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J Manipulative Physiol Ther. 2019 May;42(4):267-275. doi: 10.1016/j.jmpt.2018.11.008. Epub 2019 Jun 29.

Reliability in Mandibular Movement Evaluation Using Photogrammetry in Patients With Temporomandibular Disorders.

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Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil; Department of Physical Therapy, Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil. Electronic address:
Rehabilitation and Functional Development Program, School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Department of Post-Graduation of Health Sciences, University of Santo Amaro, São Paulo, Brazil.
Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
School of Odontology, University of São Paulo, São Paulo, Brazil.



The purpose of this study was to propose a quantitative evaluation for mandibular opening-closing movement asymmetries and to verify the intraexaminer and interexaminer reliability using photogrammetry in individuals with and without myogenic temporomandibular disorders.


Forty-nine female participants between ages 18 and 40 were enrolled in this study. They were assigned to 2 different groups: a temporomandibular disorder group, (n = 25; 28.1 ± 3.6 years) and an asymptomatic group (n = 24; 25.6 ± 5.1 years). Data were collected through photogrammetry using Corel Draw X3 software (Corel Corp, Ottawa, Ontario, Canada) for angle measurements. Reliability analysis was done on the total sample, and the photographs were obtained by a singular examiner on 2 occasions (intraexaminer) 1 month apart and from measurement made by another examiner (interexaminer) on different days. The intraclass correlation coefficient (ICC) was applied with a significance level of 5%.


The photogrammetry had excellent intrarater and inter-rater reliability for the evaluation of opening and closing movements of the jaw (intrarater: opening ICC = 0.99; closing ICC = 0.98; inter-rater: opening ICC = 0.89 and closing ICC = 0.82). Photogrammetry also demonstrated excellent intra- and inter-rater reliability in the evaluation of head posture (intra-rater: head deviation ICC = 0.96; head position ICC = 0.75; inter-rater: head deviation ICC = 0.98; head position ICC = 0.98).


Under these experimental conditions, most angular values presented excellent intra- and interexaminer reliability.


Chronic Pain; Photogrammetry; Posture; Reproducibility of Results; Temporomandibular Joint Disorders


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