Evolution of Diagnostic Strategies for Temporomandibular Joint Disorders: A Scoping Review (2009-2025).

Abstract

Background: Diagnostic approaches to temporomandibular joint (TMJ) disorders have evolved substantially in recent years with the development of advanced imaging technologies, functional diagnostic tools, and emerging biomarker-based research.

Objective: To evaluate temporal trends in diagnostic methods used for TMJ disorders and to examine how major diagnostic modalities have evolved between 2009 and 2025.

Methods: A scoping review was conducted using the Arksey and O'Malley methodological framework and reported according to PRISMA-ScR guidelines. A structured literature search was performed in MEDLINE/PubMed, Scopus, and Web of Science, with Google Scholar used as a supplementary source. Publications from January 2009 to December 2025 were screened. A total of 9,024 records were identified; after duplicate removal, screening, and methodological appraisal using Joanna Briggs Institute tools, 187 studies were included in the final synthesis. Studies were categorized into three time intervals (2009-2014, 2015-2019, and 2020-2025) and grouped according to four diagnostic domains: radiologic imaging, functional diagnostics, psychometric and clinical assessment, and biomarker-based approaches.

Results: Psychometric instruments, particularly RDC/DC-TMD criteria and the Visual Analog Scale, were reported in approximately 50-60% of clinical studies. Imaging trends demonstrated a clear shift from planar radiography toward three-dimensional modalities. Reports involving CT increased from 246 to 751, and CBCT from 108 to 329, while the use of orthopantomography and cephalography declined to less than 10% in the most recent period. MRI usage nearly doubled (434-789 reports), maintaining its role as the reference standard for soft-tissue evaluation. Ultrasonography showed growing adoption as a radiation-free adjunct diagnostic method.

Conclusion: TMJ diagnostics have undergone a substantial evidence-driven transition over the past sixteen years. The shift from planar radiography to three-dimensional modalities-primarily CBCT for osseous pathology and MRI for soft-tissue assessment-enables earlier detection of structural changes that directly influence treatment selection and outcomes. Progressive adoption of the DC/TMD framework has improved diagnostic consistency and supports more targeted clinical decision-making. Functional diagnostics and emerging biomarker research are expanding individualized assessment, although further standardization is required before routine implementation. Taken together, these transitions support a phenotype-oriented multimodal diagnostic strategy: CBCT for suspected osseous involvement, MRI for internal derangement or inflammatory pathology, functional tools for myofunctional presentations, and biomarker or contrast-enhanced imaging in patients with suspected systemic inflammatory disease. Integrating these modalities according to the dominant clinical presentation may optimize diagnostic yield, reduce unnecessary radiation exposure, and improve outcomes in patients with temporomandibular joint disorders.