6–27.
• Topaloglu Yasan, G., Adiloglu, S., Tuz, H. H., & Sahar, D. (2023). Evaluation of clinical signs and magnetic resonance imaging findings in patients with temporomandibular disorders. Journal of Cranio-Maxillofacial Surgery, 51(7–8), 441–447.
• Luo, D., Yang, H., Yuan, M., Wang, D., Qiu, C., Zhou, R., et al. (2024). Anatomical factors influencing temporomandibular joint clicking in young adults: Temporomandibular joint structure disorder or lateral pterygoid muscle dysfunction? Frontiers in Bioengineering and Biotechnology, 12, 1337267.
• Balel, Y., Yildiz, S., Gokce, E., Tumer, M. K., & Ege, B. (2023). Does temporomandibular joint magnetic resonance imaging diagnosis support clinical examination diagnosis following diagnostic criteria for temporomandibular disorders? Journal of Oral and Maxillofacial Surgery, 81(7), 813–819.
• Tegnander, T., Chladek, G., Hovland, A., Żmudzki, J., & Wojtek, P. (2021). Relationship between clinical symptoms and magnetic resonance imaging in temporomandibular disorder (TMD) patients utilizing the Piper MRI diagnostic system. Journal of Clinical Medicine, 10(20), 4698.