A five-stage system for describing jaw joint disorders, combining what the patient experiences, what imaging shows, and what the surgeon sees inside the joint.
Peer-reviewed publication
ART-TMJ: Arthroscopic real-time classification system for temporomandibular joint disorders.
Zar K, Janmohamed T, Talisman S, Hanna S, Komath D. Journal of Cranio-Maxillo-Facial Surgery. 2026;54. Published 24 October 2026.
ART-TMJ stands for Arthroscopic Real-Time classification for Temporomandibular Joint disorders. It places a jaw joint problem into one of five stages, using three sources of information together:
The classification was developed by Mr Komath and colleagues from a prospective cohort of 160 patients (295 jaw joints), all operated on by Mr Komath.
The two best-known staging systems — Wilkes (1989) and the arthroscopic staging of Bronstein and Merrill (1992) — remain landmarks, but both centre mainly on the position of the disc. They do not capture in detail features that are now assessed routinely, such as inflammation of the joint lining (synovitis) and cartilage changes. MRI is the best non-invasive test for the jaw joint, but it does not always show everything happening inside it.
ART-TMJ brings the arthroscopic picture into the staging. The aim is that the stage reflects what is actually happening in the joint, which can help:
If you have arthroscopy with Mr Komath, your joint may be staged using ART-TMJ. Your stage is one part of the picture. It helps explain what was found and guides planning, but it does not on its own predict how you will respond. Treatment is always individual and discussed with you at consultation. Outcomes vary.
About TMJ arthroscopy → Symptoms of TMJ disorders →
A simplified, plain-English summary of the published classification. Each stage combines symptoms, imaging and what is seen at arthroscopy, and points to a matching treatment approach. The full criteria are in the paper.
SymptomsMild or occasional jaw pain, sometimes an occasional click; no locking.
Imaging & arthroscopyNormal joint, or only a slight forward position of the disc. Disc in a normal or near-normal position; healthy joint lining and cartilage.
Typical approachNon-surgical care: physiotherapy, soft diet, a splint, and treatment of overactive chewing muscles where needed.
SymptomsOn-and-off joint pain, clicking or popping, and brief episodes of locking.
Imaging & arthroscopyThe disc slips forward and returns to place as the mouth opens. Disc can be repositioned; early inflammation of the joint lining and early adhesions; cartilage intact.
Typical approachKeyhole joint wash-out and release, with disc repositioning and PRP where indicated, then a splint and physiotherapy.
SymptomsLonger-standing pain, often restricted opening (under 40 mm) and difficulty eating. In hypermobile patients opening may stay normal.
Imaging & arthroscopyThe disc stays in front of the joint and no longer returns to place; it may be folded or deformed. Disc can still be reduced at arthroscopy; more marked inflammation; early cartilage softening.
Typical approachAdvanced (Level II/III) arthroscopy to reduce and stabilise the disc, with PRP where indicated, then a splint and physiotherapy.
SymptomsContinuous joint pain, grating (crepitus) and restricted opening.
Imaging & arthroscopyChanges to the bone of the joint (flattening, spurs) as well as a deformed, displaced disc. Disc may have small perforations but can often still be reduced; adhesions and more advanced cartilage changes.
Typical approachAdvanced arthroscopy to repair and stabilise the disc where possible; open joint surgery in selected cases.
SymptomsChronic pain, constant crepitus; the bite and jaw movement may be affected.
Imaging & arthroscopySevere degeneration of the joint; the disc may be destroyed or hard to see. Disc cannot be repositioned; large perforations and severe cartilage and lining damage.
Typical approachArthroscopy may still give relief for some. Otherwise open surgery or total joint replacement, considered only after joint-preserving treatment.
Simplified from Table 1 of Zar et al., 2026. Treatment is always individual and agreed with you at consultation. Not every patient at a given stage needs surgery, and outcomes vary.
In this study, looking inside the joint often showed more advanced disease than clinical examination and MRI alone. Disease was upstaged in 32% of right-sided and 39% of left-sided joints. On average, patients had less pain, could open their mouths a little wider, and could eat a wider range of foods after arthroscopy. Earlier stages were associated with better outcomes than advanced stages. The patients were mostly women (85%), with an average age of 41.
These are group results from one study. They do not predict how any individual patient will respond.
Colleagues in OMFS, ENT, dentistry, physiotherapy and pain medicine who would like to discuss the classification or refer a patient are welcome to contact the practice.
Zar K, Janmohamed T, Talisman S, Hanna S, Komath D. ART-TMJ: Arthroscopic real-time classification system for temporomandibular joint disorders. J Craniomaxillofac Surg. 2026;54. doi:10.1016/j.jcms.2026.109928
Page by Mr Deepak Komath, Consultant Oral & Maxillofacial Surgeon. Last reviewed: October 2026.
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