Artificial Intelligence for Diagnosis of Temporomandibular and Cranio-Cervico-Mandibular Musculoskeletal Disorders: A Systematic Review and Exploratory Diagnostic Test Accuracy Meta-Analysis

Abstract

Objectives: To systematically evaluate the diagnostic accuracy, clinical applicability, and methodological maturity of artificial intelligence (AI)-based methods for temporomandibular disorders (TMD), temporomandibular joint (TMJ) abnormalities, and related cranio-cervico-mandibular (CCM) musculoskeletal conditions compared with conventional diagnostic methods and accepted reference standards. Materials and Methods: This systematic review and exploratory diagnostic test accuracy meta-analysis was conducted in accordance with PRISMA 2020 and PRISMA-DTA. The protocol was retrospectively registered in PROSPERO (CRD420261428138). PubMed/MEDLINE, Embase, and Scopus were searched from database inception through February 2026. Eligibility for the primary synthesis was restricted to published studies in English or Spanish involving adults aged 18 years or older. All extracted records were re-audited article by article to align the evidence with the diagnostic question. The domain-specific quantitative synthesis was restricted to TMJ osteoarthritis studies with explicit 2 × 2 diagnostic data or a unique, verifiable reconstruction from reported class totals and sensitivity/specificity. Risk of bias was assessed with QUADAS-2. Results: From 1471 records identified, 174 entered the master extraction dataset. After reclassification, 84 records were retained for primary TMD/TMJ qualitative synthesis, 8 as secondary CCM musculoskeletal evidence, 31 as conventional or reference standard supporting evidence, 33 as methodological or contextual evidence, 4 as differential orofacial pain evidence, and 14 as excluded or minimal-background records. Twenty-one studies were assessed as potential diagnostic accuracy candidates. Three TMJ osteoarthritis studies contributed to the domain-specific exploratory meta-analysis: two with explicit 2 × 2 data and one with a reproducible reconstruction. Pooled sensitivity was 0.791 (95% CI: 0.700–0.861) and pooled specificity was 0.869 (95% CI: 0.811–0.911). Heterogeneity was substantial for sensitivity (I2 = 68.2%) and moderate for specificity (I2 = 57.3%). Conclusions: AI demonstrates promising performance in selected image-based TMJ osteoarthritis tasks. Nevertheless, the evidence remains exploratory because only three studies were quantitatively comparable, one table was reconstructed, and modalities and validation designs differed. AI should be interpreted as an augmentative decision support tool rather than a replacement for MRI, CBCT, or validated clinical frameworks such as DC/TMD. Clinical Relevance: AI may support image-based TMD/TMJ workflows, but present evidence does not justify autonomous diagnosis or replacement of established clinical and imaging reference standards.