Bias, Study Quality, and Confounding in Temporomandibular Disorder Research Compared to General Orthodontic Studies: A Systematic Review and Meta-Analysis.

Abstract

<b>Background/Objectives</b>: Temporomandibular disorders (TMDs) are a heterogeneous subset of orthodontic conditions with persistent diagnostic and reporting variability. This review compared transparency, reporting quality, and spin prevalence in TMD/TMJ (temporomandibular joint)-focused orthodontic randomized controlled trials (RCTs) versus general orthodontic RCTs. <b>Methods</b>: The review followed PRISMA 2020 and was registered in PROSPERO (4201024184). Searches were performed in PubMed/MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest available records in each database up to 15 October 2025. Eligible studies were peer-reviewed human orthodontic RCTs. Five transparency indicators (funding disclosure, bias discussion, confounder consideration, protocol registration, reporting-guideline adherence) and five spin indicators (selective focus, unsupported efficacy claims, emphasis on benefits, recommendations despite nonsignificance, "trend toward significance" language) were coded dichotomously. Beta-binomial mixed-effects models compared composite scores between groups, adjusting for publication era, impact factor, and journal clustering. <b>Results</b>: Among 874 included trials (840 general, 34 TMD/TMJ-focused), TMD/TMJ-focused studies showed lower adjusted transparency (odds ratio (OR) = 0.58; 95% confidence interval (CI) 0.34-0.99; <i>p</i> = 0.047), mainly due to limited registration and incomplete guideline adherence. Predicted transparency proportions were 0.82 for general and 0.73 for TMD/TMJ-focused studies. Composite spin did not differ (OR = 1.05; 95% CI 0.68-1.62; <i>p</i> = 0.821), though TMD/TMJ-focused abstracts more often emphasized benefits (OR = 4.62) and recommended interventions despite nonsignificant primary outcomes (OR = 2.83). <b>Conclusions</b>: TMD-focused orthodontic trials exhibited lower transparency and a distinct pattern of interpretive spin, particularly a greater tendency to emphasize benefits or recommend interventions despite non-significant results, compared with general orthodontic research.