Risk factors of temporomandibular joint anterior disc displacement associated with dental malocclusion: a cross-sectional study

Risk factors of temporomandibular joint anterior disc displacement associated with dental malocclusion: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors of temporomandibular joint anterior disc displacement associated with dental malocclusion: a cross-sectional study Guanlin Qu, Lingtong Bu, Pei Shen, Qianyang Xie, Jing Ge, Yi Luo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3326678/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to investigate the risk factors associated with temporomandibular joint (TMJ) anterior disc displacement (ADD) in relation to dental malocclusion. Methods In this cross-sectional study, a clinical examination was conducted on patients aged 11–35 years who visited the TMJ and Orthodontic Clinic at a hospital. Magnetic resonance imaging (MRI) of the TMJ was performed to diagnose both ADD and condylar resorption (CR). Occlusal measurements were obtained and analyzed using 3D scanning models. Results A total of 552 patients underwent TMJ MRI examination and dental occlusion scanning. The presence of mandibular midline shift > 2 mm and posterior crossbite were found to be associated with unilateral ADD (OR > 1, p 3 mm showed a strong correlation with unilateral ADD accompanied by CR (OR > 1, p 4 mm and posterior crossbite were associated with bilateral ADD (OR > 1, p 5 mm, and anterior open bite > 3 mm were strongly correlated with bilateral ADD accompanied by CR (OR > 1, p 2 mm, posterior crossbite, and overbite > 4 mm appear to be associated with the presence of TMJ ADD. Angle Class II malocclusion, anterior open bite and overjet > 5 mm seem to be associated with progression of ADD. These findings emphasize the crucial importance of early detection and management of malocclusions to prevent or minimize the development of TMJ ADD and associated complications. Temporomandibular joint Anterior disc displacement Condylar resorption Dental malocclusion Magnetic resonance imaging Figures Figure 1 Introduction Temporomandibular disorders include a range of conditions that impact the temporomandibular joint (TMJ) as well as the surrounding muscles and tissues [ 1 , 2 ] . Among these disorders, anterior disc displacement (ADD) stands as the most prevalent type, affecting up to 26% of adolescents and young adult females [ 3 , 4 ] . It is characterized by clicking and popping sounds during mandible movement, limited mouth opening, and pain in the front of the ear [ 5 , 6 ] . ADD can be categorized into two subtypes: anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR), depending on whether the disc can return to the normal position upon mouth opening. ADDwoR generally corresponds to the advanced stage of ADD, and with the progression of the condition, it can lead to condylar resorption (CR) [ 7 , 8 ] . Unilateral CR can result in mandible deviation, while bilateral CR can lead to mandible retrusion, ultimately causing secondary occlusal disorders and dentofacial deformities [ 5 ] . Therefore, there is a close relationship between the occlusal disorders and progression of ADD. Dental malocclusions can be both a result of the progression of ADD and a contributing factor to the occurrence of ADD [ 9 ] . Biomechanical factors are widely believed to play a pivotal role in the pathogenesis of ADD [ 10 ] . Mechanically, abnormal pressure exerted on the TMJ can cause the articular disc to displace from the condyle, while prolonged malocclusion can result in detrimental stress and chronic trauma to the TMJ [ 11 ] . Thus, dental occlusion also plays a critical role in maintaining the stability of the TMJ [ 9 , 12 , 13 ] . However, the specific malocclusions that serve as risk factors for the development of ADD remain unclear. Previous studies have demonstrated that the prevalence of ADD in asymptomatic populations is approximately 30% [ 14 ] . Consequently, relying solely on clinical symptoms for diagnosing ADD may lead to underdiagnosis. In terms of imaging examinations, magnetic resonance imaging (MRI) is an effective tool for diagnosing ADD due to its ability to provide clear visualization of the morphology and relative positions of the temporomandibular joint disc, condyle, and joint fossa. Moreover, MRI is considered safer than CT as it does not involve ionizing radiation [ 15 ] . Thus, MRI has been widely used in the diagnosis of temporomandibular joint disorders, including disc displacement and condylar resorption. [ 4 ] . In this study, TMJ MRI was employed to diagnose ADD and CR to evaluate their correlation with dental malocclusion, with a focus on identifying specific malocclusions that may serve as risk factors for ADD. Materials and methods Ethics approval and consent to participate This study enrolled a consecutive series of patients who sought care at the TMJ and Orthodontic Clinic within the Department of Oral Surgery at Shanghai Ninth People's Hospital, between January 2020 and December 2022, and provided their informed consent to participate. The study obtained approval from the Human Research Ethics Committee of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (SH9H-2020-T7-1), and adhered to the principles outlined in the Declaration of Helsinki and the STROBE Guidelines. Study population The inclusion criteria for this study were defined as follows: (1) patients aged between 11 and 35 years, (2) patients with permanent dentition, and (3) requirement of patients to provide their own consent to participate, along with consent obtained from their parents or legal guardians. The following criteria were used for exclusion: (1) individuals with contraindications for MRI examination, (2) individuals with a history of TMJ surgery, (3) individuals with a history of orthodontic treatment, (4) individuals with systemic diseases, (5) individuals with craniofacial growth disturbances, infections, or trauma affecting the craniofacial area, (6) individuals with psychological disorders or a history of prolonged medication use (exceeding 1 month), and (7) individuals who declined to participate or whose parents declined their participation. Magnetic resonance imaging examination and evaluation All participants underwent TMJ MRI examination using a uniform 3.0-T MRI scanner (Signa, General Electric, USA). The position of the disc was assessed through sagittal and coronal slices of T1-weighted or proton-density MRI, both with the mouth closed and open. Following the method developed by Ikeda [16, 17] , a normal disc position was determined when the posterior band was observed at the 12 o'clock position with the mouth closed (Fig. 1A) . If the posterior band was located at 10 o'clock or lower in the OSag images, it was classified as ADD. ADDwR was diagnosed when the disc was displaced anteriorly in relation to the posterior slope of the articular eminence and the condyle head, accompanied by disc reduction upon mouth opening (Fig. 1B) . ADDwoR was diagnosed when the disc was displaced anteriorly in relation to the posterior slope of the articular eminence and the condyle head, but without reduction of the disc upon mouth opening (Fig. 1C) . CR was assessed through the utilization of MRI to observe the morphological characteristics of the condyle. (Fig. 1D) . Two experienced doctors, who underwent standardized training, independently interpreted all MRI images in a blinded manner. Participants were categorized into eight groups based on the findings from TMJ MRI to assess the presence of ADD and CR. The groups were defined as follows: Group 1 included individuals with bilateral normal TMJ; Group 2 comprised individuals with ADDwR without CR on one side and normal TMJ on the other side; Group 3 consisted of individuals with ADDwoR without CR on one side and normal TMJ on the other side; Group 4 included individuals with ADDwoR with CR on one side and normal TMJ on the other side; Group 5 comprised individuals with bilateral ADDwR without CR; Group 6 consisted of individuals with one side showing ADDwR without CR and the other side showing ADDwoR without CR; Group 7 included individuals with bilateral ADDwoR without CR; and Group 8 consisted of individuals with bilateral ADDwoR with CR 3D measurements of malocclusion The dental arches were captured digitally using a 3D scanner (3Shape, Copenhagen, Denmark), and subsequent measurements were conducted in sagittal and occlusal view planes using 3Shape software. This study examined the following dental malocclusions: Angle Class II, Angle Class III, mandibular midline shift > 2 mm, overbite > 4 mm, overjet > 5 mm, anterior open bite > 3 mm, individual crossbite, edge-to-edge incisor occlusion, posterior crossbite, posterior teeth absence, and lingual tipping deep overbite [9, 18] . Statistical analysis Statistical analyses were conducted using IBM SPSS Statistics software version 25.0. Descriptive statistics, including means and frequencies, were utilized to present data for categorical variables. One-way ANOVA was performed to assess significant differences among means of more than two groups. The chi-squared test was employed to detect significant differences between categorical variables. Fisher's exact test was utilized for sample sizes less than five. Multivariable logistic regression analysis was conducted to investigate the association between dental malocclusion and ADD, calculating odds ratios (ORs) with corresponding 95% confidence intervals (CIs). All statistical tests were two-tailed, and a significance level of p < 0.05 was considered statistically significant. Results Participant characteristics A total of 552 patients underwent dental occlusion scanning and TMJ MRI examination. Results from the one-way ANOVA indicated a statistically significant difference in age among the different groups. Specifically, patients in the ADD with CR groups (Group 4 and Group 8) were older compared to those in the ADD without CR groups (Group 2, Group 3, Group 5, Group 6, and Group 7) as well as the normal group (Group 1). This finding suggests that the severity of ADD tends to increase with age. Furthermore, the chi-square test revealed a higher incidence of ADD in females as compared to males (Table 1). Proportion of dental malocclusion in patients with unilateral ADD The proportion of dental malocclusion was compared between patients with unilateral ADD (Group 2, 3, and 4) and the normal group (Group 1). The findings revealed that among the unilateral ADD population, the proportions of mandibular midline shift > 2 mm, anterior open bite > 3 mm, posterior teeth absence, individual crossbite, and posterior crossbite were significantly higher compared to the normal group. Moreover, as the severity of ADD increased, the proportions of mandibular midline shift > 2 mm, anterior open bite > 3 mm, and posterior teeth absence also increased (Table 2) . To further examine the characteristics and distinctions in malocclusion between patients with unilateral ADD without CR and patients with unilateral ADD with CR, we combined the Group 2 and Group 3 as unilateral ADD without CR. The results indicated that the proportions of Angle Class II, mandibular midline shift > 2 mm, anterior open bite > 3 mm, posterior crossbite, and posterior teeth absence were higher in the group with unilateral ADD with CR compared to the group with unilateral ADD without CR and the normal group. Additionally, the proportion of individual crossbite was higher in both the group with unilateral ADD without CR and the group with unilateral ADD with CR compared to the normal group (Table 3) . Risk factors of unilateral ADD associated with dental malocclusion To further investigate the actual impact of these malocclusions on unilateral ADD, a multivariate logistic regression analysis was conducted. Variables that demonstrated a P -value of less than 0.05 in the chi-square test were included in the analysis. The findings revealed that age (OR = 1.169), mandibular midline shift > 2 mm (OR = 2.631), and posterior crossbite (OR = 16.654) significantly increased the likelihood of unilateral ADD without CR Moreover, age (OR = 1.342), mandibular midline shift > 2 mm (OR = 6.291), anterior open bite > 3 mm (OR = 51.482), and posterior crossbite (OR = 26.437) significantly increased the likelihood of unilateral ADD with CR (Table 4) . Proportion of dental malocclusion in patients with bilateral ADD Subsequently, we compared the malocclusion characteristics of patients with bilateral ADD (Group 5, 6, 7, and 8) to the normal group (Group 1). Within the population exhibiting bilateral ADD, there were significantly higher proportions of Angle Class II malocclusion, overbite > 4 mm, overjet > 5 mm, anterior open bite > 3 mm, posterior crossbite, posterior teeth absence, and lingual tipping deep overbite compared to the normal group. Moreover, as the severity of ADD progressed, the proportion of overbite > 4 mm decreased, while the proportions of overjet > 5 mm and anterior open bite > 3 mm increased (Table 5) . In order to further examine the characteristics and disparities in malocclusion between patients with bilateral ADD without CR and patients with bilateral ADD with CR, we combined the Group 5, Group 6 and Group 7 as unilateral ADD without CR. The findings indicated that the proportions of Angle Class II malocclusion, overjet > 5 mm, anterior open bite > 3 mm, and posterior teeth absence were higher in the group with bilateral ADD with CR compared to the group with bilateral ADD without CR and the normal group. Moreover, the proportions of posterior crossbite and lingual tipping deep overbite were higher in both the group with bilateral ADD without CR and the group with bilateral ADD with CR compared to the normal group, while the proportion of overbite > 4 mm was higher in the group with bilateral ADD without CR in comparison to the group with bilateral ADD with CR and the normal group (Table 6) . Risk factors of bilateral ADD associated with dental malocclusion To further investigate the actual impact of these malocclusions on bilateral ADD, a multivariate logistic regression analysis was conducted. Variables with a P -value of less than 0.05 in the chi-square test were included in the analysis. The findings revealed that being female (OR = 3.708), age (OR = 1.255), overbite > 4 mm (OR = 4.942), and posterior crossbite (OR = 14.303) significantly increased the likelihood of bilateral ADD without. Furthermore, age (OR = 1.337), Angle Class II malocclusion (OR = 2.694), overjet > 5 mm (OR = 2.629), anterior open bite > 3 mm (OR = 51.203), and posterior crossbite (OR = 5.568) significantly increased the likelihood of bilateral ADD with CR (Table 7) . Discussion The condyle plays a significant role in the growth of the mandible, and a healthy relationship between the articular disc and condyle is crucial for normal masticatory function and facial growth [ 19 ] . Existing evidence suggests that long-term malocclusion can subject the TMJ to unfavorable stress and chronic trauma causing abnormal displacement of the articular disc [ 20 ] . However, it remains unclear which specific malocclusions serve as risk factors for ADD [ 21 ] . To investigate the malocclusions associated with ADD, we employed TMJ MRI for the diagnosis of ADD. Occlusal measurements were obtained using a three-dimensional digital model, which has been shown to offer greater precision and reliability compared to intraoral photographs and plaster models [ 22 , 23 ] . We examined the prevalence of sagittal and vertical occlusal relationships, midline deviations, and individual crossbites, along with their association with ADD. In our sample of 552 young individuals, we observed a higher incidence of ADD in females compared to males, consistent with previous literature [ 24 , 25 ] . This gender difference may be attributed to hormonal and anatomical variations, which could influence the susceptibility to ADD. Furthermore, the prevalence of ADD increased with age, indicating a progressive nature of the condition over time [ 26 ] . By comparing patients with unilateral and bilateral ADD to a normal joint group, we were able to identify distinct malocclusion characteristics associated with each group. Among individuals with unilateral ADD, we found significantly higher proportions of individuals with mandibular midline shift > 2 mm, anterior open bite > 3 mm, posterior teeth absence, individual crossbite, and posterior crossbite compared to the normal group. These findings suggest that these malocclusions may be associated with the presence of unilateral ADD. Moreover, in the group of individuals with unilateral ADD accompanied by CR, we observed higher proportions of individuals with Angle Class II malocclusion, mandibular midline shift > 2 mm, anterior open bite > 3 mm, posterior crossbite, and posterior teeth absence compared to the group with unilateral ADD without CR and the normal group. This suggests that occlusal characteristics may change with the development of unilateral ADD. This may be influenced by unilateral CR and the resulting mandibular deviation [ 27 ] . Multivariate logistic regression analysis further supported the association between specific malocclusions and the likelihood of developing ADD. Mandibular midline shift > 2 mm, and posterior crossbite were identified as significant risk factors for unilateral ADD without CR. Additionally, mandibular midline shift > 2 mm, anterior open bite > 3 mm, and posterior crossbite were found to significantly increase the likelihood of unilateral ADD with CR. These findings suggest that while mandibular midline shift and anterior open bite may not be the sole etiological factors for unilateral ADD, they may serve as indicators of the progression of ADD when accompanied by secondary occlusal changes resulting from CR. Moving on to the comparison between patients with bilateral ADD and the normal group, we observed several malocclusion characteristics that were significantly more prevalent in the bilateral ADD population. These included Angle Class II malocclusion, overbite > 4 mm, overjet > 5 mm, anterior open bite > 3 mm, posterior crossbite, posterior teeth absence, and lingual tipping deep overbite. These findings suggest that these malocclusions may be associated with the presence of bilateral ADD. In the group of individuals with bilateral ADD accompanied by CR, we observed higher proportions of individuals with Angle Class II malocclusion, overjet > 5 mm, anterior open bite > 3 mm, and posterior teeth absence compared to the group with bilateral ADD without CR and the normal group. Interestingly, the proportion of individuals with overbite > 4 mm was higher in the group with bilateral ADD without CR compared to the group with bilateral ADD with CR and the normal group. This may be attributed to the progression of bilateral ADD, which leads to a shortening of the bilateral condyles and clockwise rotation of the mandible [ 18 , 28 ] . As a result, it causes deep overjet and anterior open bite, while simultaneously reducing the severity of deep overbite. These findings further support the view that specific malocclusions may be associated with the presence and progression of bilateral ADD. Multivariate logistic regression analysis revealed that overbite > 4 mm, and posterior crossbite were significant risk factors for bilateral ADD without CR. Moreover, Angle Class II malocclusion, overjet > 5 mm, anterior open bite > 3 mm, and posterior crossbite significantly increased the likelihood of bilateral ADD with CR. These findings suggest that overjet > 5 mm and anterior open bite > 3 mm may not be the risk factors for bilateral ADD without CR but rather indicative of the progression of ADD with accompanying secondary occlusal changes resulting from CR. It is important to note that our study provides valuable insights into the association between dental malocclusions and ADD, but further longitudinal studies are necessary to establish a causal relationship. Long-term follow-up studies would help elucidate the relationship between malocclusions and the development and progression of ADD, as well as the impact of CR on occlusal changes. Additionally, investigating other potential risk factors such as genetic predisposition, environmental factors, and occlusal habits could contribute to a more comprehensive understanding of the etiology of ADD [ 29 – 31 ] . Conclusions In conclusion, our study highlights the significance of occlusal characteristics in relation to TMJ health. Specific malocclusions, such as mandibular midline shift > 2 mm, posterior crossbite, and overbite > 4 mm are associated with the presence of ADD. Angle Class II malocclusion, anterior open bite and overjet > 5 mm are associated with progression of ADD. These findings emphasize the crucial importance of early treatment of malocclusions to prevent the development and progression of ADD. Abbreviations TMJ: temporomandibular joint ADD: anterior disc displacement ADDwR: anterior disc displacement with reduction ADDwoR: anterior disc displacement without reduction CR: condylar resorption MRI: magnetic resonance imaging ORs: odds ratios CIs: confidence intervals Declarations Ethics approval and consent to participate The study was approved by the Human Research Ethics Committee of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (SH9H-2020-T7-1). Informed consent was obtained from all study participants. All study participants and their parents have provided informed consent for to publish their identifiable images or information in open access journal in this study. All methods were carried out in accordance with relevant guidelines and regulations in the declaration. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study received support from the National Natural Science Foundation of China (81870785 and 82071134) and a dominant disease biological sample project at the Ninth People’s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (YBKA201908). Authors’ contributions All authors contributed to the conception and design of the study. Guanlin Qu contributed to the conception, design, data acquisition, statistical analysis, and drafted the manuscript. Lingtong Bu contributed to the data acquisition and statistical analysis. Pei Shen, Qianyang Xie, Jing Ge and Yi Luo contributed to the data acquisition. Zhigui Ma contributed to conception, design, data acquisition, statistical analysis, and critically revised the manuscript. Chi Yang contributed to the conception, design, analysis, interpretation, and critically revised the manuscript. All authors provided final approval and agreed to be accountable for all aspects of the work. Acknowledgements We would like to thank the participants to join this study. References Ohrbach R, Dworkin SF. The Evolution of TMD Diagnosis: Past, Present, Future. J Dent Res, 2016, 95(10) : 1093-1101. He D, Yang C, Zhu H, Ellis E, 3rd. Temporomandibular Joint Disc Repositioning by Suturing Through Open Incision: A Technical Note. J Oral Maxillofac Surg, 2018, 76(5) : 948-954. Nebbe B, Major PW. Prevalence of TMJ disc displacement in a pre-orthodontic adolescent sample. Angle Orthod, 2000, 70(6) : 454-463. 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Is there a relationship between psychological factors and TMD? Brain Behav, 2019, 9(9) : e01360. Bergmann A, Edelhoff D, Schubert O, Erdelt KJ, Pho Duc JM. Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial. Clin Oral Investig, 2020, 24(11) : 4005-4018. Tables Table 1 . Participant characteristics Group 1 n = 365 Group 2 n = 22 Group 3 n = 24 Group 4 n = 28 Group 5 n = 21 Group 6 n = 24 Group 7 n = 22 Group 8 n = 46 p value Age (Mean ± SD) Range in years Gender Male Female 13.12 ± 3.76 11-34 194 (53.2%) 171 (46.8%) 18.32 ± 5.84 11-32 8 (36.4%) 14 (63.6%) 20.46 ± 5.59 12-30 4 (16.7%) 20 (83.3%) 25.14 ± 6.53 14-35 6 (21.4%) 22 (78.6%) 19.05 ± 6.25 11-33 3 (14.3%) 18 (85.7%) 20.58 ± 3.82 14-26 5 (20.8%) 19 (79.2%) 23.27 ± 4.80 14-34 3 (13.6%) 19 (86.4%) 23.74 ± 5.64 12-35 6 (13.0%) 40 (87.0%) <0.001* <0.001 # Results of one-way ANOVA, * p < 0.05 Results of chi-squared test, # p < 0.05 Table 2 . Proportion of dental malocclusion in patients with unilateral ADD Group 1 n = 365 Group 2 n = 22 Group 3 n = 24 Group 4 n = 28 p value Molar relationship Angle Class I Angle Class II Angle Class III 158 (43.3%) 137 (37.5%) 70 (19.2%) 7 (31.8%) 10 (45.5%) 5 (22.7%) 11 (45.8%) 9 (37.5%) 4 (16.7%) 12 (42.9%) 12 (42.9%) 4 (14.3%) 0.940 Mandibular midline shift > 2 mm Overbite > 4 mm Overjet > 5 mm Anterior open bite > 3 mm Individual crossbite Edge-to-edge incisor occlusion Posterior crossbite Posterior teeth absence Lingual tipping deep overbite 33 (9.0%) 62 (17.0%) 106 (29.0%) 2 (0.5%) 34 (9.3%) 13 (3.6%) 3 (0.8%) 5 (1.4%) 3 (0.8%) 5 (22.7%) 5 (22.7%) 7 (31.8%) 1 (4.5%) 4 (18.2%) 0 (0.0%) 5 (22.7%) 1 (4.5%) 0 (0.0%) 5 (20.8%) 4 (16.7%) 5 (20.8%) 1 (4.2%) 7 (29.2%) 2 (8.3%) 5 (20.8%) 2 (8.3%) 1 (4.2%) 10 (35.7%) 7 (25.0%) 11 (39.3%) 3 (10.7%) 6 (21.4%) 3 (10.7%) 8 (28.6%) 5 (17.9%) 0 (0.0%) <0.001* 0.672 0.522 <0.001 # <0.001 # 0.144 <0.001 # <0.001 # 0.346 Chi-squared test for unilateral ADD, * p < 0.05 Results of Fisher’s exact test, # p < 0.05 Table 3 . Proportion of dental malocclusion in patients with unilateral ADD with or without CR Normal (Group 1) n = 365 Unilateral ADD without CR (Group 2 and 3) n = 46 Unilateral ADD with CR (Group 4) n = 28 p value Molar relationship Angle Class I Angle Class II Angle Class III 158 (43.3%) 137 (37.5%) 70 (19.2%) 18 (39.1%) 19 (41.3%) 9 (19.6%) 12 (42.9%) 12 (42.9%) 4 (14.3%) 0.028* Mandibular midline shift > 2 mm Overbite > 4 mm Overjet > 5 mm Anterior open bite > 3 mm Individual crossbite Edge-to-edge incisor occlusion Posterior crossbite Posterior teeth absence Lingual tipping deep overbite 33 (9.0%) 62 (17.0%) 106 (29.0%) 2 (0.5%) 34 (9.3%) 13 (3.6%) 3 (0.8%) 5 (1.4%) 3 (0.8%) 10 (21.7%) 9 (19.6%) 12 (26.1%) 2 (4.3%) 11 (23.9%) 2 (4.3%) 10 (21.7%) 3 (6.5%) 1 (0.2%) 10 (35.7%) 7 (25.0%) 11 (39.3%) 3 (10.7%) 6 (21.4%) 3 (10.7%) 8 (28.6%) 5 (17.9%) 0 (0.0%) <0.001* 0.533 0.453 <0.001 # 0.004* 0.183 <0.001* <0.001 # 0.576 Chi-squared test for unilateral ADD, * p < 0.05 Results of Fisher’s exact test, # p < 0.05 Table 4 . Risk factors of unilateral ADD with or without CR associated with dental malocclusion Unilateral ADD without CR (Group 2 and 3) n = 46 Unilateral ADD with CR (Group 4) n = 28 Odds ratio (95% CI) p value Odds ratio (95% CI) p value Gender Male Female Age Molar relationship Angle Class I Angle Class II Angle Class III 1.169 (1.101-1.241) <0.001* 1.342 (1.228-1.467) 2 mm Anterior open bite > 3 mm Individual crossbite Posterior crossbite Posterior teeth absence 2.631 (1.055-6.560) 16.654 (4.041-68.642) 0.038* <0.001* 6.291 (1.874-21.113) 51.482 (4.668-567.797) 26.437 (5.118-136.557) 0.003* <0.001* <0.001* Results of multivariate logistic regression analysis, * p < 0.05. Table 5 . Proportion of dental malocclusion in patients with bilateral ADD Group 1 n = 365 Group 5 n = 21 Group 6 n = 24 Group 7 n = 22 Group 8 n = 46 p value Molar relationship Angle Class I Angle Class II Angle Class III 158 (43.3%) 137 (37.5%) 70 (19.2%) 7 (33.3%) 12 (57.1%) 2 (9.5%) 7 (29.2%) 13 (54.2%) 4 (16.7%) 8 (36.4%) 10 (45.5%) 4 (18.2%) 12 (26.1%) 30 (65.2%) 4 (8.7%) 0.028* Mandibular midline shift > 2 mm Overbite > 4 mm Overjet > 5 mm Anterior open bite > 3 mm Individual crossbite Edge-to-edge incisor occlusion Posterior crossbite Posterior teeth absence Lingual tipping deep overbite 33 (9.0%) 62 (17.0%) 106 (29.0%) 2 (0.5%) 34 (9.3%) 13 (3.6%) 3 (0.8%) 5 (1.4%) 6 (1.6%) 4 (19.0%) 15 (71.4%) 5 (23.8%) 1 (4.8%) 2 (9.5%) 1 (4.8%) 5 (23.8%) 1 (4.8%) 5 (23.8%) 4 (16.7%) 8 (33.3%) 5 (20.8%) 0 (0.0%) 4 (16.7%) 0 (0.0%) 6 (25.0%) 0 (0.0%) 2 (8.3%) 2 (9.1%) 8 (36.4%) 8 (36.4%) 0 (0.0%) 4 (18.2%) 1 (4.5%) 4 (18.2%) 2 (9.1%) 1 (4.5%) 6 (13.0%) 8 (17.4%) 23 (50.0%) 11 (23.9%) 3 (6.5%) 3 (6.5%) 5 (10.9%) 5 (10.9%) 2 (4.3%) 0.428 <0.001* 0.034* <0.001 # 0.452 0.186 <0.001 # <0.001 # <0.001 # Chi-squared test for bilateral ADD, * p < 0.05 Results of Fisher’s exact test, # p < 0.05 Table 6 . Proportion of dental malocclusion in patients with bilateral ADD with or without CR Normal (Group 1) n = 365 Bilateral ADD without CR (Group 5, 6 and 7) n = 67 Bilateral ADD with CR (Group 8) n = 46 p value Molar relationship Angle Class I Angle Class II Angle Class III 158 (43.3%) 137 (37.5%) 70 (19.2%) 22 (32.8%) 35 (52.2%) 10 (14.9%) 12 (26.1%) 30 (65.2%) 4 (8.7%) 0.003* Mandibular midline shift > 2 mm Overbite > 4 mm Overjet > 5 mm Anterior open bite > 3 mm Individual crossbite Edge-to-edge incisor occlusion Posterior crossbite Posterior teeth absence Lingual tipping deep overbite 33 (9.0%) 62 (17.0%) 106 (29.0%) 2 (0.5%) 34 (9.3%) 13 (3.6%) 3 (0.8%) 5 (1.4%) 3 (0.8%) 10 (14.9%) 31 (46.3%) 18 (26.9%) 1 (1.5%) 10 (14.9%) 2 (3.0%) 15 (22.4%) 3 (4.5%) 8 (11.9%) 6 (13.0%) 8 (17.4%) 23 (50.0%) 11 (23.9%) 3 (6.5%) 3 (6.5%) 5 (10.9%) 5 (10.9%) 2 (4.3%) 0.278 <0.001* 0.011* <0.001 # 0.267 0.572 <0.001 # <0.001 # <0.001 # Chi-squared test for bilateral ADD, * p < 0.05 Results of Fisher’s exact test, # p < 0.05 Table 7 . Risk factors of bilateral ADD with or without CR associated with dental malocclusion Bilateral ADD without CR (Group 5, 6 and 7) n = 67 Bilateral ADD with CR (Group 8) n = 46 Odds ratio (95% CI) p value Odds ratio (95% CI) p value Gender Male Female Age Molar relationship Angle Class I Angle Class II Angle Class III 3.708 (1.614-8.521) 1.255 (1.180-1.335) 0.002* <0.001* 1.337 (1.240-1.441) 2.694 (0.972-7.464) 4 mm Overjet > 5 mm Anterior open bite > 3 mm Posterior crossbite Posterior teeth absence Lingual tipping deep overbite 4.942 (2.139-11.416) 14.303 (3.170-64.535) <0.001* <0.001* 2.629 (0.982-7.038) 51.203 (6.387-410.506) 5.568 (0.933-33.248) 0.044* <0.001* 0.040* Results of multivariate logistic regression analysis, * p < 0.05. Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lingtong","middleName":"","lastName":"Bu","suffix":""},{"id":235596519,"identity":"081b76e2-99c3-44f9-b03c-665f521a122e","order_by":2,"name":"Pei Shen","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pei","middleName":"","lastName":"Shen","suffix":""},{"id":235596520,"identity":"4e357833-7333-4a5c-84ee-48d379f46857","order_by":3,"name":"Qianyang Xie","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qianyang","middleName":"","lastName":"Xie","suffix":""},{"id":235596521,"identity":"7db0acba-1f12-4beb-9408-18dff1ef3c64","order_by":4,"name":"Jing Ge","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Ge","suffix":""},{"id":235596522,"identity":"74120536-ac55-4edd-b88f-6edecf478f47","order_by":5,"name":"Yi Luo","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Luo","suffix":""},{"id":235596523,"identity":"7fcff0f9-fd60-47c9-ba21-3f249b04abdc","order_by":6,"name":"Zhigui Ma","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhigui","middleName":"","lastName":"Ma","suffix":""},{"id":235596524,"identity":"f032dffa-cf50-41c2-8952-e05c0afe9f77","order_by":7,"name":"Chi Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYPCCAzz8/M0HDnz4QYoWyRnHEg/O7CFBC4NBQ47xYQ42ItQaHD97+AVDzR0ZA4YzHw4z8DDI84sdIKDlTF6aBcOxZzzmzL0bDhdYMBjOnJ1AQMuBHDMDxobDPJYNZzccnsHDkGBwm5CW828gWoB6HxzmYSNGy40c4wdQLQzEaZG88caMgeHYYVAgGwADWYKwX/jO5xh/YKg5bA+MyscfPvywkeeXJqBF4QADm/QfBF8Cv3IQkG9gYP5AWNkoGAWjYBSMaAAAujtL93A2qI0AAAAASUVORK5CYII=","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chi","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2023-09-05 07:44:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3326678/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3326678/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":43912140,"identity":"d7c1d13e-0d44-4e26-99f3-26add2729bec","added_by":"auto","created_at":"2023-09-29 22:30:35","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":268953,"visible":true,"origin":"","legend":"\u003cp\u003eExamples of subgrouping patients based on MRIs. \u003cstrong\u003e(A)\u003c/strong\u003e Normal radiographic relationship between disc and condyle. \u003cstrong\u003e(B)\u003c/strong\u003e ADDwR without CR. \u003cstrong\u003e(C)\u003c/strong\u003e ADDwoR without CR. \u003cstrong\u003e(D) \u003c/strong\u003eADDwoR with CR.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3326678/v1/c9b65b918466603322b7c9b8.jpg"},{"id":44780523,"identity":"ccd2179b-0ab7-4d68-8a6e-efef394f06d1","added_by":"auto","created_at":"2023-10-17 12:52:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":543791,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3326678/v1/2beba8f0-5842-4117-b2bc-d9c283d01806.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factors of temporomandibular joint anterior disc displacement associated with dental malocclusion: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTemporomandibular disorders include a range of conditions that impact the temporomandibular joint (TMJ) as well as the surrounding muscles and tissues\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Among these disorders, anterior disc displacement (ADD) stands as the most prevalent type, affecting up to 26% of adolescents and young adult females\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. It is characterized by clicking and popping sounds during mandible movement, limited mouth opening, and pain in the front of the ear\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eADD can be categorized into two subtypes: anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR), depending on whether the disc can return to the normal position upon mouth opening. ADDwoR generally corresponds to the advanced stage of ADD, and with the progression of the condition, it can lead to condylar resorption (CR)\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Unilateral CR can result in mandible deviation, while bilateral CR can lead to mandible retrusion, ultimately causing secondary occlusal disorders and dentofacial deformities\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Therefore, there is a close relationship between the occlusal disorders and progression of ADD.\u003c/p\u003e \u003cp\u003eDental malocclusions can be both a result of the progression of ADD and a contributing factor to the occurrence of ADD\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Biomechanical factors are widely believed to play a pivotal role in the pathogenesis of ADD\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Mechanically, abnormal pressure exerted on the TMJ can cause the articular disc to displace from the condyle, while prolonged malocclusion can result in detrimental stress and chronic trauma to the TMJ\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Thus, dental occlusion also plays a critical role in maintaining the stability of the TMJ\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. However, the specific malocclusions that serve as risk factors for the development of ADD remain unclear.\u003c/p\u003e \u003cp\u003ePrevious studies have demonstrated that the prevalence of ADD in asymptomatic populations is approximately 30%\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Consequently, relying solely on clinical symptoms for diagnosing ADD may lead to underdiagnosis. In terms of imaging examinations, magnetic resonance imaging (MRI) is an effective tool for diagnosing ADD due to its ability to provide clear visualization of the morphology and relative positions of the temporomandibular joint disc, condyle, and joint fossa. Moreover, MRI is considered safer than CT as it does not involve ionizing radiation\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Thus, MRI has been widely used in the diagnosis of temporomandibular joint disorders, including disc displacement and condylar resorption.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, TMJ MRI was employed to diagnose ADD and CR to evaluate their correlation with dental malocclusion, with a focus on identifying specific malocclusions that may serve as risk factors for ADD.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study enrolled a consecutive series of patients who sought care at the TMJ and Orthodontic Clinic within the Department of Oral Surgery at Shanghai Ninth People\u0026apos;s Hospital, between January 2020 and December 2022, and provided their informed consent to participate. The study obtained approval from the Human Research Ethics Committee of Shanghai Ninth People\u0026apos;s Hospital, Shanghai Jiao Tong University School of Medicine (SH9H-2020-T7-1), and adhered to the principles outlined in the Declaration of Helsinki and the STROBE Guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for this study were defined as follows: (1) patients aged between 11 and 35 years, (2) patients with permanent dentition, and (3) requirement of patients to provide their own consent to participate, along with consent obtained from their parents or legal guardians.\u003c/p\u003e\n\u003cp\u003eThe following criteria were used for exclusion: (1) individuals with contraindications for MRI examination, (2) individuals with a history of TMJ surgery, (3) individuals with a history of orthodontic treatment, (4) individuals with systemic diseases, (5) individuals with craniofacial growth disturbances, infections, or trauma affecting the craniofacial area, (6) individuals with psychological disorders or a history of prolonged medication use (exceeding 1 month), and (7) individuals who declined to participate or whose parents declined their participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMagnetic resonance imaging examination and evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants underwent TMJ MRI examination using a uniform 3.0-T MRI scanner (Signa, General Electric, USA). The position of the disc was assessed through sagittal and coronal slices of T1-weighted or proton-density MRI, both with the mouth closed and open. Following the method developed by Ikeda\u003csup\u003e[16, 17]\u003c/sup\u003e, a normal disc position was determined when the posterior band was observed at the 12 o\u0026apos;clock position with the mouth closed \u003cstrong\u003e(Fig. 1A)\u003c/strong\u003e. If the posterior band was located at 10 o\u0026apos;clock or lower in the OSag images, it was classified as ADD. ADDwR was diagnosed when the disc was displaced anteriorly in relation to the posterior slope of the articular eminence and the condyle head, accompanied by disc reduction upon mouth opening \u003cstrong\u003e(Fig. 1B)\u003c/strong\u003e. ADDwoR was diagnosed when the disc was displaced anteriorly in relation to the posterior slope of the articular eminence and the condyle head, but without reduction of the disc upon mouth opening \u003cstrong\u003e(Fig. 1C)\u003c/strong\u003e. CR was assessed through the utilization of MRI to observe the morphological characteristics of the condyle. \u003cstrong\u003e(Fig. 1D)\u003c/strong\u003e. Two experienced doctors, who underwent standardized training, independently interpreted all MRI images in a blinded manner.\u003c/p\u003e\n\u003cp\u003eParticipants were categorized into eight groups based on the findings from TMJ MRI to assess the presence of ADD and CR. The groups were defined as follows: Group 1 included individuals with bilateral normal TMJ; Group 2 comprised individuals with ADDwR without CR on one side and normal TMJ on the other side; Group 3 consisted of individuals with ADDwoR without CR on one side and normal TMJ on the other side; Group 4 included individuals with ADDwoR with CR on one side and normal TMJ on the other side; Group 5 comprised individuals with bilateral ADDwR without CR; Group 6 consisted of individuals with one side showing ADDwR without CR and the other side showing ADDwoR without CR; Group 7 included individuals with bilateral ADDwoR without CR; and Group 8 consisted of individuals with bilateral ADDwoR with CR\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3D measurements of malocclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dental arches were captured digitally using a 3D scanner (3Shape, Copenhagen, Denmark), and subsequent measurements were conducted in sagittal and occlusal view planes using 3Shape software. This study examined the following dental malocclusions: Angle Class II, Angle Class III, mandibular midline shift \u0026gt; 2 mm, overbite \u0026gt; 4 mm, overjet \u0026gt; 5 mm, anterior open bite \u0026gt; 3 mm, individual crossbite, edge-to-edge incisor occlusion, posterior crossbite, posterior teeth absence, and lingual tipping deep overbite\u003csup\u003e[9, 18]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were conducted using IBM SPSS Statistics software version 25.0. Descriptive statistics, including means and frequencies, were utilized to present data for categorical variables. One-way ANOVA was performed to assess significant differences among means of more than two groups. The chi-squared test was employed to detect significant differences between categorical variables. Fisher\u0026apos;s exact test was utilized for sample sizes less than five. Multivariable logistic regression analysis was conducted to investigate the association between dental malocclusion and ADD, calculating odds ratios (ORs) with corresponding 95% confidence intervals (CIs). All statistical tests were two-tailed, and a significance level of \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 552 patients underwent dental occlusion scanning and TMJ MRI examination. Results from the one-way ANOVA indicated a statistically significant difference in age among the different groups. Specifically, patients in the ADD with CR groups (Group 4 and Group 8) were older compared to those in the ADD without CR groups (Group 2, Group 3, Group 5, Group 6, and Group 7) as well as the normal group (Group 1). This finding suggests that the severity of ADD tends to increase with age. Furthermore, the chi-square test revealed a higher incidence of ADD in females as compared to males \u003cstrong\u003e(Table\u0026nbsp;1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProportion of dental malocclusion in patients with unilateral ADD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proportion of dental malocclusion was compared between patients with unilateral ADD (Group 2, 3, and 4) and the normal group (Group 1). The findings revealed that among the unilateral ADD population, the proportions of mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, posterior teeth absence, individual crossbite, and posterior crossbite were significantly higher compared to the normal group. Moreover, as the severity of ADD increased, the proportions of mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, and posterior teeth absence also increased \u003cstrong\u003e(Table\u0026nbsp;2)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTo further examine the characteristics and distinctions in malocclusion between patients with unilateral ADD without CR and patients with unilateral ADD with CR, we combined the Group 2 and Group 3 as unilateral ADD without CR. The results indicated that the proportions of Angle Class II, mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, posterior crossbite, and posterior teeth absence were higher in the group with unilateral ADD with CR compared to the group with unilateral ADD without CR and the normal group. Additionally, the proportion of individual crossbite was higher in both the group with unilateral ADD without CR and the group with unilateral ADD with CR compared to the normal group \u003cstrong\u003e(Table\u0026nbsp;3)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk factors of unilateral ADD associated with dental malocclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further investigate the actual impact of these malocclusions on unilateral ADD, a multivariate logistic regression analysis was conducted. Variables that demonstrated a \u003cem\u003eP\u003c/em\u003e-value of less than 0.05 in the chi-square test were included in the analysis. The findings revealed that age (OR\u0026thinsp;=\u0026thinsp;1.169), mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm (OR\u0026thinsp;=\u0026thinsp;2.631), and posterior crossbite (OR\u0026thinsp;=\u0026thinsp;16.654) significantly increased the likelihood of unilateral ADD without CR Moreover, age (OR\u0026thinsp;=\u0026thinsp;1.342), mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm (OR\u0026thinsp;=\u0026thinsp;6.291), anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm (OR\u0026thinsp;=\u0026thinsp;51.482), and posterior crossbite (OR\u0026thinsp;=\u0026thinsp;26.437) significantly increased the likelihood of unilateral ADD with CR \u003cstrong\u003e(Table\u0026nbsp;4)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProportion of dental malocclusion in patients with bilateral ADD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubsequently, we compared the malocclusion characteristics of patients with bilateral ADD (Group 5, 6, 7, and 8) to the normal group (Group 1). Within the population exhibiting bilateral ADD, there were significantly higher proportions of Angle Class II malocclusion, overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm, overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, posterior crossbite, posterior teeth absence, and lingual tipping deep overbite compared to the normal group. Moreover, as the severity of ADD progressed, the proportion of overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm decreased, while the proportions of overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm and anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm increased \u003cstrong\u003e(Table\u0026nbsp;5)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eIn order to further examine the characteristics and disparities in malocclusion between patients with bilateral ADD without CR and patients with bilateral ADD with CR, we combined the Group 5, Group 6 and Group 7 as unilateral ADD without CR. The findings indicated that the proportions of Angle Class II malocclusion, overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, and posterior teeth absence were higher in the group with bilateral ADD with CR compared to the group with bilateral ADD without CR and the normal group. Moreover, the proportions of posterior crossbite and lingual tipping deep overbite were higher in both the group with bilateral ADD without CR and the group with bilateral ADD with CR compared to the normal group, while the proportion of overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm was higher in the group with bilateral ADD without CR in comparison to the group with bilateral ADD with CR and the normal group \u003cstrong\u003e(Table\u0026nbsp;6)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk factors of bilateral ADD associated with dental malocclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further investigate the actual impact of these malocclusions on bilateral ADD, a multivariate logistic regression analysis was conducted. Variables with a \u003cem\u003eP\u003c/em\u003e-value of less than 0.05 in the chi-square test were included in the analysis. The findings revealed that being female (OR\u0026thinsp;=\u0026thinsp;3.708), age (OR\u0026thinsp;=\u0026thinsp;1.255), overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm (OR\u0026thinsp;=\u0026thinsp;4.942), and posterior crossbite (OR\u0026thinsp;=\u0026thinsp;14.303) significantly increased the likelihood of bilateral ADD without. Furthermore, age (OR\u0026thinsp;=\u0026thinsp;1.337), Angle Class II malocclusion (OR\u0026thinsp;=\u0026thinsp;2.694), overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm (OR\u0026thinsp;=\u0026thinsp;2.629), anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm (OR\u0026thinsp;=\u0026thinsp;51.203), and posterior crossbite (OR\u0026thinsp;=\u0026thinsp;5.568) significantly increased the likelihood of bilateral ADD with CR \u003cstrong\u003e(Table\u0026nbsp;7)\u003c/strong\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe condyle plays a significant role in the growth of the mandible, and a healthy relationship between the articular disc and condyle is crucial for normal masticatory function and facial growth\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Existing evidence suggests that long-term malocclusion can subject the TMJ to unfavorable stress and chronic trauma causing abnormal displacement of the articular disc\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. However, it remains unclear which specific malocclusions serve as risk factors for ADD\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eTo investigate the malocclusions associated with ADD, we employed TMJ MRI for the diagnosis of ADD. Occlusal measurements were obtained using a three-dimensional digital model, which has been shown to offer greater precision and reliability compared to intraoral photographs and plaster models\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. We examined the prevalence of sagittal and vertical occlusal relationships, midline deviations, and individual crossbites, along with their association with ADD. In our sample of 552 young individuals, we observed a higher incidence of ADD in females compared to males, consistent with previous literature\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. This gender difference may be attributed to hormonal and anatomical variations, which could influence the susceptibility to ADD. Furthermore, the prevalence of ADD increased with age, indicating a progressive nature of the condition over time\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBy comparing patients with unilateral and bilateral ADD to a normal joint group, we were able to identify distinct malocclusion characteristics associated with each group. Among individuals with unilateral ADD, we found significantly higher proportions of individuals with mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, posterior teeth absence, individual crossbite, and posterior crossbite compared to the normal group. These findings suggest that these malocclusions may be associated with the presence of unilateral ADD. Moreover, in the group of individuals with unilateral ADD accompanied by CR, we observed higher proportions of individuals with Angle Class II malocclusion, mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, posterior crossbite, and posterior teeth absence compared to the group with unilateral ADD without CR and the normal group. This suggests that occlusal characteristics may change with the development of unilateral ADD. This may be influenced by unilateral CR and the resulting mandibular deviation\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis further supported the association between specific malocclusions and the likelihood of developing ADD. Mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, and posterior crossbite were identified as significant risk factors for unilateral ADD without CR. Additionally, mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, and posterior crossbite were found to significantly increase the likelihood of unilateral ADD with CR. These findings suggest that while mandibular midline shift and anterior open bite may not be the sole etiological factors for unilateral ADD, they may serve as indicators of the progression of ADD when accompanied by secondary occlusal changes resulting from CR.\u003c/p\u003e\n\u003cp\u003eMoving on to the comparison between patients with bilateral ADD and the normal group, we observed several malocclusion characteristics that were significantly more prevalent in the bilateral ADD population. These included Angle Class II malocclusion, overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm, overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, posterior crossbite, posterior teeth absence, and lingual tipping deep overbite. These findings suggest that these malocclusions may be associated with the presence of bilateral ADD. In the group of individuals with bilateral ADD accompanied by CR, we observed higher proportions of individuals with Angle Class II malocclusion, overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, and posterior teeth absence compared to the group with bilateral ADD without CR and the normal group. Interestingly, the proportion of individuals with overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm was higher in the group with bilateral ADD without CR compared to the group with bilateral ADD with CR and the normal group. This may be attributed to the progression of bilateral ADD, which leads to a shortening of the bilateral condyles and clockwise rotation of the mandible\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. As a result, it causes deep overjet and anterior open bite, while simultaneously reducing the severity of deep overbite. These findings further support the view that specific malocclusions may be associated with the presence and progression of bilateral ADD.\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis revealed that overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm, and posterior crossbite were significant risk factors for bilateral ADD without CR. Moreover, Angle Class II malocclusion, overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, and posterior crossbite significantly increased the likelihood of bilateral ADD with CR. These findings suggest that overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm and anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm may not be the risk factors for bilateral ADD without CR but rather indicative of the progression of ADD with accompanying secondary occlusal changes resulting from CR.\u003c/p\u003e\n\u003cp\u003eIt is important to note that our study provides valuable insights into the association between dental malocclusions and ADD, but further longitudinal studies are necessary to establish a causal relationship. Long-term follow-up studies would help elucidate the relationship between malocclusions and the development and progression of ADD, as well as the impact of CR on occlusal changes. Additionally, investigating other potential risk factors such as genetic predisposition, environmental factors, and occlusal habits could contribute to a more comprehensive understanding of the etiology of ADD\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, our study highlights the significance of occlusal characteristics in relation to TMJ health. Specific malocclusions, such as mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, posterior crossbite, and overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm are associated with the presence of ADD. Angle Class II malocclusion, anterior open bite and overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm are associated with progression of ADD. These findings emphasize the crucial importance of early treatment of malocclusions to prevent the development and progression of ADD.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTMJ: temporomandibular joint\u003c/p\u003e\n\u003cp\u003eADD: anterior disc displacement\u003c/p\u003e\n\u003cp\u003eADDwR: anterior disc displacement with reduction\u003c/p\u003e\n\u003cp\u003eADDwoR: anterior disc displacement without reduction\u003c/p\u003e\n\u003cp\u003eCR: condylar resorption\u003c/p\u003e\n\u003cp\u003eMRI: magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eORs: odds ratios\u003c/p\u003e\n\u003cp\u003eCIs: confidence intervals\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Human Research Ethics Committee of Shanghai Ninth People\u0026apos;s Hospital, Shanghai Jiao Tong University School of Medicine (SH9H-2020-T7-1). Informed consent was obtained from all study participants. All study participants and their parents have provided informed consent for to publish their identifiable images or information in open access journal in this study. All methods were carried out in accordance with relevant guidelines and regulations in the declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received support from the National Natural Science Foundation of China (81870785 and 82071134) and a dominant disease biological sample project at the Ninth People\u0026rsquo;s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (YBKA201908).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the study. Guanlin Qu contributed to the conception, design, data acquisition, statistical analysis, and drafted the manuscript. Lingtong Bu contributed to the data acquisition and statistical analysis. Pei Shen, Qianyang Xie, Jing Ge and Yi Luo contributed to the data acquisition. Zhigui Ma contributed to conception, design, data acquisition, statistical analysis, and critically revised the manuscript. Chi Yang contributed to the conception, design, analysis, interpretation, and critically revised the manuscript. All authors provided final approval and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the participants to join this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOhrbach R, Dworkin SF. The Evolution of TMD Diagnosis: Past, Present, Future. 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J Prosthodont, 2014, 23(5)\u003cstrong\u003e:\u003c/strong\u003e397-401.\u003c/li\u003e\n\u003cli\u003eIkeda K. A reference line on temporomandibular joint MRI. J Prosthodont, 2013, 22(8)\u003cstrong\u003e:\u003c/strong\u003e603-607.\u003c/li\u003e\n\u003cli\u003eKalladka M, Young A, Thomas D, Heir GM, Quek SYP, Khan J. The relation of temporomandibular disorders and dental occlusion: a narrative review. Quintessence Int, 2022, 53(5)\u003cstrong\u003e:\u003c/strong\u003e450-459.\u003c/li\u003e\n\u003cli\u003eIoi H, Matsumoto R, Nishioka M, Goto TK, Nakata S, Nakasima A, Counts AL. Relationship of TMJ osteoarthritis / osteoarthrosis to head posture and dentofacial morphology. Orthod Craniofac Res, 2008, 11(1)\u003cstrong\u003e:\u003c/strong\u003e8-16.\u003c/li\u003e\n\u003cli\u003eMcNamara JA, Jr., Seligman DA, Okeson JP. Occlusion, Orthodontic treatment, and temporomandibular disorders: a review. J Orofac Pain, 1995, 9(1)\u003cstrong\u003e:\u003c/strong\u003e73-90.\u003c/li\u003e\n\u003cli\u003eMohlin B, Axelsson S, Paulin G, Pietil\u0026auml; T, Bondemark L, Brattstr\u0026ouml;m V, Hansen K, Holm AK. TMD in relation to malocclusion and orthodontic treatment. Angle Orthod, 2007, 77(3)\u003cstrong\u003e:\u003c/strong\u003e542-548.\u003c/li\u003e\n\u003cli\u003eTomita Y, Uechi J, Konno M, Sasamoto S, Iijima M, Mizoguchi I. Accuracy of digital models generated by conventional impression/plaster-model methods and intraoral scanning. Dent Mater J, 2018, 37(4)\u003cstrong\u003e:\u003c/strong\u003e628-633.\u003c/li\u003e\n\u003cli\u003eKardach H, Szponar-Żurowska A, Biedziak B. A Comparison of Teeth Measurements on Plaster and Digital Models. J Clin Med, 2023, 12(3).\u003c/li\u003e\n\u003cli\u003eWang S, Chen Y, Guo W, She D, Liao Y, Xing Z, Huang N, Huang H, Cao D. Gender differences in lateral pterygoid muscle in patients with anterior disk displacement. Oral Dis, 2022.\u003c/li\u003e\n\u003cli\u003eKaya K, Dulgeroglu D, Unsal-Delialioglu S, Babadag M, Tacal T, Barlak A, Ozel S. Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement. J Craniomaxillofac Surg, 2010, 38(5)\u003cstrong\u003e:\u003c/strong\u003e391-395.\u003c/li\u003e\n\u003cli\u003eHuddleston Slater JJ, Lobbezoo F, Onland-Moret NC, Naeije M. Anterior disc displacement with reduction and symptomatic hypermobility in the human temporomandibular joint: prevalence rates and risk factors in children and teenagers. J Orofac Pain, 2007, 21(1)\u003cstrong\u003e:\u003c/strong\u003e55-62.\u003c/li\u003e\n\u003cli\u003eNojima K, Niizuma-Kosaka F, Nishii Y, Sueishi K, Yamakura D, Ikumoto H, Ohata H, Inoue T. Multidisciplinary treatment of peripheral osteoma arising from mandibular condyle in patient presenting with facial asymmetry. Bull Tokyo Dent Coll, 2014, 55(1)\u003cstrong\u003e:\u003c/strong\u003e39-47.\u003c/li\u003e\n\u003cli\u003eIngawal\u0026eacute; S, Goswami T. Temporomandibular joint: disorders, treatments, and biomechanics. Ann Biomed Eng, 2009, 37(5)\u003cstrong\u003e:\u003c/strong\u003e976-996.\u003c/li\u003e\n\u003cli\u003eList T, Jensen RH. Temporomandibular disorders: Old ideas and new concepts. Cephalalgia, 2017, 37(7)\u003cstrong\u003e:\u003c/strong\u003e692-704.\u003c/li\u003e\n\u003cli\u003eS\u0026oacute;jka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav, 2019, 9(9)\u003cstrong\u003e:\u003c/strong\u003ee01360.\u003c/li\u003e\n\u003cli\u003eBergmann A, Edelhoff D, Schubert O, Erdelt KJ, Pho Duc JM. Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial. Clin Oral Investig, 2020, 24(11)\u003cstrong\u003e:\u003c/strong\u003e4005-4018.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Participant characteristics\u003c/p\u003e\n\u003ctable border=\"1\" width=\"950\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"12.686567164179104%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.343283582089553%\"\u003e\n\u003cp\u003eGroup 1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003eGroup 2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003eGroup 3\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003eGroup 4\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003eGroup 5\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003eGroup 6\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003eGroup 7\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003eGroup 8\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"7.014925373134329%\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"12.686567164179104%\"\u003e\n\u003cp\u003eAge (Mean \u0026plusmn; SD)\u003c/p\u003e\n\u003cp\u003eRange in years\u003c/p\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.343283582089553%\"\u003e\n\u003cp\u003e13.12 \u0026plusmn; 3.76\u003c/p\u003e\n\u003cp\u003e11-34\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e194 (53.2%)\u003c/p\u003e\n\u003cp\u003e171 (46.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003e18.32 \u0026plusmn; 5.84\u003c/p\u003e\n\u003cp\u003e11-32\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e8 (36.4%)\u003c/p\u003e\n\u003cp\u003e14 (63.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003e20.46 \u0026plusmn; 5.59\u003c/p\u003e\n\u003cp\u003e12-30\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4 (16.7%)\u003c/p\u003e\n\u003cp\u003e20 (83.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003e25.14 \u0026plusmn; 6.53\u003c/p\u003e\n\u003cp\u003e14-35\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6 (21.4%)\u003c/p\u003e\n\u003cp\u003e22 (78.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003e19.05 \u0026plusmn; 6.25\u003c/p\u003e\n\u003cp\u003e11-33\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3 (14.3%)\u003c/p\u003e\n\u003cp\u003e18 (85.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003e20.58 \u0026plusmn; 3.82\u003c/p\u003e\n\u003cp\u003e14-26\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5 (20.8%)\u003c/p\u003e\n\u003cp\u003e19 (79.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003e23.27 \u0026plusmn; 4.80\u003c/p\u003e\n\u003cp\u003e14-34\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3 (13.6%)\u003c/p\u003e\n\u003cp\u003e19 (86.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"9.850746268656716%\"\u003e\n\u003cp\u003e23.74 \u0026plusmn; 5.64\u003c/p\u003e\n\u003cp\u003e12-35\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6 (13.0%)\u003c/p\u003e\n\u003cp\u003e40 (87.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"7.014925373134329%\"\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults of one-way ANOVA, *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003eResults of chi-squared test, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Proportion of dental malocclusion in patients with unilateral ADD\u003c/p\u003e\n\u003ctable border=\"1\" width=\"850\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 59.625px;\"\u003e\n\u003ctd style=\"height: 59.625px;\" valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 59.625px;\" valign=\"top\" width=\"13.768115942028986%\"\u003e\n\u003cp\u003eGroup 1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 59.625px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003eGroup 2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 59.625px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003eGroup 3\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 59.625px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003eGroup 4\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 59.625px;\" valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 107px;\"\u003e\n\u003ctd style=\"height: 107px;\" valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003eMolar relationship\u003c/p\u003e\n\u003cp\u003eAngle Class I\u003c/p\u003e\n\u003cp\u003eAngle Class II\u003c/p\u003e\n\u003cp\u003eAngle Class III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 107px;\" valign=\"top\" width=\"13.768115942028986%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e158 (43.3%)\u003c/p\u003e\n\u003cp\u003e137 (37.5%)\u003c/p\u003e\n\u003cp\u003e70 (19.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 107px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7 (31.8%)\u003c/p\u003e\n\u003cp\u003e10 (45.5%)\u003c/p\u003e\n\u003cp\u003e5 (22.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 107px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11 (45.8%)\u003c/p\u003e\n\u003cp\u003e9 (37.5%)\u003c/p\u003e\n\u003cp\u003e4 (16.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 107px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12 (42.9%)\u003c/p\u003e\n\u003cp\u003e12 (42.9%)\u003c/p\u003e\n\u003cp\u003e4 (14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 107px;\" valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e0.940\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 240px;\"\u003e\n\u003ctd style=\"height: 240px;\" valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003eMandibular midline shift \u0026gt; 2 mm\u003c/p\u003e\n\u003cp\u003eOverbite \u0026gt; 4 mm\u003c/p\u003e\n\u003cp\u003eOverjet \u0026gt; 5 mm\u003c/p\u003e\n\u003cp\u003eAnterior open bite \u0026gt; 3 mm\u003c/p\u003e\n\u003cp\u003eIndividual crossbite\u003c/p\u003e\n\u003cp\u003eEdge-to-edge incisor occlusion\u003c/p\u003e\n\u003cp\u003ePosterior crossbite\u003c/p\u003e\n\u003cp\u003ePosterior teeth absence\u003c/p\u003e\n\u003cp\u003eLingual tipping deep overbite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 240px;\" valign=\"top\" width=\"13.768115942028986%\"\u003e\n\u003cp\u003e33 (9.0%)\u003c/p\u003e\n\u003cp\u003e62 (17.0%)\u003c/p\u003e\n\u003cp\u003e106 (29.0%)\u003c/p\u003e\n\u003cp\u003e2 (0.5%)\u003c/p\u003e\n\u003cp\u003e34 (9.3%)\u003c/p\u003e\n\u003cp\u003e13 (3.6%)\u003c/p\u003e\n\u003cp\u003e3 (0.8%)\u003c/p\u003e\n\u003cp\u003e5 (1.4%)\u003c/p\u003e\n\u003cp\u003e3 (0.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 240px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e5 (22.7%)\u003c/p\u003e\n\u003cp\u003e5 (22.7%)\u003c/p\u003e\n\u003cp\u003e7 (31.8%)\u003c/p\u003e\n\u003cp\u003e1 (4.5%)\u003c/p\u003e\n\u003cp\u003e4 (18.2%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003cp\u003e5 (22.7%)\u003c/p\u003e\n\u003cp\u003e1 (4.5%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 240px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e5 (20.8%)\u003c/p\u003e\n\u003cp\u003e4 (16.7%)\u003c/p\u003e\n\u003cp\u003e5 (20.8%)\u003c/p\u003e\n\u003cp\u003e1 (4.2%)\u003c/p\u003e\n\u003cp\u003e7 (29.2%)\u003c/p\u003e\n\u003cp\u003e2 (8.3%)\u003c/p\u003e\n\u003cp\u003e5 (20.8%)\u003c/p\u003e\n\u003cp\u003e2 (8.3%)\u003c/p\u003e\n\u003cp\u003e1 (4.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 240px;\" valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e10 (35.7%)\u003c/p\u003e\n\u003cp\u003e7 (25.0%)\u003c/p\u003e\n\u003cp\u003e11 (39.3%)\u003c/p\u003e\n\u003cp\u003e3 (10.7%)\u003c/p\u003e\n\u003cp\u003e6 (21.4%)\u003c/p\u003e\n\u003cp\u003e3 (10.7%)\u003c/p\u003e\n\u003cp\u003e8 (28.6%)\u003c/p\u003e\n\u003cp\u003e5 (17.9%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 240px;\" valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e0.672\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.522\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e0.144\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e0.346\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eChi-squared test\u0026nbsp;for unilateral ADD, *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003eResults of Fisher\u0026rsquo;s exact test, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Proportion of dental malocclusion in patients with unilateral ADD with or without CR\u003c/p\u003e\n\u003ctable border=\"1\" width=\"850\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"17.82608695652174%\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003e(Group 1)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003eUnilateral ADD without CR\u003c/p\u003e\n\u003cp\u003e(Group 2 and 3)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003eUnilateral ADD with CR\u003c/p\u003e\n\u003cp\u003e(Group 4)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003eMolar relationship\u003c/p\u003e\n\u003cp\u003eAngle Class I\u003c/p\u003e\n\u003cp\u003eAngle Class II\u003c/p\u003e\n\u003cp\u003eAngle Class III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"17.82608695652174%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e158 (43.3%)\u003c/p\u003e\n\u003cp\u003e137 (37.5%)\u003c/p\u003e\n\u003cp\u003e70 (19.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e18 (39.1%)\u003c/p\u003e\n\u003cp\u003e19 (41.3%)\u003c/p\u003e\n\u003cp\u003e9 (19.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12 (42.9%)\u003c/p\u003e\n\u003cp\u003e12 (42.9%)\u003c/p\u003e\n\u003cp\u003e4 (14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e0.028*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003eMandibular midline shift \u0026gt; 2 mm\u003c/p\u003e\n\u003cp\u003eOverbite \u0026gt; 4 mm\u003c/p\u003e\n\u003cp\u003eOverjet \u0026gt; 5 mm\u003c/p\u003e\n\u003cp\u003eAnterior open bite \u0026gt; 3 mm\u003c/p\u003e\n\u003cp\u003eIndividual crossbite\u003c/p\u003e\n\u003cp\u003eEdge-to-edge incisor occlusion\u003c/p\u003e\n\u003cp\u003ePosterior crossbite\u003c/p\u003e\n\u003cp\u003ePosterior teeth absence\u003c/p\u003e\n\u003cp\u003eLingual tipping deep overbite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"17.82608695652174%\"\u003e\n\u003cp\u003e33 (9.0%)\u003c/p\u003e\n\u003cp\u003e62 (17.0%)\u003c/p\u003e\n\u003cp\u003e106 (29.0%)\u003c/p\u003e\n\u003cp\u003e2 (0.5%)\u003c/p\u003e\n\u003cp\u003e34 (9.3%)\u003c/p\u003e\n\u003cp\u003e13 (3.6%)\u003c/p\u003e\n\u003cp\u003e3 (0.8%)\u003c/p\u003e\n\u003cp\u003e5 (1.4%)\u003c/p\u003e\n\u003cp\u003e3 (0.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e10 (21.7%)\u003c/p\u003e\n\u003cp\u003e9 (19.6%)\u003c/p\u003e\n\u003cp\u003e12 (26.1%)\u003c/p\u003e\n\u003cp\u003e2 (4.3%)\u003c/p\u003e\n\u003cp\u003e11 (23.9%)\u003c/p\u003e\n\u003cp\u003e2 (4.3%)\u003c/p\u003e\n\u003cp\u003e10 (21.7%)\u003c/p\u003e\n\u003cp\u003e3 (6.5%)\u003c/p\u003e\n\u003cp\u003e1 (0.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e10 (35.7%)\u003c/p\u003e\n\u003cp\u003e7 (25.0%)\u003c/p\u003e\n\u003cp\u003e11 (39.3%)\u003c/p\u003e\n\u003cp\u003e3 (10.7%)\u003c/p\u003e\n\u003cp\u003e6 (21.4%)\u003c/p\u003e\n\u003cp\u003e3 (10.7%)\u003c/p\u003e\n\u003cp\u003e8 (28.6%)\u003c/p\u003e\n\u003cp\u003e5 (17.9%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e0.533\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.453\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e0.004*\u003c/p\u003e\n\u003cp\u003e0.183\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e0.576\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eChi-squared test\u0026nbsp;for unilateral ADD, *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003eResults of Fisher\u0026rsquo;s exact test, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e. Risk factors of unilateral ADD with or without CR associated with dental malocclusion\u003c/p\u003e\n\u003ctable border=\"1\" width=\"690\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" valign=\"top\" width=\"35.65217391304348%\"\u003e\n\u003cp\u003eUnilateral ADD without CR\u003c/p\u003e\n\u003cp\u003e(Group 2 and 3)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" valign=\"top\" width=\"39.710144927536234%\"\u003e\n\u003cp\u003eUnilateral ADD with CR\u003c/p\u003e\n\u003cp\u003e(Group 4)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 28\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n\u003cp\u003eOdds ratio\u003c/p\u003e\n\u003cp\u003e(95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"27.391304347826086%\"\u003e\n\u003cp\u003eOdds ratio\u003c/p\u003e\n\u003cp\u003e(95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003cp\u003eMolar relationship\u003c/p\u003e\n\u003cp\u003eAngle Class I\u003c/p\u003e\n\u003cp\u003eAngle Class II\u003c/p\u003e\n\u003cp\u003eAngle Class III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.169 (1.101-1.241)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"27.391304347826086%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.342 (1.228-1.467)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003eMandibular midline shift \u0026gt; 2 mm\u003c/p\u003e\n\u003cp\u003eAnterior open bite \u0026gt; 3 mm\u003c/p\u003e\n\u003cp\u003eIndividual crossbite\u003c/p\u003e\n\u003cp\u003ePosterior crossbite\u003c/p\u003e\n\u003cp\u003ePosterior teeth absence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n\u003cp\u003e2.631 (1.055-6.560)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16.654 (4.041-68.642)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e0.038*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"27.391304347826086%\"\u003e\n\u003cp\u003e6.291 (1.874-21.113)\u003c/p\u003e\n\u003cp\u003e51.482 (4.668-567.797)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e26.437 (5.118-136.557)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.318840579710145%\"\u003e\n\u003cp\u003e0.003*\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults of multivariate logistic regression analysis, *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e. Proportion of dental malocclusion in patients with bilateral ADD\u003c/p\u003e\n\u003ctable border=\"1\" width=\"850\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.049204052098407%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003eGroup 1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003eGroup 5\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003eGroup 6\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003eGroup 7\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"13.748191027496382%\"\u003e\n\u003cp\u003eGroup 8\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"10.998552821997105%\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.049204052098407%\"\u003e\n\u003cp\u003eMolar relationship\u003c/p\u003e\n\u003cp\u003eAngle Class I\u003c/p\u003e\n\u003cp\u003eAngle Class II\u003c/p\u003e\n\u003cp\u003eAngle Class III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e158 (43.3%)\u003c/p\u003e\n\u003cp\u003e137 (37.5%)\u003c/p\u003e\n\u003cp\u003e70 (19.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7 (33.3%)\u003c/p\u003e\n\u003cp\u003e12 (57.1%)\u003c/p\u003e\n\u003cp\u003e2 (9.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7 (29.2%)\u003c/p\u003e\n\u003cp\u003e13 (54.2%)\u003c/p\u003e\n\u003cp\u003e4 (16.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e8 (36.4%)\u003c/p\u003e\n\u003cp\u003e10 (45.5%)\u003c/p\u003e\n\u003cp\u003e4 (18.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"13.748191027496382%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12 (26.1%)\u003c/p\u003e\n\u003cp\u003e30 (65.2%)\u003c/p\u003e\n\u003cp\u003e4 (8.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"10.998552821997105%\"\u003e\n\u003cp\u003e0.028*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.049204052098407%\"\u003e\n\u003cp\u003eMandibular midline shift \u0026gt; 2 mm\u003c/p\u003e\n\u003cp\u003eOverbite \u0026gt; 4 mm\u003c/p\u003e\n\u003cp\u003eOverjet \u0026gt; 5 mm\u003c/p\u003e\n\u003cp\u003eAnterior open bite \u0026gt; 3 mm\u003c/p\u003e\n\u003cp\u003eIndividual crossbite\u003c/p\u003e\n\u003cp\u003eEdge-to-edge incisor occlusion\u003c/p\u003e\n\u003cp\u003ePosterior crossbite\u003c/p\u003e\n\u003cp\u003ePosterior teeth absence\u003c/p\u003e\n\u003cp\u003eLingual tipping deep overbite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e33 (9.0%)\u003c/p\u003e\n\u003cp\u003e62 (17.0%)\u003c/p\u003e\n\u003cp\u003e106 (29.0%)\u003c/p\u003e\n\u003cp\u003e2 (0.5%)\u003c/p\u003e\n\u003cp\u003e34 (9.3%)\u003c/p\u003e\n\u003cp\u003e13 (3.6%)\u003c/p\u003e\n\u003cp\u003e3 (0.8%)\u003c/p\u003e\n\u003cp\u003e5 (1.4%)\u003c/p\u003e\n\u003cp\u003e6 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e4 (19.0%)\u003c/p\u003e\n\u003cp\u003e15 (71.4%)\u003c/p\u003e\n\u003cp\u003e5 (23.8%)\u003c/p\u003e\n\u003cp\u003e1 (4.8%)\u003c/p\u003e\n\u003cp\u003e2 (9.5%)\u003c/p\u003e\n\u003cp\u003e1 (4.8%)\u003c/p\u003e\n\u003cp\u003e5 (23.8%)\u003c/p\u003e\n\u003cp\u003e1 (4.8%)\u003c/p\u003e\n\u003cp\u003e5 (23.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e4 (16.7%)\u003c/p\u003e\n\u003cp\u003e8 (33.3%)\u003c/p\u003e\n\u003cp\u003e5 (20.8%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003cp\u003e4 (16.7%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003cp\u003e6 (25.0%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003cp\u003e2 (8.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"12.301013024602026%\"\u003e\n\u003cp\u003e2 (9.1%)\u003c/p\u003e\n\u003cp\u003e8 (36.4%)\u003c/p\u003e\n\u003cp\u003e8 (36.4%)\u003c/p\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003cp\u003e4 (18.2%)\u003c/p\u003e\n\u003cp\u003e1 (4.5%)\u003c/p\u003e\n\u003cp\u003e4 (18.2%)\u003c/p\u003e\n\u003cp\u003e2 (9.1%)\u003c/p\u003e\n\u003cp\u003e1 (4.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"13.748191027496382%\"\u003e\n\u003cp\u003e6 (13.0%)\u003c/p\u003e\n\u003cp\u003e8 (17.4%)\u003c/p\u003e\n\u003cp\u003e23 (50.0%)\u003c/p\u003e\n\u003cp\u003e11 (23.9%)\u003c/p\u003e\n\u003cp\u003e3 (6.5%)\u003c/p\u003e\n\u003cp\u003e3 (6.5%)\u003c/p\u003e\n\u003cp\u003e5 (10.9%)\u003c/p\u003e\n\u003cp\u003e5 (10.9%)\u003c/p\u003e\n\u003cp\u003e2 (4.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"10.998552821997105%\"\u003e\n\u003cp\u003e0.428\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e0.034*\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e0.452\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.186\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eChi-squared test\u0026nbsp;for bilateral ADD, *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003eResults of Fisher\u0026rsquo;s exact test, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e. Proportion of dental malocclusion in patients with bilateral ADD with or without CR\u003c/p\u003e\n\u003ctable border=\"1\" width=\"850\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003e(Group 1)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003eBilateral ADD without CR\u003c/p\u003e\n\u003cp\u003e(Group 5, 6 and 7)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003eBilateral ADD with CR\u003c/p\u003e\n\u003cp\u003e(Group 8)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"13.768115942028986%\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003eMolar relationship\u003c/p\u003e\n\u003cp\u003eAngle Class I\u003c/p\u003e\n\u003cp\u003eAngle Class II\u003c/p\u003e\n\u003cp\u003eAngle Class III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e158 (43.3%)\u003c/p\u003e\n\u003cp\u003e137 (37.5%)\u003c/p\u003e\n\u003cp\u003e70 (19.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e22 (32.8%)\u003c/p\u003e\n\u003cp\u003e35 (52.2%)\u003c/p\u003e\n\u003cp\u003e10 (14.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12 (26.1%)\u003c/p\u003e\n\u003cp\u003e30 (65.2%)\u003c/p\u003e\n\u003cp\u003e4 (8.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"13.768115942028986%\"\u003e\n\u003cp\u003e0.003*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"26.08695652173913%\"\u003e\n\u003cp\u003eMandibular midline shift \u0026gt; 2 mm\u003c/p\u003e\n\u003cp\u003eOverbite \u0026gt; 4 mm\u003c/p\u003e\n\u003cp\u003eOverjet \u0026gt; 5 mm\u003c/p\u003e\n\u003cp\u003eAnterior open bite \u0026gt; 3 mm\u003c/p\u003e\n\u003cp\u003eIndividual crossbite\u003c/p\u003e\n\u003cp\u003eEdge-to-edge incisor occlusion\u003c/p\u003e\n\u003cp\u003ePosterior crossbite\u003c/p\u003e\n\u003cp\u003ePosterior teeth absence\u003c/p\u003e\n\u003cp\u003eLingual tipping deep overbite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"16.3768115942029%\"\u003e\n\u003cp\u003e33 (9.0%)\u003c/p\u003e\n\u003cp\u003e62 (17.0%)\u003c/p\u003e\n\u003cp\u003e106 (29.0%)\u003c/p\u003e\n\u003cp\u003e2 (0.5%)\u003c/p\u003e\n\u003cp\u003e34 (9.3%)\u003c/p\u003e\n\u003cp\u003e13 (3.6%)\u003c/p\u003e\n\u003cp\u003e3 (0.8%)\u003c/p\u003e\n\u003cp\u003e5 (1.4%)\u003c/p\u003e\n\u003cp\u003e3 (0.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e10 (14.9%)\u003c/p\u003e\n\u003cp\u003e31 (46.3%)\u003c/p\u003e\n\u003cp\u003e18 (26.9%)\u003c/p\u003e\n\u003cp\u003e1 (1.5%)\u003c/p\u003e\n\u003cp\u003e10 (14.9%)\u003c/p\u003e\n\u003cp\u003e2 (3.0%)\u003c/p\u003e\n\u003cp\u003e15 (22.4%)\u003c/p\u003e\n\u003cp\u003e3 (4.5%)\u003c/p\u003e\n\u003cp\u003e8 (11.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"21.884057971014492%\"\u003e\n\u003cp\u003e6 (13.0%)\u003c/p\u003e\n\u003cp\u003e8 (17.4%)\u003c/p\u003e\n\u003cp\u003e23 (50.0%)\u003c/p\u003e\n\u003cp\u003e11 (23.9%)\u003c/p\u003e\n\u003cp\u003e3 (6.5%)\u003c/p\u003e\n\u003cp\u003e3 (6.5%)\u003c/p\u003e\n\u003cp\u003e5 (10.9%)\u003c/p\u003e\n\u003cp\u003e5 (10.9%)\u003c/p\u003e\n\u003cp\u003e2 (4.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"13.768115942028986%\"\u003e\n\u003cp\u003e0.278\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e0.011*\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e0.267\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.572\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eChi-squared test\u0026nbsp;for bilateral ADD, *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003eResults of Fisher\u0026rsquo;s exact test, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e. Risk factors of bilateral ADD with or without CR associated with dental malocclusion\u003c/p\u003e\n\u003ctable border=\"1\" width=\"690\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" valign=\"top\" width=\"35.65217391304348%\"\u003e\n\u003cp\u003eBilateral ADD without CR\u003c/p\u003e\n\u003cp\u003e(Group 5, 6 and 7)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" valign=\"top\" width=\"39.710144927536234%\"\u003e\n\u003cp\u003eBilateral ADD with CR\u003c/p\u003e\n\u003cp\u003e(Group 8)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003eOdds ratio\u003c/p\u003e\n\u003cp\u003e(95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"28.695652173913043%\"\u003e\n\u003cp\u003eOdds ratio\u003c/p\u003e\n\u003cp\u003e(95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003cp\u003eMolar relationship\u003c/p\u003e\n\u003cp\u003eAngle Class I\u003c/p\u003e\n\u003cp\u003eAngle Class II\u003c/p\u003e\n\u003cp\u003eAngle Class III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.708 (1.614-8.521)\u003c/p\u003e\n\u003cp\u003e1.255 (1.180-1.335)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.002*\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"28.695652173913043%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.337 (1.240-1.441)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.694 (0.972-7.464)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.047*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003eOverbite \u0026gt; 4 mm\u003c/p\u003e\n\u003cp\u003eOverjet \u0026gt; 5 mm\u003c/p\u003e\n\u003cp\u003eAnterior open bite \u0026gt; 3 mm\u003c/p\u003e\n\u003cp\u003ePosterior crossbite\u003c/p\u003e\n\u003cp\u003ePosterior teeth absence\u003c/p\u003e\n\u003cp\u003eLingual tipping deep overbite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"24.63768115942029%\"\u003e\n\u003cp\u003e4.942 (2.139-11.416)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e14.303 (3.170-64.535)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"28.695652173913043%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.629 (0.982-7.038)\u003c/p\u003e\n\u003cp\u003e51.203 (6.387-410.506)\u003c/p\u003e\n\u003cp\u003e5.568 (0.933-33.248)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd valign=\"top\" width=\"11.014492753623188%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.044*\u003c/p\u003e\n\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n\u003cp\u003e0.040*\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults of multivariate logistic regression analysis, *\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\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, Anterior disc displacement, Condylar resorption, Dental malocclusion, Magnetic resonance imaging","lastPublishedDoi":"10.21203/rs.3.rs-3326678/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3326678/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to investigate the risk factors associated with temporomandibular joint (TMJ) anterior disc displacement (ADD) in relation to dental malocclusion.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, a clinical examination was conducted on patients aged 11\u0026ndash;35 years who visited the TMJ and Orthodontic Clinic at a hospital. Magnetic resonance imaging (MRI) of the TMJ was performed to diagnose both ADD and condylar resorption (CR). Occlusal measurements were obtained and analyzed using 3D scanning models.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 552 patients underwent TMJ MRI examination and dental occlusion scanning. The presence of mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm and posterior crossbite were found to be associated with unilateral ADD (OR\u0026thinsp;\u0026gt;\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, apart from these malocclusions, anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm showed a strong correlation with unilateral ADD accompanied by CR (OR\u0026thinsp;\u0026gt;\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm and posterior crossbite were associated with bilateral ADD (OR\u0026thinsp;\u0026gt;\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition to these malocclusions, Angle Class II malocclusion, overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm, and anterior open bite\u0026thinsp;\u0026gt;\u0026thinsp;3 mm were strongly correlated with bilateral ADD accompanied by CR (OR\u0026thinsp;\u0026gt;\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn conclusion, our study highlights the significance of occlusal characteristics in relation to TMJ health. Specific malocclusions, such as mandibular midline shift\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, posterior crossbite, and overbite\u0026thinsp;\u0026gt;\u0026thinsp;4 mm appear to be associated with the presence of TMJ ADD. Angle Class II malocclusion, anterior open bite and overjet\u0026thinsp;\u0026gt;\u0026thinsp;5 mm seem to be associated with progression of ADD. These findings emphasize the crucial importance of early detection and management of malocclusions to prevent or minimize the development of TMJ ADD and associated complications.\u003c/p\u003e","manuscriptTitle":"Risk factors of temporomandibular joint anterior disc displacement associated with dental malocclusion: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-29 22:30:31","doi":"10.21203/rs.3.rs-3326678/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":"98f04cd2-1ac5-4768-ad5f-e85795200fb9","owner":[],"postedDate":"September 29th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-10-17T12:44:37+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-29 22:30:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3326678","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3326678","identity":"rs-3326678","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}