Clinical and MRI markers for acute vs chronic temporomandibular disorders using a machine learning and deep neural networks

Abstract

Background Exploring the transition from acute to chronic temporomandibular disorders (TMD) remains challenging due to the multifactorial nature of the disease. This study aims to identify clinical, behavioral, and imaging-based predictors that contribute to symptom chronicity in patients with TMD. Methods We enrolled 239 patients with TMD (161 women, 78 men; mean age 35.60 +/- 17.93 years), classified as acute ( < 6 months) or chronic ( >= 6 months) based on symptom duration. TMD was diagnosed according to the Diagnostic Criteria for TMD (DC/TMD Axis I). Clinical data, sleep-related variables, and temporomandibular joint magnetic resonance imaging (MRI) were collected. MRI assessments included anterior disc displacement (ADD), joint space narrowing, osteoarthritis, and effusion using 3 T T2-weighted and proton density scans. Predictors were evaluated using logistic regression and deep neural networks (DNN), and performance was compared. Results Chronic TMD is observed in 51.05% of patients. Compared to acute cases, chronic TMD is more frequently associated with TMJ noise (70.5%), bruxism (31.1%), and higher pain intensity (VAS: 4.82 +/- 2.47). They also have shorter sleep and higher STOP-Bang scores, indicating greater risk of obstructive sleep apnea. MRI findings reveal increased prevalence of ADD (86.9%), TMJ-OA (82.0%), and joint space narrowing (88.5%) in chronic TMD. Logistic regression achieves an AUROC of 0.7550 (95% CI: 0.6550-0.8550), identifying TMJ noise, bruxism, VAS, sleep disturbance, STOP-Bang >= 5, ADD, and joint space narrowing as significant predictors. The DNN model improves accuracy to 79.49% compared to 75.50%, though the difference is not statistically significant (p = 0.3067). Conclusions Behavioral and TMJ-related structural factors are key predictors of chronic TMD and may aid early identification. Timely recognition may support personalized strategies and improve outcomes.