Association of Articular Eminence Inclination and Glenoid Fossa Roof Thickness with Sagittal Skeletal Classes: A CBCT Study

Association of Articular Eminence Inclination and Glenoid Fossa Roof Thickness with Sagittal Skeletal Classes: A CBCT 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 Association of Articular Eminence Inclination and Glenoid Fossa Roof Thickness with Sagittal Skeletal Classes: A CBCT Study Mustafa Kenan Hürmüzlü, Sinem COŞKUN ALBAYRAK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8864220/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background This study aimed to evaluate the association between skeletal sagittal malocclusion (based on ANB angle) and temporomandibular joint (TMJ) morphology by assessing bilateral articular eminence inclination (aeı) and glenoid fossa roof thickness, and to determine right–left symmetry patterns in these parameters. Methods CBCT images of 123 individuals were analyzed. Skeletal classification was performed using ANB angle and participants were distributed equally into Skeletal Class I, II, and III (n = 41 each). AEI was measured bilaterally on sagittal TMJ sections relative to the Frankfort horizontal plane, and glenoid fossa height was recorded bilaterally. Side-to-side differences were evaluated using paired tests. Intergroup comparisons were performed across skeletal classes, and right–left associations were assessed using correlation analyses. Results The cohort had a mean age of 40.1 ± 18.0 years (range: 11–84), with no significant differences across skeletal classes for age (p = 0.535) or sex distribution (p = 0.156). Right and left AEI showed a strong positive correlation (r = 0.764, p < 0.001), while glenoid fossa height demonstrated a moderate correlation between sides (ρ = 0.440, p < 0.001). The right AEI (48.0 ± 12.4°) was significantly higher than the left (46.4 ± 12.7°) (p = 0.033). No significant differences in AEI or glenoid fossa height were detected among skeletal classes (p > 0.05), although left AEI tended to be lower in Class III (p = 0.082). Conclusions TMJ measurements demonstrated high bilateral association with a small but significant right–left difference in AEI. Skeletal sagittal malocclusion, as classified by ANB angle, was not significantly associated with AEI or glenoid fossa height in this sample. malocclusion temporomandibular joint disorders articular eminence Figures Figure 1 Figure 2 Figure 3 BACKGROUND The temporomandibular joint (TMJ) consists of several anatomical components, including the mandibular condyle, the articular disc, the temporal bone’s articular surface, and the surrounding capsule, ligaments, lateral pterygoid muscle. The articular eminence constitutes the supero-anterior portion of the mandibular fossa and represents the region most frequently contacted and traversed by the condyle during mandibular movements [ 1 , 2 ]. The articular eminence inclination (AEI) plays a crucial role in temporomandibular joint biodynamics by shaping the direction and pattern of motion of the condyle and articular disc as a functional unit [ 3 ]. Widman reported an inverse association between the articular eminence (AE) angle and both the occlusal and mandibular planes, and suggested that the Frankfort horizontal plane–AE angle may be clinically useful in orthodontic treatment planning [ 4 ]. Since the inclination of the AEI directs the translation pathway of the condyle, variations in eminence angulation may lead to biomechanical alterations within the TMJ [ 5 , 6 ]. Moreover, certain osseous morphological patterns may increase susceptibility to TMJ-related affections or complications, and the AEI itself is continuously exposed to functional masticatory loads [ 7 , 8 ]. Accordingly, the eminence can be considered a dynamic structure that reflects the prevailing mechanical environment and undergoes remodeling to minimize joint stress. The inclination of the AE is commonly evaluated relative to the Frankfort horizontal plane, and it influences the trajectory of condylar movement as well as the degree of disc rotation over the condyle [ 9 ]. During growth, investigations on dried human skulls have indicated that AE inclination develops rapidly and is largely established by early adulthood, with approximately 90–94% of maturation completed around 20 years of age [ 9 ]. Reported annual increases are approximately 1° to 1.2°–1.3°,and this maturation may occur earlier than the morphological development of the mandibular condyle [ 10 – 12 ]. Nevertheless, AE inclination exhibits substantial inter-individual variability, and values ranging from 30° to 94° have been reported in the literature [ 3 , 13 ]. The condyle–fossa relationship is closely linked to TMJ functional anatomy. Sagittal skeletal imbalance may modify TMJ morphology by affecting condylar positioning and joint loading conditions [ 9 , 14 , 15 ]. The translational pathway of the mandibular condyle within the glenoid fossa is primarily guided by the inclination of the articular eminence. In addition to its slope, the morphological characteristics of the articular eminence—such as its contour and overall configuration—may influence mandibular movement patterns [ 6 , 9 ]. These functional dynamics can be further affected by several factors, including tooth loss, age-related changes, sagittal skeletal malocclusion, sex, and variations in masticatory loading [ 15 – 21 ]. Consequently, morphological variations of the articular eminence may contribute to changes in TMJ biomechanics and have been considered potential predisposing factors for internal joint dysfunctions. Therefore, the present study aimed to investigate the effect of sagittal skeletal malocclusion on AEI, to evaluate possible right–left differences in AEI, and to examine variations in glenoid fossa height among malocclusion groups. METHODS Study Design And Ethical Approval This retrospective cross-sectional study was conducted using cone-beam computed tomography (CBCT) images obtained from the institutional radiology archive. Sample Selection And Eligibility Criteria A priori sample size calculation was performed using G*Power software (version 3.1.9.7, Heinrich Heine University Düsseldorf, Düsseldorf, Germany). Since each participant contributed bilateral AEI measurements (right and left) and comparisons were planned across three skeletal classes (Class I, II, III), the analysis was based on a mixed-design (repeated measures) ANOVA within–between interaction model. The following parameters were used: effect size f=0.25 (medium), α error probability 0.05, power (1–β) 0.80, number of groups 3, number of measurements 2, correlation among repeated measures 0.60, and nonsphericity correction ε=1.0. Under these assumptions, the minimum required total sample size was 108 participants (36 per group). To compensate for possible exclusions due to image quality or eligibility criteria, the target sample size was increased accordingly. Images were included if they met the following criteria: 1. adequate image quality for TMJ evaluation, 2. complete visualization of the articular eminence and mandibular condyle bilaterally, and 3. availability of cephalometric measurements required for skeletal classification. Scans were excluded in cases of: • history of maxillofacial trauma, orthognathic surgery, or TMJ surgery, • congenital craniofacial anomalies, • radiographic evidence of severe TMJ degenerative changes, tumors, or cystic lesions affecting the TMJ region, • significant motion artifacts or metallic artifacts preventing reliable measurements. All CBCT scans were obtained using the NewTom VGi evo CBCT unit (Cefla S.C., Imola, Italy). The field of view (FOV) was selected according to the clinical indication and ranged from 15 × 15 cm to 24 × 19 cm, with a voxel size of 0.2 mm. Tube voltage was set at 110 kVp, while the tube current (mA) was adjusted based on the selected FOV and clinical indication in accordance with the manufacturer’s exposure protocols. Data were exported and evaluated using dedicated imaging software NNT Viewer version 13 (NewTom, Verona, Italy). To ensure measurement standardization, multiplanar reconstructions were oriented so that the Frankfort horizontal (FH) plane, defined by the line connecting the orbitale and porion landmarks, was set parallel to the horizontal reference plane. The mid-sagittal plane was aligned to pass through the nasion and was perpendicular to the FH plane. Skeletal classification using ANB angle Skeletal sagittal relationships were classified using the ANB angle measured on standardized lateral cephalometric reconstructions obtained from the CBCT dataset. The ANB angle was defined according to the Steiner analysis [22]. Participants were categorized as Class I (0° < ANB < 4°), Class II (ANB ≥ 4°), and Class III (ANB ≤ 0°), consistent with previous CBCT-based skeletal classification approaches [23]. (Figure 1) Measurement of AEI AEI was measured bilaterally on sagittal TMJ reconstructions in accordance with previously described CBCT-based protocols [18,24,25]. For each TMJ, the sagittal section was oriented perpendicular to the long axis of the condyle, and AEI was defined as the angle between the Frankfort horizontal reference line and a tangent line representing the posterior slope of the articular eminence. (Figure 2) Measurement of thickness of the roof of the glenoid fossa The thickness of the roof of the glenoid fossa (RGF) was measured bilaterally on standardized CBCT reconstructions using sagittal TMJ sections, following previously described CBCT-based assessment protocols [18,25]. For each TMJ, the sagittal slice passing through the center of the condylar head (widest mediolateral dimension on the corresponding axial view) was selected. The RGF thickness was defined as the shortest linear distance between the superior cortical outline of the glenoid fossa and its inferior cortical boundary, measured perpendicular to the fossa roof at the thinnest point [18,25]. Right and left values were recorded separately for each participant. (Figure 3) Statistical analysis Statistical analyses were performed using IBM SPSS Statistics, version 30 (IBM Corp., Armonk, NY, USA). Normality of continuous variables was evaluated using the Shapiro–Wilk test and visual inspection of histograms and Q–Q plots. Since each participant contributed bilateral AEI measurements (right and left), a mixed-design model was used to account for within-subject correlation. Skeletal class (Class I, II, III) was included as the between-subject factor, and side (right/left) as the within-subject factor. The main effects of skeletal class and side, as well as the skeletal class × side interaction, were tested. Post hoc pairwise comparisons were performed using Bonferroni correction. Continuous variables were reported as mean±standard deviation for normally distributed data or median (interquartile range) for non-normally distributed data. Statistical significance was set at p<0.05. RESULTS Demographic characteristics A total of 123 participants were included in the study (mean age: 40.1 ± 18.0 years, range: 11–84). According to ANB-based skeletal classification, the sample was equally distributed across Skeletal Class I, II, and III (n=41 per group). No statistically significant differences were observed among groups regarding age (p=0.535) or sex distribution (p=0.156). (Table 1) TMJ measurements by skeletal class Group comparisons demonstrated no significant differences in the right TMJ inclination angle across skeletal classes (p=0.522). Although the left TMJ inclination angle tended to be lower in Skeletal Class III (Class I: 48.8 ± 11.5°; Class III: 42.8 ± 13.7°), the overall intergroup comparison did not reach statistical significance (p=0.082) (Table 1). Similarly, glenoid fossa roof thickness did not differ significantly across skeletal classes for either the right (p=0.939) or left side (p=0.317) (Table 1). Correlation analysis revealed a strong positive association between right and left TMJ inclination angles (Pearson r=0.764, p<0.001). In contrast, right and left glenoid fossa roof thickness measurements showed a moderate positive correlation (Spearman ρ=0.440, p<0.001) (Table 2). Paired analyses showed that the right TMJ inclination angle (48.0 ± 12.4°) was slightly higher than the left TMJ inclination angle (46.4 ± 12.7°). This side-to-side difference was statistically significant (paired t-test, mean difference = 1.68°, 95% CI: 0.15–3.20, p=0.033). Conversely, no significant right–left difference was detected for glenoid fossa roof thickness (Wilcoxon signed-rank test, p=0.810) (Table 3). Bilateral summary calculations based on group means indicated that the average TMJ inclination angle ((R+L)/2) tended to be highest in Class I and lowest in Class III (Class I: 49.3°, Class II: 47.5°, Class III: 44.8°). In contrast, the mean glenoid fossa roof thickness ((R+L)/2) was slightly higher in Class III (1.05) compared with Class I and II (0.96 for both). Regarding asymmetry, the right–left difference in TMJ inclination angle (R–L) was most pronounced in Class III (+4.0°) compared with Class I (+1.0°) and Class II (+0.1°). Roof thickness asymmetry values were small across groups (Table 4). Overall, AEI angles were largely comparable across skeletal classes, while a small but significant right–left difference was observed for TMJ inclination, and glenoid fossa roof thickness remained stable across both sides and skeletal groups. (Table 5) DISCUSSION The present CBCT-based study investigated whether sagittal skeletal malocclusion (ANB-based classification) is associated with variations in AEI, right–left symmetry, and thickness of the roof of the glenoid fossa. Overall, AEI values were largely comparable across skeletal classes, while a small but statistically significant right–left difference was identified in TMJ inclination angles. In contrast, glenoid fossa roof thickness remained stable across both sides and skeletal groups. These findings suggest that sagittal skeletal discrepancy alone may not be a dominant determinant of TMJ osseous morphology in adults, and that individual adaptive responses to functional loading may contribute to subtle asymmetries. In our cohort, AEI did not show statistically significant differences across skeletal Class I, II, and III. This observation closely aligns with the findings of Moscagiuri et al. [ 24 ], who evaluated normodivergent adults using CBCT and similarly reported no significant association between AEI and sagittal skeletal class. The agreement between studies may be explained by the multifactorial nature of eminence morphology, which is influenced not only by sagittal relationships but also by vertical pattern, age-related remodeling, sex-related craniofacial differences, and functional loading conditions. However, the literature is not fully consistent. For example, Arieta-Miranda et al. [ 15 ] demonstrated that sagittal skeletal relationship can be associated with differences in TMJ spatial characteristics assessed by CBCT, suggesting that craniofacial pattern may influence joint morphology and position. More recent CBCT evidence also indicates that TMJ morphology may vary in skeletal Class III individuals and may show sex dimorphism in osseous parameters, including eminence inclination [ 14 ]. These discrepancies across studies may be related to methodological differences (measurement definitions, slice selection, reference planes), sample heterogeneity (age range, dentition status, vertical growth pattern), and inclusion/exclusion criteria regarding TMJ symptoms or degenerative changes. Importantly, AEI is considered biomechanically relevant because the articular eminence is exposed to functional loads, and its inclination influences the pathway of condylar movement and disc rotation during mandibular function [ 26 ]. Therefore, it is plausible that detectable differences in AEI across skeletal classes may emerge more clearly in specific subgroups (e.g., symptomatic Temporomandibuar disorders (TMD) cohorts, extreme vertical patterns, or pronounced skeletal discrepancies) rather than in mixed adult samples. A notable finding of this study was the strong right–left correlation observed for AEI, indicating that articular eminence morphology demonstrates substantial bilateral correspondence at the individual level. This supports the view that TMJ osseous architecture is generally symmetrical, consistent with CBCT-based evaluations of TMJ morphology that emphasize wide inter-individual variability but relative bilateral stability within individuals [ 18 ]. Despite this strong bilateral association, AEI was slightly higher on the right side than the left, reaching statistical significance. While the magnitude of this difference was small, this pattern may reflect functional laterality, dominant chewing side, or asymmetric mechanical loading leading to mild adaptive remodeling. Such subtle asymmetries are compatible with the concept that the eminence represents a dynamic structure shaped by loading environment over time [ 21 ]. Clinically, this finding suggests that side-specific assessment may provide additional insight in TMJ evaluation, particularly when planning orthodontic or prosthetic treatments in patients with suspected functional asymmetry. In the current study, roof thickness of the glenoid fossa did not differ significantly between skeletal groups or between sides. A similar pattern is plausible in non-selected adult populations, as roof thickness is often considered a stable structural parameter unless modified by substantial changes in joint loading or pathology. Studies assessing roof thickness in asymptomatic adults provide reference values and support the notion that this feature may not necessarily vary with sagittal skeletal class alone [ 27 ]. Conversely, several reports indicate that roof thickness may be affected in association with TMJ disorders. Khojastepour et al.[ 28 ] reported differences in glenoid fossa roof thickness when comparing TMD and non-TMD groups, supporting a relationship between roof thickness changes and joint dysfunction rather than skeletal classification. In addition, dentition status may influence roof thickness: edentulism or partial edentulism can alter mandibular biomechanics and joint loading, potentially contributing to roof thickness variations [ 29 ]. Accordingly, the lack of group differences in our study may reflect the predominance of non-pathological remodeling patterns in this retrospective adult cohort and supports the interpretation that sagittal skeletal discrepancy alone may not be sufficient to drive roof thickness changes in the absence of overt joint pathology. The absence of significant intergroup differences may be attributable to the multifactorial determinants of TMJ osseous morphology, where sagittal skeletal class represents only one component among vertical pattern, functional loading, and individual remodeling capacity. From a clinical perspective, the present findings suggest that sagittal skeletal classification based on ANB may not reliably predict AEI or glenoid fossa roof thickness. This is consistent with CBCT literature emphasizing that TMJ morphology is influenced by multiple craniofacial and functional variables [ 21 ]. Therefore, clinicians should be cautious about inferring TMJ morphology solely from skeletal class and should consider individualized imaging assessment when evaluating TMJ biomechanics, occlusal rehabilitation planning, or orthodontic movement strategies. Clinicians should avoid relying solely on sagittal skeletal classification when estimating TMJ morphology and should consider individualized CBCT-based assessment in selected cases. Several limitations should be acknowledged. First, the retrospective nature of the study limits causal interpretation. Second, TMJ symptoms and functional factors (e.g., parafunctional habits, chewing preference, occlusal scheme, disc position) were not directly evaluated, which may contribute to unexplained variability in AEI and roof thickness. Third, skeletal classification was based on ANB alone; incorporating additional sagittal and vertical parameters may help refine subgroup differentiation. Given the evidence that vertical pattern may influence eminence inclination, future studies should stratify analyses by vertical skeletal type and consider sex and dentition status as potential effect modifiers [ 30 ]. Prospective designs integrating clinical TMD assessments, standardized functional indices, and longitudinal follow-up may further clarify how sagittal malocclusion interacts with TMJ adaptive remodeling over time. CONCLUSIONS In conclusion, this CBCT-based analysis demonstrated a strong bilateral association in TMJ angulation and a moderate right–left concordance for glenoid fossa height. Although the right articular eminence inclination was slightly higher than the left, skeletal sagittal malocclusion classified by ANB angle did not result in statistically significant differences in AEI or glenoid fossa height across skeletal classes. These findings suggest that TMJ morphology may exhibit minor side-related variations, while sagittal skeletal pattern alone may not be a dominant determinant of AEI and fossa height. Future studies incorporating vertical skeletal patterns, functional status, and larger multi-center samples may provide a more comprehensive explanation of TMJ adaptive remodeling in different malocclusion types. Abbreviations TMJ: Temporomandibular joint AEI: Articular Eminence Inclination ANB angle: Angle between points A, Nasion, and B RGF: The roof of the glenoid fossa CBCT: cone-beam computed tomography FH: Frankfort horizontal TMD: Temporomandibuar disorders Declarations Ethics approval and consent to participate The study protocol was reviewed and approved by the Lokman Hekim Scientific Research Ethics Committee (approval number: 2025/310; date: 30.12.2025). All procedures were performed in accordance with the Declaration of Helsinki. The requirement for informed consent was waived by the Lokman Hekim Scientific Research Ethics Committee due to the retrospective nature of the study. Patient identifiers were removed prior to analysis. 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 None Authors' contributions S.C.A. and M.K.H. contributed to conceptualization, data curation, investigation, methodology, and resources. S.C.A. and M.K.H. were responsible for writing—review and editing. S.C.A. performed supervision, validation, and writing—original draft preparation. All authors reviewed and approved the final version of the manuscript. Acknowledgements Not applicable. References Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al. Anatomy of the temporomandibular joint. Semin Ultrasound CT MR . 2007;28(3):170–183. doi:10.1053/j.sult.2007.02.002. Marková M, Gallo LM. The influence of the human TMJ eminence inclination on predicted masticatory muscle forces. 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Comparative cone-beam computed tomography evaluation of temporomandibular joint position and morphology in female patients with skeletal class II malocclusion. J Int Med Res . 2019;48(2). doi:10.1177/0300060519892388. Tables Table 1. Demographic characteristics and TMJ measurements by skeletal class Variable Class I (n=41) Class II (n=41) Class III (n=41) p-value Age (years), mean ± SD 38.2 ± 15.5 42.5 ± 19.0 39.5 ± 19.5 0.535 Female, n (%) 18 (43.9) 25 (61.0) 17 (41.5) 0.156 Male, n (%) 23 (56.1) 16 (39.0) 24 (58.5) — TMJ inclination angle (Right), mean ± SD (°) 49.8 ± 12.5 47.5 ± 12.0 46.8 ± 12.9 0.522 TMJ inclination angle (Left), mean ± SD (°) 48.8 ± 11.5 47.4 ± 12.2 42.8 ± 13.7 0.082 Glenoid fossa roof thickness (Right), mean ± SD 0.97 ± 0.53 0.97 ± 0.62 1.00 ± 0.71 0.939 Glenoid fossa roof thickness (Left), mean ± SD 0.94 ± 0.66 0.94 ± 0.53 1.09 ± 0.64 0.317 Demographic variables and TMJ measurements according to ANB-based skeletal classification. Continuous variables are presented as mean ± standard deviation; categorical variables are presented as number (%). Table 2. Correlation analysis between right and left TMJ measurements. Measurement Correlation test r / ρ p-value TMJ inclination angle (Right vs Left) Pearson 0.764 <0.001 Glenoid fossa roof thickness (Right vs Left) Spearman 0.440 <0.001 Table 3: Comparison of right and left TMJ measurements Parameter Right Left Difference (R–L) Test p-value TMJ inclination angle (°), mean ± SD 48.0 ± 12.4 46.4 ± 12.7 +1.68° (95% CI: 0.15–3.20) Paired t-test 0.033 Glenoid fossa roof thickness median (min–max) median (min–max) ~0 Wilcoxon signed-rank 0.810 TMJ inclination angle values were normally distributed; therefore, paired t-test was applied. Glenoid fossa roof thickness showed non-normal distribution; therefore, Wilcoxon signed-rank test was used. Table 4: Correlation matrix demonstrating the association between right and left TMJ measurements. Variables Correlation coefficient Strength p-value TMJ inclination angle (Right vs Left) r = 0.764 (Pearson) Strong positive <0.001 Glenoid fossa roof thickness (Right vs Left) ρ = 0.440 (Spearman) Moderate positive <0.001 Table 5. Bilateral summary measures for TMJ inclination and glenoid fossa roof thickness according to skeletal class. Variable Class I (n=41) Class II (n=41) Class III (n=41) Mean TMJ inclination angle ((R+L)/2), ° 49.3 47.5 44.8 Mean glenoid fossa roof thickness ((R+L)/2) 0.96 0.96 1.05 Side difference in TMJ inclination angle (R–L), ° +1.0 +0.1 +4.0 Side difference in roof thickness (R–L) +0.03 +0.03 −0.09 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8864220","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606192640,"identity":"8bc8c9c2-e9cb-47ef-8bac-08721f127b0c","order_by":0,"name":"Mustafa Kenan Hürmüzlü","email":"data:image/png;base64,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","orcid":"","institution":"Yozgat Bozok University","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"Kenan","lastName":"Hürmüzlü","suffix":""},{"id":606192641,"identity":"cee3babf-f9fe-49db-8233-895643244678","order_by":1,"name":"Sinem COŞKUN ALBAYRAK","email":"","orcid":"","institution":"Lokman Hekim University","correspondingAuthor":false,"prefix":"","firstName":"Sinem","middleName":"COŞKUN","lastName":"ALBAYRAK","suffix":""}],"badges":[],"createdAt":"2026-02-12 16:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8864220/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8864220/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104874134,"identity":"4fd37c8d-99fc-4ff5-9635-67ae8fffde41","added_by":"auto","created_at":"2026-03-18 08:29:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":281675,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of ANB angle on CBCT\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8864220/v1/cfb8ccd1a4728e2749024060.png"},{"id":104873894,"identity":"fc71287e-5cf3-4f14-a425-5fcc5e1142d4","added_by":"auto","created_at":"2026-03-18 08:28:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":305274,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of articular eminence inclination (AEI) on standardized sagittal CBCT reconstructions.\u003c/p\u003e\n\u003cp\u003eAEI was defined as the angle between the Frankfort horizontal plane and a tangent line representing the posterior slope of the articular eminence, drawn from the most superior point of the eminence to the most inferior point along its posterior surface.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8864220/v1/51198fccbc26b90abef6b886.png"},{"id":104874154,"identity":"f0b90f47-8634-40ea-85b9-2bd270878ff7","added_by":"auto","created_at":"2026-03-18 08:29:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":228080,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of glenoid fossa roof thickness on sagittal reconstructed plane of CBCT\u003c/p\u003e\n\u003cp\u003eThe thickness of the roof of the glenoid fossa was defined as the shortest linear distance between the superior and inferior cortical boundaries of the fossa roof, measured perpendicular to the roof at its thinnest point.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8864220/v1/16cb19d9e9d5732382ba1689.png"},{"id":104874256,"identity":"f2ffb352-2466-4d62-834b-ea6ea4d7e3dc","added_by":"auto","created_at":"2026-03-18 08:29:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1827257,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8864220/v1/26851760-6750-402b-bc99-5e5f7726a36c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of Articular Eminence Inclination and Glenoid Fossa Roof Thickness with Sagittal Skeletal Classes: A CBCT Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe temporomandibular joint (TMJ) consists of several anatomical components, including the mandibular condyle, the articular disc, the temporal bone\u0026rsquo;s articular surface, and the surrounding capsule, ligaments, lateral pterygoid muscle. The articular eminence constitutes the supero-anterior portion of the mandibular fossa and represents the region most frequently contacted and traversed by the condyle during mandibular movements [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The articular eminence inclination (AEI) plays a crucial role in temporomandibular joint biodynamics by shaping the direction and pattern of motion of the condyle and articular disc as a functional unit [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWidman reported an inverse association between the articular eminence (AE) angle and both the occlusal and mandibular planes, and suggested that the Frankfort horizontal plane\u0026ndash;AE angle may be clinically useful in orthodontic treatment planning [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Since the inclination of the AEI directs the translation pathway of the condyle, variations in eminence angulation may lead to biomechanical alterations within the TMJ [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, certain osseous morphological patterns may increase susceptibility to TMJ-related affections or complications, and the AEI itself is continuously exposed to functional masticatory loads [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Accordingly, the eminence can be considered a dynamic structure that reflects the prevailing mechanical environment and undergoes remodeling to minimize joint stress. The inclination of the AE is commonly evaluated relative to the Frankfort horizontal plane, and it influences the trajectory of condylar movement as well as the degree of disc rotation over the condyle [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. During growth, investigations on dried human skulls have indicated that AE inclination develops rapidly and is largely established by early adulthood, with approximately 90\u0026ndash;94% of maturation completed around 20 years of age [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Reported annual increases are approximately 1\u0026deg; to 1.2\u0026deg;\u0026ndash;1.3\u0026deg;,and this maturation may occur earlier than the morphological development of the mandibular condyle [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nevertheless, AE inclination exhibits substantial inter-individual variability, and values ranging from 30\u0026deg; to 94\u0026deg; have been reported in the literature [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe condyle\u0026ndash;fossa relationship is closely linked to TMJ functional anatomy. Sagittal skeletal imbalance may modify TMJ morphology by affecting condylar positioning and joint loading conditions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe translational pathway of the mandibular condyle within the glenoid fossa is primarily guided by the inclination of the articular eminence. In addition to its slope, the morphological characteristics of the articular eminence\u0026mdash;such as its contour and overall configuration\u0026mdash;may influence mandibular movement patterns [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These functional dynamics can be further affected by several factors, including tooth loss, age-related changes, sagittal skeletal malocclusion, sex, and variations in masticatory loading [\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19 CR20\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Consequently, morphological variations of the articular eminence may contribute to changes in TMJ biomechanics and have been considered potential predisposing factors for internal joint dysfunctions. Therefore, the present study aimed to investigate the effect of sagittal skeletal malocclusion on AEI, to evaluate possible right\u0026ndash;left differences in AEI, and to examine variations in glenoid fossa height among malocclusion groups.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design And Ethical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cross-sectional study was conducted using cone-beam computed tomography (CBCT) images obtained from the institutional radiology archive.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Selection And Eligibility Criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA priori sample size calculation was performed using G*Power software (version 3.1.9.7, Heinrich Heine University Düsseldorf, Düsseldorf, Germany). Since each participant contributed bilateral AEI measurements (right and left) and comparisons were planned across three skeletal classes (Class I, II, III), the analysis was based on a mixed-design (repeated measures) ANOVA within–between interaction model. The following parameters were used: effect size f=0.25 (medium), α error probability 0.05, power (1–β) 0.80, number of groups 3, number of measurements 2, correlation among repeated measures 0.60, and nonsphericity correction ε=1.0. Under these assumptions, the minimum required total sample size was 108 participants (36 per group). To compensate for possible exclusions due to image quality or eligibility criteria, the target sample size was increased accordingly.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImages were included if they met the following criteria:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. adequate image quality for TMJ evaluation,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. complete visualization of the articular eminence and mandibular condyle bilaterally, and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. availability of cephalometric measurements required for skeletal classification.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScans were excluded in cases of:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e• history of maxillofacial trauma, orthognathic surgery, or TMJ surgery,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e• congenital craniofacial anomalies,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e• radiographic evidence of severe TMJ degenerative changes, tumors, or cystic lesions affecting the TMJ region,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e• significant motion artifacts or metallic artifacts preventing reliable measurements.\u003c/p\u003e\n\u003cp\u003eAll CBCT scans were obtained using the NewTom VGi evo CBCT unit (Cefla S.C., Imola, Italy). The field of view (FOV) was selected according to the clinical indication and ranged from 15 × 15 cm to 24 × 19 cm, with a voxel size of 0.2 mm. Tube voltage was set at 110 kVp, while the tube current (mA) was adjusted based on the selected FOV and clinical indication in accordance with the manufacturer’s exposure protocols. Data were exported and evaluated using dedicated imaging software NNT Viewer version 13 (NewTom, Verona, Italy). To ensure measurement standardization, multiplanar reconstructions were oriented so that the Frankfort horizontal (FH) plane, defined by the line connecting the orbitale and porion landmarks, was set parallel to the horizontal reference plane. The mid-sagittal plane was aligned to pass through the nasion and was perpendicular to the FH plane.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSkeletal classification using ANB angle\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSkeletal sagittal relationships were classified using the ANB angle measured on standardized lateral cephalometric reconstructions obtained from the CBCT dataset. The ANB angle was defined according to the Steiner analysis\u0026nbsp;[22]. Participants were categorized as Class I (0° \u0026lt; ANB \u0026lt; 4°), Class II (ANB ≥ 4°), and Class III (ANB ≤ 0°), consistent with previous CBCT-based skeletal classification approaches\u0026nbsp;[23]. (Figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement of AEI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAEI was measured bilaterally on sagittal TMJ reconstructions in accordance with previously described CBCT-based protocols\u0026nbsp;[18,24,25]. For each TMJ, the sagittal section was oriented perpendicular to the long axis of the condyle, and AEI was defined as the angle between the Frankfort horizontal reference line and a tangent line representing the posterior slope of the articular eminence. (Figure 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement of thickness of the roof of the glenoid fossa\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe thickness of the roof of the glenoid fossa (RGF) was measured bilaterally on standardized CBCT reconstructions using sagittal TMJ sections, following previously described CBCT-based assessment protocols\u0026nbsp;[18,25]. For each TMJ, the sagittal slice passing through the center of the condylar head (widest mediolateral dimension on the corresponding axial view) was selected. The RGF thickness was defined as the shortest linear distance between the superior cortical outline of the glenoid fossa and its inferior cortical boundary, measured perpendicular to the fossa roof at the thinnest point\u0026nbsp;[18,25]. Right and left values were recorded separately for each participant. (Figure 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics, version 30 (IBM Corp., Armonk, NY, USA). Normality of continuous variables was evaluated using the Shapiro–Wilk test and visual inspection of histograms and Q–Q plots. Since each participant contributed bilateral AEI measurements (right and left), a mixed-design model was used to account for within-subject correlation. Skeletal class (Class I, II, III) was included as the between-subject factor, and side (right/left) as the within-subject factor. The main effects of skeletal class and side, as well as the skeletal class × side interaction, were tested. Post hoc pairwise comparisons were performed using Bonferroni correction. Continuous variables were reported as mean±standard deviation for normally distributed data or median (interquartile range) for non-normally distributed data. Statistical significance was set at p\u0026lt;0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 123 participants were included in the study (mean age: 40.1 ± 18.0 years, range: 11–84). According to ANB-based skeletal classification, the sample was equally distributed across Skeletal Class I, II, and III (n=41 per group). No statistically significant differences were observed among groups regarding age (p=0.535) or sex distribution (p=0.156). (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTMJ measurements by skeletal class\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGroup comparisons demonstrated no significant differences in the right TMJ inclination angle across skeletal classes (p=0.522). Although the left TMJ inclination angle tended to be lower in Skeletal Class III (Class I: 48.8 ± 11.5°; Class III: 42.8 ± 13.7°), the overall intergroup comparison did not reach statistical significance (p=0.082) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilarly, glenoid fossa roof thickness did not differ significantly across skeletal classes for either the right (p=0.939) or left side (p=0.317) (Table 1).\u003c/p\u003e\n\u003cp\u003eCorrelation analysis revealed a strong positive association between right and left TMJ inclination angles (Pearson r=0.764, p\u0026lt;0.001). In contrast, right and left glenoid fossa roof thickness measurements showed a moderate positive correlation (Spearman ρ=0.440, p\u0026lt;0.001) (Table 2).\u003c/p\u003e\n\u003cp\u003ePaired analyses showed that the right TMJ inclination angle (48.0 ± 12.4°) was slightly higher than the left TMJ inclination angle (46.4 ± 12.7°). This side-to-side difference was statistically significant (paired t-test, mean difference = 1.68°, 95% CI: 0.15–3.20, p=0.033).\u003c/p\u003e\n\u003cp\u003eConversely, no significant right–left difference was detected for glenoid fossa roof thickness (Wilcoxon signed-rank test, p=0.810) (Table 3).\u003c/p\u003e\n\u003cp\u003eBilateral summary calculations based on group means indicated that the average TMJ inclination angle ((R+L)/2) tended to be highest in Class I and lowest in Class III (Class I: 49.3°, Class II: 47.5°, Class III: 44.8°). In contrast, the mean glenoid fossa roof thickness ((R+L)/2) was slightly higher in Class III (1.05) compared with Class I and II (0.96 for both). Regarding asymmetry, the right–left difference in TMJ inclination angle (R–L) was most pronounced in Class III (+4.0°) compared with Class I (+1.0°) and Class II (+0.1°). Roof thickness asymmetry values were small across groups (Table 4).\u003c/p\u003e\n\u003cp\u003eOverall, AEI angles were largely comparable across skeletal classes, while a small but significant right–left difference was observed for TMJ inclination, and glenoid fossa roof thickness remained stable across both sides and skeletal groups. (Table 5)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present CBCT-based study investigated whether sagittal skeletal malocclusion (ANB-based classification) is associated with variations in AEI, right\u0026ndash;left symmetry, and thickness of the roof of the glenoid fossa. Overall, AEI values were largely comparable across skeletal classes, while a small but statistically significant right\u0026ndash;left difference was identified in TMJ inclination angles. In contrast, glenoid fossa roof thickness remained stable across both sides and skeletal groups. These findings suggest that sagittal skeletal discrepancy alone may not be a dominant determinant of TMJ osseous morphology in adults, and that individual adaptive responses to functional loading may contribute to subtle asymmetries.\u003c/p\u003e \u003cp\u003eIn our cohort, AEI did not show statistically significant differences across skeletal Class I, II, and III. This observation closely aligns with the findings of Moscagiuri et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], who evaluated normodivergent adults using CBCT and similarly reported no significant association between AEI and sagittal skeletal class. The agreement between studies may be explained by the multifactorial nature of eminence morphology, which is influenced not only by sagittal relationships but also by vertical pattern, age-related remodeling, sex-related craniofacial differences, and functional loading conditions.\u003c/p\u003e \u003cp\u003eHowever, the literature is not fully consistent. For example, Arieta-Miranda et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] demonstrated that sagittal skeletal relationship can be associated with differences in TMJ spatial characteristics assessed by CBCT, suggesting that craniofacial pattern may influence joint morphology and position. More recent CBCT evidence also indicates that TMJ morphology may vary in skeletal Class III individuals and may show sex dimorphism in osseous parameters, including eminence inclination [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These discrepancies across studies may be related to methodological differences (measurement definitions, slice selection, reference planes), sample heterogeneity (age range, dentition status, vertical growth pattern), and inclusion/exclusion criteria regarding TMJ symptoms or degenerative changes.\u003c/p\u003e \u003cp\u003eImportantly, AEI is considered biomechanically relevant because the articular eminence is exposed to functional loads, and its inclination influences the pathway of condylar movement and disc rotation during mandibular function [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Therefore, it is plausible that detectable differences in AEI across skeletal classes may emerge more clearly in specific subgroups (e.g., symptomatic Temporomandibuar disorders (TMD) cohorts, extreme vertical patterns, or pronounced skeletal discrepancies) rather than in mixed adult samples.\u003c/p\u003e \u003cp\u003eA notable finding of this study was the strong right\u0026ndash;left correlation observed for AEI, indicating that articular eminence morphology demonstrates substantial bilateral correspondence at the individual level. This supports the view that TMJ osseous architecture is generally symmetrical, consistent with CBCT-based evaluations of TMJ morphology that emphasize wide inter-individual variability but relative bilateral stability within individuals [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this strong bilateral association, AEI was slightly higher on the right side than the left, reaching statistical significance. While the magnitude of this difference was small, this pattern may reflect functional laterality, dominant chewing side, or asymmetric mechanical loading leading to mild adaptive remodeling. Such subtle asymmetries are compatible with the concept that the eminence represents a dynamic structure shaped by loading environment over time [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Clinically, this finding suggests that side-specific assessment may provide additional insight in TMJ evaluation, particularly when planning orthodontic or prosthetic treatments in patients with suspected functional asymmetry.\u003c/p\u003e \u003cp\u003eIn the current study, roof thickness of the glenoid fossa did not differ significantly between skeletal groups or between sides. A similar pattern is plausible in non-selected adult populations, as roof thickness is often considered a stable structural parameter unless modified by substantial changes in joint loading or pathology. Studies assessing roof thickness in asymptomatic adults provide reference values and support the notion that this feature may not necessarily vary with sagittal skeletal class alone [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConversely, several reports indicate that roof thickness may be affected in association with TMJ disorders. Khojastepour et al.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] reported differences in glenoid fossa roof thickness when comparing TMD and non-TMD groups, supporting a relationship between roof thickness changes and joint dysfunction rather than skeletal classification. In addition, dentition status may influence roof thickness: edentulism or partial edentulism can alter mandibular biomechanics and joint loading, potentially contributing to roof thickness variations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Accordingly, the lack of group differences in our study may reflect the predominance of non-pathological remodeling patterns in this retrospective adult cohort and supports the interpretation that sagittal skeletal discrepancy alone may not be sufficient to drive roof thickness changes in the absence of overt joint pathology.\u003c/p\u003e \u003cp\u003eThe absence of significant intergroup differences may be attributable to the multifactorial determinants of TMJ osseous morphology, where sagittal skeletal class represents only one component among vertical pattern, functional loading, and individual remodeling capacity.\u003c/p\u003e \u003cp\u003eFrom a clinical perspective, the present findings suggest that sagittal skeletal classification based on ANB may not reliably predict AEI or glenoid fossa roof thickness. This is consistent with CBCT literature emphasizing that TMJ morphology is influenced by multiple craniofacial and functional variables [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, clinicians should be cautious about inferring TMJ morphology solely from skeletal class and should consider individualized imaging assessment when evaluating TMJ biomechanics, occlusal rehabilitation planning, or orthodontic movement strategies. Clinicians should avoid relying solely on sagittal skeletal classification when estimating TMJ morphology and should consider individualized CBCT-based assessment in selected cases.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, the retrospective nature of the study limits causal interpretation. Second, TMJ symptoms and functional factors (e.g., parafunctional habits, chewing preference, occlusal scheme, disc position) were not directly evaluated, which may contribute to unexplained variability in AEI and roof thickness. Third, skeletal classification was based on ANB alone; incorporating additional sagittal and vertical parameters may help refine subgroup differentiation. Given the evidence that vertical pattern may influence eminence inclination, future studies should stratify analyses by vertical skeletal type and consider sex and dentition status as potential effect modifiers [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Prospective designs integrating clinical TMD assessments, standardized functional indices, and longitudinal follow-up may further clarify how sagittal malocclusion interacts with TMJ adaptive remodeling over time.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, this CBCT-based analysis demonstrated a strong bilateral association in TMJ angulation and a moderate right\u0026ndash;left concordance for glenoid fossa height. Although the right articular eminence inclination was slightly higher than the left, skeletal sagittal malocclusion classified by ANB angle did not result in statistically significant differences in AEI or glenoid fossa height across skeletal classes. These findings suggest that TMJ morphology may exhibit minor side-related variations, while sagittal skeletal pattern alone may not be a dominant determinant of AEI and fossa height. Future studies incorporating vertical skeletal patterns, functional status, and larger multi-center samples may provide a more comprehensive explanation of TMJ adaptive remodeling in different malocclusion types.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTMJ: Temporomandibular joint\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAEI: Articular Eminence Inclination\u003c/p\u003e\n\u003cp\u003eANB angle: Angle between points A, Nasion, and B\u003c/p\u003e\n\u003cp\u003eRGF: The roof of the glenoid fossa\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCBCT: cone-beam computed tomography\u003c/p\u003e\n\u003cp\u003eFH: Frankfort horizontal\u003c/p\u003e\n\u003cp\u003eTMD: Temporomandibuar disorders\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Lokman Hekim Scientific Research Ethics Committee (approval number: 2025/310; date: 30.12.2025). All procedures were performed in accordance with the Declaration of Helsinki. The requirement for informed consent was waived by the Lokman Hekim Scientific Research Ethics Committee due to the retrospective nature of the study. Patient identifiers were removed prior to analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\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\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.C.A. and M.K.H. contributed to conceptualization, data curation, investigation, methodology, and resources. S.C.A. and M.K.H. were responsible for writing—review and editing. S.C.A. performed supervision, validation, and writing—original draft preparation. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al. Anatomy of the temporomandibular joint. \u003cstrong\u003eSemin Ultrasound CT MR\u003c/strong\u003e. 2007;28(3):170\u0026ndash;183. doi:10.1053/j.sult.2007.02.002.\u003c/li\u003e\n\u003cli\u003eMarkov\u0026aacute; M, Gallo LM. 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Comparative cone-beam computed tomography evaluation of temporomandibular joint position and morphology in female patients with skeletal class II malocclusion. \u003cstrong\u003eJ Int Med Res\u003c/strong\u003e. 2019;48(2). doi:10.1177/0300060519892388.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographic characteristics and TMJ measurements by skeletal class\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass I (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass II (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass III (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.2 \u0026plusmn; 15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.5 \u0026plusmn; 19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.5 \u0026plusmn; 19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (61.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 (39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTMJ inclination angle (Right), mean \u0026plusmn; SD (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.8 \u0026plusmn; 12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.5 \u0026plusmn; 12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.8 \u0026plusmn; 12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTMJ inclination angle (Left), mean \u0026plusmn; SD (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.8 \u0026plusmn; 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.4 \u0026plusmn; 12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.8 \u0026plusmn; 13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGlenoid fossa roof thickness (Right), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97 \u0026plusmn; 0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97 \u0026plusmn; 0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 \u0026plusmn; 0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGlenoid fossa roof thickness (Left), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.09 \u0026plusmn; 0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDemographic variables and TMJ measurements according to ANB-based skeletal classification. Continuous variables are presented as mean \u0026plusmn; standard deviation; categorical variables are presented as number (%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Correlation analysis between right and left TMJ measurements.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasurement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003er / \u0026rho;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTMJ inclination angle (Right vs Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePearson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGlenoid fossa roof thickness (Right vs Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpearman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.440\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Comparison of right and left TMJ measurements\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifference (R\u0026ndash;L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTMJ inclination angle (\u0026deg;), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.0 \u0026plusmn; 12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.4 \u0026plusmn; 12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+1.68\u0026deg; (95% CI: 0.15\u0026ndash;3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePaired t-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGlenoid fossa roof thickness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003emedian (min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003emedian (min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e~0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWilcoxon signed-rank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eTMJ inclination angle values were normally distributed; therefore, paired t-test was applied.\u003c/li\u003e\n \u003cli\u003eGlenoid fossa roof thickness showed non-normal distribution; therefore, Wilcoxon signed-rank test was used.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Correlation matrix demonstrating the association between right and left TMJ measurements.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrength\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTMJ inclination angle (Right vs Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003er = 0.764 (Pearson)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGlenoid fossa roof thickness (Right vs Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026rho; = 0.440 (Spearman)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModerate positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Bilateral summary measures for TMJ inclination and glenoid fossa roof thickness according to skeletal class.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass I (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass II (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass III (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean TMJ inclination angle\u003c/strong\u003e ((R+L)/2), \u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean glenoid fossa roof thickness\u003c/strong\u003e ((R+L)/2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide difference in TMJ inclination angle\u003c/strong\u003e (R\u0026ndash;L), \u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide difference in roof thickness\u003c/strong\u003e (R\u0026ndash;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026minus;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"malocclusion, temporomandibular joint disorders, articular eminence","lastPublishedDoi":"10.21203/rs.3.rs-8864220/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8864220/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study aimed to evaluate the association between skeletal sagittal malocclusion (based on ANB angle) and temporomandibular joint (TMJ) morphology by assessing bilateral articular eminence inclination (aeı) and glenoid fossa roof thickness, and to determine right\u0026ndash;left symmetry patterns in these parameters.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eCBCT images of 123 individuals were analyzed. Skeletal classification was performed using ANB angle and participants were distributed equally into Skeletal Class I, II, and III (n\u0026thinsp;=\u0026thinsp;41 each). AEI was measured bilaterally on sagittal TMJ sections relative to the Frankfort horizontal plane, and glenoid fossa height was recorded bilaterally. Side-to-side differences were evaluated using paired tests. Intergroup comparisons were performed across skeletal classes, and right\u0026ndash;left associations were assessed using correlation analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe cohort had a mean age of 40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0 years (range: 11\u0026ndash;84), with no significant differences across skeletal classes for age (p\u0026thinsp;=\u0026thinsp;0.535) or sex distribution (p\u0026thinsp;=\u0026thinsp;0.156). Right and left AEI showed a strong positive correlation (r\u0026thinsp;=\u0026thinsp;0.764, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while glenoid fossa height demonstrated a moderate correlation between sides (ρ\u0026thinsp;=\u0026thinsp;0.440, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The right AEI (48.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u0026deg;) was significantly higher than the left (46.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u0026deg;) (p\u0026thinsp;=\u0026thinsp;0.033). No significant differences in AEI or glenoid fossa height were detected among skeletal classes (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), although left AEI tended to be lower in Class III (p\u0026thinsp;=\u0026thinsp;0.082).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTMJ measurements demonstrated high bilateral association with a small but significant right\u0026ndash;left difference in AEI. Skeletal sagittal malocclusion, as classified by ANB angle, was not significantly associated with AEI or glenoid fossa height in this sample.\u003c/p\u003e","manuscriptTitle":"Association of Articular Eminence Inclination and Glenoid Fossa Roof Thickness with Sagittal Skeletal Classes: A CBCT Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-18 08:26:24","doi":"10.21203/rs.3.rs-8864220/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T09:04:56+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"93388457456127702553341557311234136214","date":"2026-04-19T12:01:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T13:29:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-09T15:01:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36773121437513248302902458794006645899","date":"2026-04-09T05:55:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T08:06:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125796818893766474496783767274385504851","date":"2026-03-19T05:03:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242535764356463822137871096705492408614","date":"2026-03-17T03:34:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T08:21:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142780208632063677446125366295435572733","date":"2026-03-13T07:46:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-12T10:35:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-12T10:34:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-04T08:19:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-02T19:52:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-03-02T11:58:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f129b17-f9a4-454c-bc2c-1ec4a98a9ec0","owner":[],"postedDate":"March 18th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T09:04:56+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:10:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-18 08:26:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8864220","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8864220","identity":"rs-8864220","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}