Analysis of factors influencing the development of temporomandibular joint disorder in patients with bimaxillary protrusion after treatment and the construction of Nomogram prediction model

LIN Shao-ping; SONG Yan-feng; PAN Hui-ling; HUANG Zhi-ting

doi:10.13820/j.cnki.gdyx.20224795

Abstract：Objective To analyze the factors influencing the development of temporomandibular joint disorder in patients with bimaxillary protrusion after treatment and to construct a Nomogram prediction model.Methods Clinical da-ta were collected from 210 patients with bimaxillary protrusion who underwent treatment from March 2020 to July 2022.They were divided into disorder group(n=39)and non-disorder group(n=171)according to whether they developed temporomandibular joint disorder after treatment.The optimal cutoff values for each factor were determined using receiver operating characteristic(ROC)curve analysis.A logistic multivariate regression model was used to analyze the independ-ent risk factors for the occurrence of temporomandibular joint disorders in patients with bimaxillary protrusion after treat-ment.A predictive Nomogram model was constructed,and internal validation of the Nomogram model was performed using calibration curves.The predictive performance of the Nomogram model was assessed using decision curves.Results Pa-tients in the disorder group were younger than those in the non-disorder group(P＜0.05).The disorder group had high-er proportions of female patients,higher scores in the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),higher proportions of bruxism or clenching,root canal treatment history,lateral chewing,and occlusal ab-normalities,compared to the non-disorder group(P＜0.05).ROC curve analysis showed that the AUC values for age,SAS and SDS were 0.908,0.877,and 0.871,respectively,with optimal cutoff values of 26 years,50 points,and 55 points,respectively.Age(≤26 years),gender(female),SAS(＞50 points),SDS(＞55 points),bruxism/clenching(present),lateral chewing(yes),and occlusal abnormalities(present)were identified as independent risk factors for temporomandibular joint disorders in patients with bimaxillary protrusion after treatment.Internal validation showed that the C-index of the Nomogram model for predicting temporomandibular joint disorders was 0.718(95％CI:0.523-0.911),indicating good consistency between observed and predicted values.The Nomogram model provided higher clini-cal net benefits than SAS,SDS,bruxism/clenching,gender,lateral chewing,age,and occlusal abnormalities,with a threshold＞0.21.Conclusion Based on age,gender,SAS,SDS,bruxism/clenching,lateral chewing,and occlusal abnormalities,a Nomogram predictive model was constructed to predict the occurrence of temporomandibular joint disor-ders in patients with bimaxillary protrusion after treatment.The model demonstrated good predictive value for temporoman-dibular joint disorders in this patient population and can be used to identify high-risk patients after treatment.