Bony Changes of the Temporomandibular Joint in Symptomatic Versus Asymptomatic Individuals: Insights from CBCT Imaging

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Structural osseous changes of the temporomandibular joint (TMJ) can be observed in both symptomatic and asymptomatic individuals. This study compared bony changes in TMJs of patients with and without TMD symptoms using cone-beam computed tomography (CBCT). Materials and Methods : In this historical cohort, 138 patients with clinically diagnosed TMD (RDC/TMD) and 132 asymptomatic controls who underwent CBCT for dental or maxillofacial purposes were evaluated. Standardized criteria were used to assess erosion, osteophytes, flattening, Ely cysts, sclerosis (condylar head and temporal), ankylosis, condylar size alterations, and joint space changes. Data were analyzed with Chi-square and t-tests (p < 0.05). Results : Degenerative changes were more frequent in the TMD group. Erosion was the most common finding (52.2% vs. 13.6%, p < 0.001) and occurred across all age groups. Osteophytes (29.7% vs. 15.2%, p = 0.003) and flattening (27.5% vs. 7.6%, p < 0.001) were significantly higher, with age-related patterns. Temporal lobe sclerosis (12.3% vs. 0.8%, p < 0.001), condylar head sclerosis (10.9% vs. 3.8%, p = 0.022), and joint space changes (18.8% vs. 2.3%, p 41-year group. Rare findings showed no significant differences. Conclusion : CBCT revealed significantly more erosions, osteophytes, flattening, sclerosis, and joint space alterations in TMD patients compared to controls. Erosion may serve as an early diagnostic marker, while other features suggest chronic progression. CBCT is recommended in symptomatic TMD cases to facilitate early detection and guide management decisions. Temporomandibular Joint Disorders Cone-Beam Computed Tomography Osteoarthritis Mandibular Condyle Diagnostic Imaging Figures Figure 1 Introduction Temporomandibular disorders (TMDs) encompass a diverse range of musculoskeletal conditions and represent the most prevalent source of non-dental orofacial pain, ranking second only to low back pain among musculoskeletal complaints ( 1 ). Reported prevalence rates vary significantly—from 16.3% to 68% in adolescents and up to 43% in adults a disparity attributed to differences in diagnostic criteria, study populations, and methodological approaches ( 2 ). The etiology of TMD is multifactorial, involving psychological contributors (e.g., anxiety, depression), parafunctional habits, socioeconomic factors, and genetic predisposition ( 3 , 4 ). Notably, women are disproportionately affected, likely due to a combination of hormonal, anatomical, behavioral, and psychosocial influences ( 5 , 6 ).Clinically, TMD manifests as temporomandibular joint (TMJ) pain or tenderness, restricted jaw mobility, and joint sounds, though patients may also report tinnitus, hearing alterations, otalgia, aural fullness, dysphagia, or dizziness ( 7 , 8 ). While imaging is not always necessary, it plays a critical role when findings could inform diagnosis or guide treatment. The Research Diagnostic Criteria for TMD (RDC/TMD), particularly its 2009 update, provides standardized diagnostic protocols, including validated imaging criteria ( 9 , 10 ). Structural changes both osseous and soft tissue are observed in a subset of TMD patients ( 11 ). Available imaging modalities include panoramic radiography, transcranial imaging, cone-beam computed tomography (CBCT), and magnetic resonance imaging (MRI) ( 12 ).Although panoramic radiography remains widely accessible and cost-effective ( 13 ), its two-dimensional nature limits diagnostic accuracy for detecting subtle osseous changes such as erosions, flattening, sclerosis, or Ely cysts compared to CBCT ( 14 , 15 ). TMJ osteoarthritis—marked by subcortical cysts, erosions, osteophytes, or sclerosis ( 10 )—is more prevalent among elderly populations but also occurs in younger patients ( 16 , 17 ). Intriguingly, structural TMJ abnormalities have been documented even in asymptomatic individuals ( 18 ), underscoring the importance of correlating imaging findings with clinical symptoms. Materials and Methods Study Design This study was designed as a historical cohort study aimed at comparing bony changes of the temporomandibular joint (TMJ) between patients with clinical symptoms of temporomandibular disorders (TMD) and asymptomatic individuals, using cone-beam computed tomography (CBCT) imaging. Study Setting and Population The study population was drawn from the TMD patient registry at the TMD Treatment Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The case group comprised patients who had been referred to the center with complaints suggestive of TMD, were clinically diagnosed with TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), and had undergone CBCT imaging for other therapeutic purposes, such as sinus surgery or dental implant planning. The control group included individuals without any clinical signs or symptoms of TMD who had undergone CBCT imaging for unrelated dental or maxillofacial therapeutic reasons. All data were retrieved from the central radiology data repository of Shahid Beheshti University of Medical Sciences. Diagnostic Criteria for TMD Diagnosis of TMD in the case group was established according to the RDC/TMD, requiring at least one of the following: pain in the jaw, temple, face, preauricular, or intra-auricular regions at rest or during function; reported pain upon palpation of predefined muscle sites (including anterior, middle, and posterior temporalis; origin and insertion of the masseter muscle; posterior mandibular region; submandibular area; lateral pterygoid; and temporalis tendon), with at least one painful site corresponding to the side of the main complaint; restricted or painful unassisted jaw opening of less than 4 mm; a difference of less than 5 mm between maximum assisted and unassisted jaw opening; or the presence of joint sounds such as clicking, disc displacement, or incoordinate joint movement. Inclusion and exclusion Criteria Eligible participants were required to have a definitive clinical diagnosis of TMD based on RDC/TMD or DC/TMD and high-quality CBCT images free from significant artifacts that would impair bony assessment. Participants were excluded if they were younger than 18 years or older than 60 years; had systemic bone or joint diseases such as rheumatoid arthritis, osteoarthritis, inflammatory arthritis, or metabolic bone disorders; had a history of TMJ surgery; were receiving medications that could influence bone metabolism (e.g., corticosteroids, NSAIDs, immunosuppressants, bisphosphonates, or hormonal agents); had incomplete or poor-quality CBCT images; suffered from severe psychiatric or neurological disorders that would impair study compliance; presented with active infection or severe inflammation in the TMJ region; were pregnant or lactating; or exhibited severe bruxism or significant occlusal wear that could independently induce TMJ bony changes. CBCT Imaging Protocol All CBCT images were obtained using a NewTom VGI 2022 system in axial, coronal, and sagittal planes. Imaging parameters included a field of view of 7.5 × 10 cm, voxel size of 0.2 mm, tube current of 10 mA, tube voltage of 90 kV, and an exposure time of approximately 16 seconds. Images were evaluated in a darkened room using a 22-inch monitor. Image analysis was performed with Romexis Viewer software (Planmeca, Helsinki, Finland) and On Demand software. Radiographic Evaluation of Bony Changes Bony changes in the TMJ were assessed according to standardized radiological definitions, including flattening of the articular surface, surface irregularity, sclerosis (increased cortical bone density extending into the medullary bone), Ely cysts (small, well-defined radiolucent areas surrounded by sclerotic margins within the subchondral bone), surface erosion (loss of cortical bone density with adjacent subcortical bone changes), condylar hypoplasia or hyperplasia, ankylosis (fibrous adhesions or bony fusion within the joint capsule), osteophyte formation (marginal bony outgrowths), and alterations in joint space width (narrowing or widening), with normal values defined according to Christiansen’s study. Statistical Analysis Data analysis was conducted using SPSS software (version 25, IBM Corp., Armonk, NY, USA). Continuous variables were compared between groups using the Independent Samples t-test, and paired comparisons within groups were analyzed using the Paired t-test. A p-value < 0.05 was considered statistically significant. Ethical Considerations The study protocol was reviewed and approved by the Research Ethics Committee of the School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. All CBCT data were anonymized prior to analysis to ensure patient confidentiality, and no personally identifiable information was reported. Results Cone-beam computed tomography (CBCT) assessment of 138 cases with temporomandibular joint disorders (TMJD) and 132 controls revealed a higher prevalence of degenerative and structural alterations (Fig. 1 ) in the TMJD group. The case group had a mean age of 36.45 ± 10.35 years, whereas the control group had a mean age of 34.82 ± 7.49 years; the difference was not statistically significant (p = 0.141). Osteophyte formation (Table 1 ) was detected in 41 cases (29.7%) compared with 20 controls (15.2%) ( p = 0.003). Erosive changes were the most frequent abnormality, affecting 72 subjects (52.2%) with TMJD versus 18 controls (13.6%) ( p < 0.001). Condylar flattening was observed in 38 patients (27.5%) in the TMJD group and 10 controls (7.6%) ( p < 0.001). Ely cysts occurred in 27 participants (19.6%) with TMJD and 19 controls (14.4%), a difference that was not statistically significant ( p = 0.167). Ankylosis was rare, recorded in 5 patients (3.6%) in the TMJD group and 2 controls (1.5%) ( p = 0.242). Temporal lobe sclerosis (TLS) was identified in 17 cases (12.3%) with TMJD compared with 1 control (0.8%) ( p < 0.001). Condylar head sclerosis (CHS) was found in 15 patients (10.9%) versus 5 controls (3.8%) ( p = 0.022). Condylar hypoplasia was noted in 7 cases (5.1%) and absent in the control group, while condylar hyperplasia was extremely uncommon, affecting only 1 case (0.7%) and absent among controls. Alterations in joint space, including narrowing or widening, were seen in 26 TMJD cases (18.8%) compared with 3 controls (2.3%) ( p < 0.001). Age-stratified analysis demonstrated (Table.2) that erosion remained significantly more frequent in TMJD across all age categories: among participants younger than 30 years, 24 cases (52.2%) compared with 7 controls (15.2%) ( p < 0.001); in the 31–40-year group, 22 cases (48.7%) versus 11 controls (17.2%) ( p = 0.01); and in those older than 41 years, 26 cases (56.5%) with TMJD, with no occurrences in controls ( p 41-year group, affecting 19 patients (41.3%) compared with 1 control (4.5%) ( p = 0.001), while differences in younger groups were nonsignificant. Condylar flattening reached statistical significance only in the 31–40-year subgroup, present in 15 cases (32.6%) compared with 4 controls (6.3%) ( p 41-year category, occurring in 14 patients (30.4%) versus 2 controls (9.1%) ( p = 0.046). CHS was more common in TMJD across age groups but did not reach significance within any specific age category. Overall, erosive changes showed the strongest and most consistent association with TMJD across all age groups, while osteophyte formation and condylar flattening demonstrated age-related significance, suggesting links to chronic disease progression and adaptive bone remodeling. TLS, CHS, and joint space alterations also exhibited strong associations with TMJD, reinforcing their potential diagnostic value. In contrast, rare abnormalities such as ankylosis, condylar hypoplasia, and condylar hyperplasia did not differ significantly between groups, likely due to their low prevalence. Table 1 Comparison of CBCT-Detected Osseous and Structural Alterations Between Patients With Temporomandibular Joint Disorders and Asymptomatic Controls No Variables TMJD n:138 Control n: 132 P.value* 1 Osteophyte 41(29.7) 20(15.2) 0.003 2 Erosion 72(52.2) 18(13.6) 0.000 3 Flattening 38(27.5) 10(7.6) 0.000 4 Ely Cyst 27(19.6) 19(14.4) 0.167 5 Ankylosis 5(3.6) 2(1.5) 0.242 6 TLS 17(12.3) 1(0.8) 0.000 7 CHS 15(10.9) 5(3.8) 0.022 8 Joint Space 26(18.8) 3(2.3) 0.000 TMJD: Temporomandibular Joint Disorders TLS: Temporal lobe sclerosis CHS: Condylar Head Sclerosis *Chi Square Table 2 Age-Stratified Distribution of Key CBCT Findings in Temporomandibular Joint Disorder and Control Groups No Variables Group Age Groups (Year) Under 30 n:92 31–40 n:110 Above 41 n:68 1 Erosion TMJD 24(52.2) 22 (48.7) 26 (56.5) Control 7(15.2) 11 (17.2) 0 (0) P.Value* 0.00 0.01 0.00 2 Osteophyte TMJD 13(28.3) 9 (19.6) 19(41.3) Control 5 (10.9) 14(21.9) 1 (4.5) P.Value* 0.32 0.481 0.001 3 Flattening TMJD 9 (19.6) 15 (32.6) 14(30.4) Control 5(10.9) 4 (6.3) 1 (4.5) P.Value* 0.192 0.000 0.13 4 Ely Cyst TMJD 3(6.5) 10(21.7) 14 (30.4) Control 7 (15.2) 10(15.6) 2 (9.1) P.Value* 0.158 0.283 0.046 5 CHS TMJD 7 (15.2) 5(10.9) 3( 6.5) Control 3 (6.5) 2 (3.1) 0 (0) P.Value* 0.158 0.107 0.303 CHS: Condylar Head Sclerosis *Chi Square Discussion In this CBCT-based analysis of 138 TMJD cases versus 132 controls, there was a clear predisposition to degenerative and structural condylar alterations among TMJD patients, in alignment with current imaging and epidemiologic evidence. Notably, erosive changes emerged as the most prevalent abnormality in TMJD, and this pattern held across all age strata including patients younger than 30 strongly suggesting that erosion is an early and robust indicator of TMJD rather than a mere consequence of advanced age or chronicity. This is consistent with previous CBCT-based studies, which identified erosion and osteophyte formation as frequent degenerative features in TMJ degenerative joint disease (DJD) ( 19 ). Quantitative CBCT analyses have further demonstrated that condylar erosion is associated with subsequent condylar volume loss, indicative of accelerated bone resorption and progression in osteoarthritic joints ( 20 ). Osteophyte formation was significantly more frequent in TMJD (29.7% vs. 15.2%, p = 0.003), with age-related significance only in the > 41-year group. This supports the concept that osteophytes develop as part of chronic adaptive remodeling. Epidemiologic data also suggest that the incidence of TMJ DJD increases notably with age, with marked differences between younger and older age groups ( 23 ). These findings align with the chronic, progressive nature of bony remodeling in TMJ pathology. Condylar flattening was also significantly more common in TMJD (27.5% vs. 7.6%, p < 0.001), particularly in the 31–40-year group, indicating structural adaptation. Reviews have consistently recognized flattening as a hallmark of TMJ degeneration visible on CBCT ( 22 ). Condylar head sclerosis (CHS) and temporal lobe sclerosis (TLS) showed significant elevations in TMJD cases. Such sclerotic changes reflect subchondral reactions to mechanical overload and are well documented in CBCT evaluations of DJD ( 22 , 24 ). Joint space alterations—including narrowing or widening—were also significantly more frequent in TMJD (18.8% vs. 2.3%, p < 0.001), consistent with positional and degenerative changes in the condyle. Some features—Ely cysts, ankylosis, hypoplasia, and hyperplasia—were less common and mostly statistically nonsignificant, likely due to their low prevalence and the limited statistical power to detect differences. Nevertheless, their presence in TMJD cases reflects the broader spectrum of osseous pathology affecting the joint ( 19 , 22 ). The age-stratified results reinforce that while erosive changes are consistently prevalent across all ages, osteophytes and flattening tend to appear later, reflecting chronic disease and adaptive remodeling processes ( 23 ). This pattern matches established epidemiologic observations of DJD progression. These findings underscore CBCT’s high diagnostic accuracy for detecting osseous pathology of the TMJ ( 21 ). CBCT is particularly valuable for evaluating features like erosion, osteophyte formation, sclerosis, and joint space alterations, although its limitation in soft tissue evaluation must be acknowledged. Clinical correlation is essential, as CBCT findings—especially erosions and osteophytes—are strongly associated with symptoms such as pain and joint noises ( 25 ). Several authors have advocated CBCT imaging in symptomatic patients, including young adults, to facilitate early diagnosis and intervention ( 26 ). Overall, the present findings reinforce the consistent association of erosions, osteophytes, flattening, sclerosis, and joint space changes with TMJD, and highlight erosion as an early and reliable marker. Age-related trends in osteophyte formation and flattening provide insight into disease progression, and further confirm CBCT as an indispensable imaging tool in TMJ assessment ( 25 , 26 ). It is also important to note that the diagnostic reliability of CBCT in TMJ pathology is supported by broader dental imaging research. Studies on root canal morphology have demonstrated that CBCT provides highly accurate assessments of complex anatomic variations across different ages and sexes, underscoring its value in detecting subtle structural changes ( 27 ). Similarly, investigations into technical parameters such as object positioning have shown that CBCT maintains reliable diagnostic performance in challenging conditions, for example in identifying root fractures in teeth with intra-canal posts ( 28 ). These findings further validate CBCT as a robust and adaptable imaging modality whose diagnostic accuracy extends beyond endodontic and dental applications, making it particularly suited for detecting osseous changes in TMJD. Conclusion In this CBCT-based investigation, degenerative condylar changes especially erosive alterations were significantly more prevalent in TMJD patients compared to controls, across all age groups. Osteophyte formation, condylar flattening, sclerosis (both condylar and temporal lobe), and joint space changes further distinguished TMJD patients, often with age-related patterns suggesting chronic progression. These findings affirm CBCT as a highly effective modality for identifying osseous pathology in TMJD, with erosion serving as a crucial early diagnostic indicator Recommendation Routine CBCT evaluation should be considered in TMJD patients especially those presenting with pain or crepitus as early detection of erosive and degenerative changes can guide timely therapeutic interventions. Future longitudinal and quantitative CBCT studies, including condylar volume assessment, are recommended to monitor progression, evaluate treatment response, and improve prognostic stratification. Abbreviations CBCT Cone-beam computed tomography TMJ Temporomandibular joint TMD Temporomandibular disorder Declarations Ethics approval: This study was approved by the Research Ethics Committee of the School of Dentistry, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (Approval ID: IR.SSU.DENTISTRY.REC.1403.091; approval date: 10.03.2025). Human Ethics and Consent to Participate: This study is retrospective and based solely on anonymized radiological data extracted from registries. No direct access to patients was obtained during the research. Therefore, individual informed consent was not required. Consent to Publish: Not applicable, as no personal or identifiable data are included in this article. Availability of data and materials: All data and materials are available for submission upon request. Conflict of interest: The authors declare no conflict of interest. Funding support: This study was supported by the Research Deputy, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Authors’ contributions: YA: Data gathering, manuscript writing, direct supervision, and submission. HR: Study planning. YS: Data preparation and case selection. MZ: Data gathering. HRS: Data analysis and manuscript revision. RJ: Manuscript writing. Acknowledgments : The authors express their gratitude to the staff of Shahid Beheshti University Dental School, Radiology Ward, for their kind assistance with data collection, and to the Research Deputy of Shahid Sadoughi University of Medical Sciences, Yazd, for their cooperation in registering and designing this study. References Velly AM, Schiffman EL, Rindal DB, Cunha-Cruz J, Gilbert GH, Lehmann M, et al. 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Valizadeh S, Vasegh Z, Rezapanah S, Safi Y, Khaeazifard MJ. Effect of Object Position in Cone Beam Computed Tomography Field of View for Detection of Root Fractures in Teeth with Intra-Canal Posts. Iran J Radiol. 2015;12(4):e25272. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7436762","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":523591596,"identity":"012f5a05-7f39-43d8-b857-f533caa40c60","order_by":0,"name":"Yasamin 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Services","correspondingAuthor":false,"prefix":"","firstName":"Mohsen","middleName":"","lastName":"Barzegar","suffix":""},{"id":523591604,"identity":"97891264-5fcd-40b7-8f38-644f83ba086d","order_by":5,"name":"Reihaneh Sadat Jafari","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences and Health Services","correspondingAuthor":false,"prefix":"","firstName":"Reihaneh","middleName":"Sadat","lastName":"Jafari","suffix":""}],"badges":[],"createdAt":"2025-08-22 18:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7436762/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7436762/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92733849,"identity":"7b87fafe-1ffe-4431-a291-595370c608a6","added_by":"auto","created_at":"2025-10-03 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16:22:32","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94917,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7436762/v1/93c8a79461e6bb38180be281.html"},{"id":92735572,"identity":"f79d6f05-db65-4519-82c5-c38f230d2133","added_by":"auto","created_at":"2025-10-03 16:30:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":507735,"visible":true,"origin":"","legend":"\u003cp\u003eCBCT images showing different bony changes in patients with temporomandibular joint disorders. (Flattening, B: Erosion, C: Condylar head hyperplasia, D: Osteophyte, E: Ely Cyst, F: Temporal sclerosis, G: Ankylosis, H: Condylar head Sclerosis, I: Condylar head hypoplasia, J: Bifid Condyle, K: Decreased joint spaced)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7436762/v1/7918876f45082f322bf7283d.png"},{"id":92736950,"identity":"4e382245-354f-463b-aa5e-3c60b51fe142","added_by":"auto","created_at":"2025-10-03 16:38:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1389334,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7436762/v1/26201b43-cec5-4d49-a5d7-bcfc21c884d1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bony Changes of the Temporomandibular Joint in Symptomatic Versus Asymptomatic Individuals: Insights from CBCT Imaging","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTemporomandibular disorders (TMDs) encompass a diverse range of musculoskeletal conditions and represent the most prevalent source of non-dental orofacial pain, ranking second only to low back pain among musculoskeletal complaints (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Reported prevalence rates vary significantly\u0026mdash;from 16.3% to 68% in adolescents and up to 43% in adults a disparity attributed to differences in diagnostic criteria, study populations, and methodological approaches (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The etiology of TMD is multifactorial, involving psychological contributors (e.g., anxiety, depression), parafunctional habits, socioeconomic factors, and genetic predisposition (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Notably, women are disproportionately affected, likely due to a combination of hormonal, anatomical, behavioral, and psychosocial influences (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).Clinically, TMD manifests as temporomandibular joint (TMJ) pain or tenderness, restricted jaw mobility, and joint sounds, though patients may also report tinnitus, hearing alterations, otalgia, aural fullness, dysphagia, or dizziness (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). While imaging is not always necessary, it plays a critical role when findings could inform diagnosis or guide treatment. The Research Diagnostic Criteria for TMD (RDC/TMD), particularly its 2009 update, provides standardized diagnostic protocols, including validated imaging criteria (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Structural changes both osseous and soft tissue are observed in a subset of TMD patients (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Available imaging modalities include panoramic radiography, transcranial imaging, cone-beam computed tomography (CBCT), and magnetic resonance imaging (MRI) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).Although panoramic radiography remains widely accessible and cost-effective (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), its two-dimensional nature limits diagnostic accuracy for detecting subtle osseous changes such as erosions, flattening, sclerosis, or Ely cysts compared to CBCT (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). TMJ osteoarthritis\u0026mdash;marked by subcortical cysts, erosions, osteophytes, or sclerosis (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u0026mdash;is more prevalent among elderly populations but also occurs in younger patients (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Intriguingly, structural TMJ abnormalities have been documented even in asymptomatic individuals (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), underscoring the importance of correlating imaging findings with clinical symptoms.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was designed as a historical cohort study aimed at comparing bony changes of the temporomandibular joint (TMJ) between patients with clinical symptoms of temporomandibular disorders (TMD) and asymptomatic individuals, using cone-beam computed tomography (CBCT) imaging.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Setting and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population was drawn from the TMD patient registry at the TMD Treatment Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The case group comprised patients who had been referred to the center with complaints suggestive of TMD, were clinically diagnosed with TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), and had undergone CBCT imaging for other therapeutic purposes, such as sinus surgery or dental implant planning. The control group included individuals without any clinical signs or symptoms of TMD who had undergone CBCT imaging for unrelated dental or maxillofacial therapeutic reasons. All data were retrieved from the central radiology data repository of Shahid Beheshti University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Criteria for TMD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDiagnosis of TMD in the case group was established according to the RDC/TMD, requiring at least one of the following: pain in the jaw, temple, face, preauricular, or intra-auricular regions at rest or during function; reported pain upon palpation of predefined muscle sites (including anterior, middle, and posterior temporalis; origin and insertion of the masseter muscle; posterior mandibular region; submandibular area; lateral pterygoid; and temporalis tendon), with at least one painful site corresponding to the side of the main complaint; restricted or painful unassisted jaw opening of less than 4 mm; a difference of less than 5 mm between maximum assisted and unassisted jaw opening; or the presence of joint sounds such as clicking, disc displacement, or incoordinate joint movement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEligible participants were required to have a definitive clinical diagnosis of TMD based on RDC/TMD or DC/TMD and high-quality CBCT images free from significant artifacts that would impair bony assessment. Participants were excluded if they were younger than 18 years or older than 60 years; had systemic bone or joint diseases such as rheumatoid arthritis, osteoarthritis, inflammatory arthritis, or metabolic bone disorders; had a history of TMJ surgery; were receiving medications that could influence bone metabolism (e.g., corticosteroids, NSAIDs, immunosuppressants, bisphosphonates, or hormonal agents); had incomplete or poor-quality CBCT images; suffered from severe psychiatric or neurological disorders that would impair study compliance; presented with active infection or severe inflammation in the TMJ region; were pregnant or lactating; or exhibited severe bruxism or significant occlusal wear that could independently induce TMJ bony changes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCBCT Imaging Protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll CBCT images were obtained using a NewTom VGI 2022 system in axial, coronal, and sagittal planes. Imaging parameters included a field of view of 7.5 \u0026times; 10 cm, voxel size of 0.2 mm, tube current of 10 mA, tube voltage of 90 kV, and an exposure time of approximately 16 seconds. Images were evaluated in a darkened room using a 22-inch monitor. Image analysis was performed with Romexis Viewer software (Planmeca, Helsinki, Finland) and On Demand software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiographic Evaluation of Bony Changes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBony changes in the TMJ were assessed according to standardized radiological definitions, including flattening of the articular surface, surface irregularity, sclerosis (increased cortical bone density extending into the medullary bone), Ely cysts (small, well-defined radiolucent areas surrounded by sclerotic margins within the subchondral bone), surface erosion (loss of cortical bone density with adjacent subcortical bone changes), condylar hypoplasia or hyperplasia, ankylosis (fibrous adhesions or bony fusion within the joint capsule), osteophyte formation (marginal bony outgrowths), and alterations in joint space width (narrowing or widening), with normal values defined according to Christiansen\u0026rsquo;s study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was conducted using SPSS software (version 25, IBM Corp., Armonk, NY, USA). Continuous variables were compared between groups using the Independent Samples t-test, and paired comparisons within groups were analyzed using the Paired t-test. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Research Ethics Committee of the School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. All CBCT data were anonymized prior to analysis to ensure patient confidentiality, and no personally identifiable information was reported.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eCone-beam computed tomography (CBCT) assessment of 138 cases with temporomandibular joint disorders (TMJD) and 132 controls revealed a higher prevalence of degenerative and structural alterations (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) in the TMJD group. The case group had a mean age of 36.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.35 years, whereas the control group had a mean age of 34.82\u0026thinsp;\u0026plusmn;\u0026thinsp;7.49 years; the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.141). Osteophyte formation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was detected in 41 cases (29.7%) compared with 20 controls (15.2%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Erosive changes were the most frequent abnormality, affecting 72 subjects (52.2%) with TMJD versus 18 controls (13.6%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Condylar flattening was observed in 38 patients (27.5%) in the TMJD group and 10 controls (7.6%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Ely cysts occurred in 27 participants (19.6%) with TMJD and 19 controls (14.4%), a difference that was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.167). Ankylosis was rare, recorded in 5 patients (3.6%) in the TMJD group and 2 controls (1.5%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.242). Temporal lobe sclerosis (TLS) was identified in 17 cases (12.3%) with TMJD compared with 1 control (0.8%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Condylar head sclerosis (CHS) was found in 15 patients (10.9%) versus 5 controls (3.8%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022). Condylar hypoplasia was noted in 7 cases (5.1%) and absent in the control group, while condylar hyperplasia was extremely uncommon, affecting only 1 case (0.7%) and absent among controls. Alterations in joint space, including narrowing or widening, were seen in 26 TMJD cases (18.8%) compared with 3 controls (2.3%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Age-stratified analysis demonstrated (Table.2) that erosion remained significantly more frequent in TMJD across all age categories: among participants younger than 30 years, 24 cases (52.2%) compared with 7 controls (15.2%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); in the 31\u0026ndash;40-year group, 22 cases (48.7%) versus 11 controls (17.2%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01); and in those older than 41 years, 26 cases (56.5%) with TMJD, with no occurrences in controls (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Osteophyte prevalence was significantly higher only in the \u0026gt;\u0026thinsp;41-year group, affecting 19 patients (41.3%) compared with 1 control (4.5%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), while differences in younger groups were nonsignificant. Condylar flattening reached statistical significance only in the 31\u0026ndash;40-year subgroup, present in 15 cases (32.6%) compared with 4 controls (6.3%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Ely cysts differed significantly only in the \u0026gt;\u0026thinsp;41-year category, occurring in 14 patients (30.4%) versus 2 controls (9.1%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046). CHS was more common in TMJD across age groups but did not reach significance within any specific age category. Overall, erosive changes showed the strongest and most consistent association with TMJD across all age groups, while osteophyte formation and condylar flattening demonstrated age-related significance, suggesting links to chronic disease progression and adaptive bone remodeling. TLS, CHS, and joint space alterations also exhibited strong associations with TMJD, reinforcing their potential diagnostic value. In contrast, rare abnormalities such as ankylosis, condylar hypoplasia, and condylar hyperplasia did not differ significantly between groups, likely due to their low prevalence.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of CBCT-Detected Osseous and Structural Alterations Between Patients With Temporomandibular Joint Disorders and Asymptomatic Controls\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTMJD\u003c/p\u003e\u003cp\u003en:138\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003cp\u003en: 132\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP.value*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOsteophyte\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41(29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20(15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eErosion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72(52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18(13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFlattening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10(7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEly Cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27(19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19(14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnkylosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2(1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTLS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1(0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5(3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJoint Space\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3(2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eTMJD: \u003cem\u003eTemporomandibular Joint Disorders\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eTLS: Temporal lobe sclerosis\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eCHS: Condylar Head Sclerosis\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Chi Square\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge-Stratified Distribution of Key CBCT Findings in Temporomandibular Joint Disorder and Control Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eAge Groups (Year)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnder 30\u003c/p\u003e\u003cp\u003en:92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003cp\u003en:110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAbove 41\u003c/p\u003e\u003cp\u003en:68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eErosion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTMJD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (48.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26 (56.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP.Value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOsteophyte\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTMJD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19(41.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14(21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP.Value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.32\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.481\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFlattening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTMJD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14(30.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP.Value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.192\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEly Cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTMJD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10(21.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (30.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10(15.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (9.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP.Value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.158\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.283\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTMJD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3( 6.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP.Value*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.158\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.107\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.303\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eCHS: Condylar Head Sclerosis\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Chi Square\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this CBCT-based analysis of 138 TMJD cases versus 132 controls, there was a clear predisposition to degenerative and structural condylar alterations among TMJD patients, in alignment with current imaging and epidemiologic evidence. Notably, erosive changes emerged as the most prevalent abnormality in TMJD, and this pattern held across all age strata including patients younger than 30 strongly suggesting that erosion is an early and robust indicator of TMJD rather than a mere consequence of advanced age or chronicity. This is consistent with previous CBCT-based studies, which identified erosion and osteophyte formation as frequent degenerative features in TMJ degenerative joint disease (DJD) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Quantitative CBCT analyses have further demonstrated that condylar erosion is associated with subsequent condylar volume loss, indicative of accelerated bone resorption and progression in osteoarthritic joints (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Osteophyte formation was significantly more frequent in TMJD (29.7% vs. 15.2%, p\u0026thinsp;=\u0026thinsp;0.003), with age-related significance only in the \u0026gt;\u0026thinsp;41-year group. This supports the concept that osteophytes develop as part of chronic adaptive remodeling. Epidemiologic data also suggest that the incidence of TMJ DJD increases notably with age, with marked differences between younger and older age groups (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These findings align with the chronic, progressive nature of bony remodeling in TMJ pathology. Condylar flattening was also significantly more common in TMJD (27.5% vs. 7.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), particularly in the 31\u0026ndash;40-year group, indicating structural adaptation. Reviews have consistently recognized flattening as a hallmark of TMJ degeneration visible on CBCT (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Condylar head sclerosis (CHS) and temporal lobe sclerosis (TLS) showed significant elevations in TMJD cases. Such sclerotic changes reflect subchondral reactions to mechanical overload and are well documented in CBCT evaluations of DJD (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Joint space alterations\u0026mdash;including narrowing or widening\u0026mdash;were also significantly more frequent in TMJD (18.8% vs. 2.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), consistent with positional and degenerative changes in the condyle. Some features\u0026mdash;Ely cysts, ankylosis, hypoplasia, and hyperplasia\u0026mdash;were less common and mostly statistically nonsignificant, likely due to their low prevalence and the limited statistical power to detect differences. Nevertheless, their presence in TMJD cases reflects the broader spectrum of osseous pathology affecting the joint (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The age-stratified results reinforce that while erosive changes are consistently prevalent across all ages, osteophytes and flattening tend to appear later, reflecting chronic disease and adaptive remodeling processes (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This pattern matches established epidemiologic observations of DJD progression. These findings underscore CBCT\u0026rsquo;s high diagnostic accuracy for detecting osseous pathology of the TMJ (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). CBCT is particularly valuable for evaluating features like erosion, osteophyte formation, sclerosis, and joint space alterations, although its limitation in soft tissue evaluation must be acknowledged. Clinical correlation is essential, as CBCT findings\u0026mdash;especially erosions and osteophytes\u0026mdash;are strongly associated with symptoms such as pain and joint noises (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Several authors have advocated CBCT imaging in symptomatic patients, including young adults, to facilitate early diagnosis and intervention (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Overall, the present findings reinforce the consistent association of erosions, osteophytes, flattening, sclerosis, and joint space changes with TMJD, and highlight erosion as an early and reliable marker. Age-related trends in osteophyte formation and flattening provide insight into disease progression, and further confirm CBCT as an indispensable imaging tool in TMJ assessment (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). It is also important to note that the diagnostic reliability of CBCT in TMJ pathology is supported by broader dental imaging research. Studies on root canal morphology have demonstrated that CBCT provides highly accurate assessments of complex anatomic variations across different ages and sexes, underscoring its value in detecting subtle structural changes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Similarly, investigations into technical parameters such as object positioning have shown that CBCT maintains reliable diagnostic performance in challenging conditions, for example in identifying root fractures in teeth with intra-canal posts (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). These findings further validate CBCT as a robust and adaptable imaging modality whose diagnostic accuracy extends beyond endodontic and dental applications, making it particularly suited for detecting osseous changes in TMJD.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this CBCT-based investigation, degenerative condylar changes especially erosive alterations were significantly more prevalent in TMJD patients compared to controls, across all age groups. Osteophyte formation, condylar flattening, sclerosis (both condylar and temporal lobe), and joint space changes further distinguished TMJD patients, often with age-related patterns suggesting chronic progression. These findings affirm CBCT as a highly effective modality for identifying osseous pathology in TMJD, with erosion serving as a crucial early diagnostic indicator\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eRecommendation\u003c/h2\u003e\u003cp\u003eRoutine CBCT evaluation should be considered in TMJD patients especially those presenting with pain or crepitus as early detection of erosive and degenerative changes can guide timely therapeutic interventions. Future longitudinal and quantitative CBCT studies, including condylar volume assessment, are recommended to monitor progression, evaluate treatment response, and improve prognostic stratification.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCBCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCone-beam computed tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTMJ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTemporomandibular joint\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTMD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTemporomandibular disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study was approved by the Research Ethics Committee of the School of Dentistry, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (Approval ID: IR.SSU.DENTISTRY.REC.1403.091; approval date: 10.03.2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study is retrospective and based solely on anonymized radiological data extracted from registries. No direct access to patients was obtained during the research. Therefore, individual informed consent was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable, as no personal or identifiable data are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;All data and materials are available for submission upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding support:\u003cbr\u003e\u003c/strong\u003eThis study was supported by the Research Deputy, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eYA: Data gathering, manuscript writing, direct supervision, and submission.\u003c/li\u003e\n \u003cli\u003eHR: Study planning.\u003c/li\u003e\n \u003cli\u003eYS: Data preparation and case selection.\u003c/li\u003e\n \u003cli\u003eMZ: Data gathering.\u003c/li\u003e\n \u003cli\u003eHRS: Data analysis and manuscript revision.\u003c/li\u003e\n \u003cli\u003eRJ: Manuscript writing.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: The authors express their gratitude to the staff of Shahid Beheshti University Dental School, Radiology Ward, for their kind assistance with data collection, and to the Research Deputy of Shahid Sadoughi University of Medical Sciences, Yazd, for their cooperation in registering and designing this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eVelly AM, Schiffman EL, Rindal DB, Cunha-Cruz J, Gilbert GH, Lehmann M, et al. The feasibility of a clinical trial of pain related to temporomandibular muscle and joint disorders: the results of a survey from the Collaboration on Networked Dental and Oral Research dental practice-based research networks. J Am Dent Assoc. 2013;144(1):e1-e10.\u003c/li\u003e\n \u003cli\u003eNilsson IM, List T, Drangsholt M. Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents. J Orofac Pain. 2005;19(2):144-50.\u003c/li\u003e\n \u003cli\u003eAdern B, Stenvinkel C, Sahlqvist L, Tegelberg A. Prevalence of temporomandibular dysfunction and pain in adult general practice patients. Acta Odontol Scand. 2014;72(8):585-90.\u003c/li\u003e\n \u003cli\u003eBlanco Aguilera A, Gonzalez Lopez L, Blanco Aguilera E, De la Hoz Aizpurua J, Rodriguez Torronteras A, Segura Saint-Gerons R, et al. Relationship between self-reported sleep bruxism and pain in patients with temporomandibular disorders. J Oral Rehabil. 2014;41(8):564-72.\u003c/li\u003e\n \u003cli\u003eFerendiuk E, Zajdel K, Pihut M. Incidence of otolaryngological symptoms in patients with temporomandibular joint dysfunctions. Biomed Res Int. 2014;2014:824684.\u003c/li\u003e\n \u003cli\u003eMazzetto MO, Rodrigues CA, Magri LV, Melchior MO, Paiva G. Severity of TMD related to age, sex and electromyographic analysis. Braz Dent J. 2014;25(1):54-8.\u003c/li\u003e\n \u003cli\u003eLee HS, Baek HS, Song DS, Kim HC, Kim HG, Kim BJ, et al. Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction. J Korean Assoc Oral Maxillofac Surg. 2013;39(1):14-20.\u003c/li\u003e\n \u003cli\u003eWeber P, Correa EC, Bolzan GP, Ferreira FS, Soares JC, Silva AM. Chewing and swallowing in young women with temporomandibular disorder. Codas. 2013;25(4):375-80.\u003c/li\u003e\n \u003cli\u003eDworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6(4):301-55.\u003c/li\u003e\n \u003cli\u003eAhmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(6):844-60.\u003c/li\u003e\n \u003cli\u003eLarheim TA. Role of magnetic resonance imaging in the clinical diagnosis of the temporomandibular joint. Cells Tissues Organs. 2005;180(1):6-21.\u003c/li\u003e\n \u003cli\u003eZhang Z, Cheng J, Li G, Shi X, Zhang J, Zhang Z, et al. Detection accuracy of condylar bony defects in Promax 3D cone beam CT images scanned with different protocols. Dentomaxillofac Radiol. 2013;42(5):20120241.\u003c/li\u003e\n \u003cli\u003eShetty US, Burde KN, Naikmasur VG, Sattur AP. Assessment of condylar changes in patients with temporomandibular joint pain using digital volumetric tomography. Radiol Res Pract. 2014;2014:106059.\u003c/li\u003e\n \u003cli\u003eZain-Alabdeen E, Alsadhan R. A comparative study of accuracy of detection of surface osseous changes in the temporomandibular joint using multidetector CT and cone beam CT. Dentomaxillofac Radiol. 2012;41(3):185-91.\u003c/li\u003e\n \u003cli\u003edos Anjos Pontual M, Freire J, Barbosa J, Frazao M, dos Anjos Pontual A. Evaluation of bone changes in the temporomandibular joint using cone beam CT. Dentomaxillofac Radiol. 2012;41(1):24-9.\u003c/li\u003e\n \u003cli\u003eNah KS. Condylar bony changes in patients with temporomandibular disorders: a CBCT study. Imaging Sci Dent. 2012;42(4):249-53.\u003c/li\u003e\n \u003cli\u003eNeville BW, Damm DD, Allen CM, Chi AC. Oral and Maxillofacial Pathology. 4th ed. St. Louis: Elsevier; 2023.\u003c/li\u003e\n \u003cli\u003eCaglayan F, Tozoglu U. Incidental findings in the maxillofacial region detected by cone beam CT. Diagn Interv Radiol. 2012;18(2):159-63.\u003c/li\u003e\n \u003cli\u003eAlexiou KE, Stamatakis HC, Tsiklakis K. Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol. 2019;48(3):20180035. doi:10.1259/dmfr.20180035.\u003c/li\u003e\n \u003cli\u003eHonda K, Larheim TA, Maruhashi K, Matsumoto K, Iwai K. Osseous abnormalities of the mandibular condyle: diagnostic reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material. Dentomaxillofac Radiol. 2016;45(5):20160030. doi:10.1259/dmfr.20160030.\u003c/li\u003e\n \u003cli\u003eAlkhader M, Ohbayashi N, Tetsumura A, Nakamura S, Okochi K, Momin MA, et al. Diagnostic performance of magnetic resonance imaging and computed tomography for temporomandibular joint disorders: a systematic review. J Oral Sci. 2020;62(1):1-9. doi:10.2334/josnusd.19-0281.\u003c/li\u003e\n \u003cli\u003eCevidanes LHS, Hajati AK, Paniagua B, Lim PF, Walker D, Palconet G, et al. Quantification of condylar resorption in temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;128(6):719-25. doi:10.1016/j.oooo.2019.08.005.\u003c/li\u003e\n \u003cli\u003eManfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. J Orofac Pain. 2019;25(1):23-37. doi:10.11607/jop.921.\u003c/li\u003e\n \u003cli\u003eZhang J, Jiao K, Zhang M, Zhou T, Liu XD, Yu SB, et al. Subchondral bone loss following orthodontically induced cartilage degradation in the mandibular condyles of rats. Bone. 2018;108:50-61. doi:10.1016/j.bone.2017.12.011.\u003c/li\u003e\n \u003cli\u003eTalaat W, Ghoneima A, Kaboudan A, Bouquot J, Velly A, Bayome M. Accuracy and reliability of cone-beam computed tomography for airway volume analysis. Eur J Orthod. 2017;39(1):110-6. doi:10.1093/ejo/cjw043.\u003c/li\u003e\n \u003cli\u003eSchmitter M, Kress B, Ludwig C, Koob A, Gabbert O, Rammelsberg P. Temporomandibular joint disk position assessed at coronal MR imaging in asymptomatic volunteers. Radiology. 2018;268(2):559-64. doi:10.1148/radiol.13121179.\u003c/li\u003e\n \u003cli\u003eNaseri M, Ali Mozayeni M, Safi Y, Heidarnia M, Akbarzadeh Baghban A, Norouzi N. Root Canal Morphology of Maxillary Second Molars according to Age and Gender in a Selected Iranian Population: A Cone-Beam Computed Tomography Evaluation. Iran Endod J. 2018;13(3):373-80.\u003c/li\u003e\n \u003cli\u003eValizadeh S, Vasegh Z, Rezapanah S, Safi Y, Khaeazifard MJ. Effect of Object Position in Cone Beam Computed Tomography Field of View for Detection of Root Fractures in Teeth with Intra-Canal Posts. Iran J Radiol. 2015;12(4):e25272.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Temporomandibular Joint Disorders, Cone-Beam Computed Tomography, Osteoarthritis, Mandibular Condyle, Diagnostic Imaging","lastPublishedDoi":"10.21203/rs.3.rs-7436762/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7436762/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Temporomandibular disorders (TMDs) are a leading cause of non-dental orofacial pain. Structural osseous changes of the temporomandibular joint (TMJ) can be observed in both symptomatic and asymptomatic individuals. This study compared bony changes in TMJs of patients with and without TMD symptoms using cone-beam computed tomography (CBCT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e: In this historical cohort, 138 patients with clinically diagnosed TMD (RDC/TMD) and 132 asymptomatic controls who underwent CBCT for dental or maxillofacial purposes were evaluated. Standardized criteria were used to assess erosion, osteophytes, flattening, Ely cysts, sclerosis (condylar head and temporal), ankylosis, condylar size alterations, and joint space changes. Data were analyzed with Chi-square and t-tests (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Degenerative changes were more frequent in the TMD group. Erosion was the most common finding (52.2% vs. 13.6%, p \u0026lt; 0.001) and occurred across all age groups. Osteophytes (29.7% vs. 15.2%, p = 0.003) and flattening (27.5% vs. 7.6%, p \u0026lt; 0.001) were significantly higher, with age-related patterns. Temporal lobe sclerosis (12.3% vs. 0.8%, p \u0026lt; 0.001), condylar head sclerosis (10.9% vs. 3.8%, p = 0.022), and joint space changes (18.8% vs. 2.3%, p \u0026lt; 0.001) were strongly associated with TMD. Ely cysts differed only in the \u0026gt;41-year group. Rare findings showed no significant differences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: CBCT revealed significantly more erosions, osteophytes, flattening, sclerosis, and joint space alterations in TMD patients compared to controls. Erosion may serve as an early diagnostic marker, while other features suggest chronic progression. CBCT is recommended in symptomatic TMD cases to facilitate early detection and guide management decisions.\u003c/p\u003e","manuscriptTitle":"Bony Changes of the Temporomandibular Joint in Symptomatic Versus Asymptomatic Individuals: Insights from CBCT Imaging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 16:22:27","doi":"10.21203/rs.3.rs-7436762/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"199e7464-40b2-4fce-9dfb-0fc1e714ba3a","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-03T16:22:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 16:22:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7436762","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7436762","identity":"rs-7436762","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}