Correlation of condylar morphology in bruxers and non-bruxers using cone beam computed tomography

Correlation of condylar morphology in bruxers and non-bruxers using cone beam computed tomography | 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 Correlation of condylar morphology in bruxers and non-bruxers using cone beam computed tomography Dr. Aakanksha Tiwari Aakanksha, Dr. Suwarna Dangore-Khasbage Suwarna This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6511533/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 Background – Bruxism (BX), the most common parafunctional habit, is reported widely in young adults due to excessive stress and sleep abnormalities. BX, if left undiagnosed and untreated, over a period of time may cause pathologic alteration in morphology of mandibular condyle leading to temporomandibular disorders (TMDs). Hence, this study aims to evaluate and correlate condylar morphology in bruxers and non-bruxers using cone beam computed tomography (CBCT). Methods – This Institutional Ethics Committee approved combined cohort study comprised of 100 patients which were equally divided into groups. The study group involved the patients with habit of BX who were diagnosed based on the questionnaire while control group patients were recruited retrospectively whose all clinical and radiologic data was available. The patients were evaluated using CBCT for condylar morphological alterations which included flattening, sclerosis, surface erosion and osteophytes Results – Regarding the pathologic alterations, flattening 26(52%) and sclerosis 31(62%) were observed in bruxers which was found to be statistically significant on comparison with non-bruxers. Similarly, surface erosion 4(8%) and osteophytes 14(28%) were also noted in bruxers, however on comparison between two groups the results were statistically not significant. Interestingly, non-bruxers also showed pathologic alterations like osteophytes 16(32%) and surface erosion 9(18%), though asymptomatic which became the point to be focused on. Conclusion – BX leads to alteration in morphology of mandibular condyle which can lead to onset of TMDs. The evaluation of these alterations can greatly help to recognize TMDs at their early stage. The prompt intervention with patient education, and conservative approach can be inculcated at this stage so as to halt the progress of the condition. Nevertheless, the present study described the possible causes for morphological alterations in mandibular condyle as observed in non-bruxers in this study. Trial Registration: The study has been registered under Clinical trial registry - India (CTRI registration number: CTRI/2023/05/052782) on 17/05/2023. temporomandibular joint temporomandibular disorders condyle cone beam computed tomography bruxism Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The temporomandibular joint (TMJ) also referred to as “ginglymo diarthrodial joint” is one of the most intricate articulations of human body that ensures smooth and synchronous mandibular movements to facilitate proper mastication, deglutition, maintain stable mandibular position and prevents dislocation due to unexpected external stresses [ 1 ]. Mandibular condyle is the center of growth in development of mandible which is broadly ovoid in shape. However, its morphology significantly fluctuates attributed to simple developmental variability, condylar remodeling to accommodate developmental variances, trauma, malocclusion, and disorders of TMJ. Rather, one of the highly prevalent factors linked to condylar morphological alteration and initiation of TMDs is parafunctional habits, including BX [ 2 ]. Bruxism (BX) is defined as repetitive activity of masticatory muscle apparatus (MMA), clinically characterized by clenching and grinding of teeth as well as contraction, immobilization (“bracing”) and projection of jaw during either wakefulness (awake BX) or sleep (sleep BX) [ 3 ]. Usually, the bruxers present with diverse clinical manifestations such as pain in pre-auricular region, pain during mastication, pain in MMA, etc.; many a times being asymptomatic. Thus, the presence of clinical manifestations and clinical examination alone is not enough for arriving at a diagnosis. It has to be complemented by radiological correlation to assess its effect on hard tissues including mandibular condyle [ 4 ]. Traditionally, the condylar morphology is evaluated using conventional radiographic techniques like orthopantomogram (OPG). Similarly, various other 2D conventional views can be considered for TMJ evaluation like reverse Towne’s projection, submentovertex, transpharyngeal, transorbital and transcranial views. Nevertheless, all these conventional imaging modalities have significant limitations such as being two dimensional techniques and superimposition of structures [ 5 ]. Hence, the present study attempted to evaluate and correlate condylar morphological alterations in bruxers and non-bruxers using advanced 3D imaging modality i.e., CBCT. The usefulness of CBCT in evaluating condylar morphology is supported by studies by Arayapisit et al. (2023) [ 6 ], Patil et al. (2024) [ 7 ], Feng et al. (2023) [ 8 ], and Zingin et al. (2025) [ 9 ] in various growth patterns, skeletal class, in different parafunctional behaviors, in osteoarthritis and in breathing disturbances. Though there are quite enough studies performed to correlate condylar morphological alterations in above mentioned conditions, but on detailed search of available literature suggesting correlation of condylar morphological alteration in bruxers and non-bruxers, it was found that the evidence was scanty. Hence, the present study aimed to explore the unique relationship of BX with condylar morphological alterations and to correlate it with those of non-bruxers using CBCT. Materials and Methods This hospital based combined cohort study was conducted in the Oral Medicine and Radiology department of Sharad Pawar Dental college and Hospital, Sawangi (Meghe), Wardha. The Ethical Approval has been received from “INSTITUTIONAL ETHICS COMMITTEE (IEC)” of Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha (Approval number DMIMS (DU)/IEC/2023/567 Dated 06/02/2023). It included 100 participants (200 mandibular condyles) which were divided into two equal groups. Inclusion criteria: Patients in age range of 18–40 years, with complete set of dentitions (except third molars), history of bruxism diagnosed based on questionnaire data and clinical examination, bruxers presenting with symptoms of orofacial pain, considerable attrition of teeth and reduced vertical height on clinical examination, the control group consisted of patients with complete set of dentitions (except third molars) with no history of bruxism, no history of orofacial pain, no evidence of attrition of teeth or reduced vertical height on clinical examination. Exclusion criteria: Patients who presented with congenital anomalies of TMJ, patients who presented with trauma or fracture involving TMJ, patients who had history of systemic diseases affecting the TMJ (osteoporosis, osteoarthritis etc), patients who had history of consumption of medications affecting the bone, patients who had history of any pathology affecting the TMJ, patient who had history of adverse habits like kharra and betel nut chewing. Methodology: All the patients were recruited based on inclusion and exclusion criteria. A written informed consent was taken from each patient to make sure their willingness to participate in the study. The diagnosis and type of BX was confirmed based on replies to questionnaire [ 10 ]. After performing thorough clinical examination all diagnosed bruxers irrespective of their type were evaluated for tooth wear index score. A detailed intra-oral examination was done to evaluate the loss of tooth structure on incisal and occlusal surfaces of maxillary and mandibular teeth and scores were assigned to all patients of study group [ 11 ]. All the findings were recorded using case history proforma. Then each participant was evaluated using CBCT (Planmeca Promax 3D, manufactured by M/s Planmeca OY, Finland with equipment ID G-XR-109125. 90 kV. Parameters were adjusted as current 6.3 mA, exposure time 12.056 sec, field of view – reduced to 5x5 mm, 447 DAP (mGy x cm2), number of slices: 251, voxel Size: 200µm, rotation angle 0, pixel size:200, software version 3.9.6.152). CBCT evaluation was done in coronal, sagittal and axial sections for morphological alterations. The morphology was classified as convex, round, flat and angled on coronal section [ 12 ], as normal, flattening, surface erosion and beak shaped on sagittal section [ 12 ], as conical, bean shaped and oval on axial section [ 13 ]. While flattening, sclerosis, osteophyte and surface erosion were evaluated on coronal and sagittal sections of CBCT and were considered to be pathologic alterations [ 11 ]. Statistical Analysis: The data was collected and Statistical analysis was done by using descriptive and inferential statistics using Chi square test. The software used in the analysis were SPSS 27.0 version and GraphPad Prism 7.0 version. The p < 0.05 value is considered as level of significance. Results Age wise distribution of the participants showed the mean age of 28.24 years in bruxers, the youngest being 21 years and the eldest being 38 years old while in non-bruxers youngest was 19 years and the eldest was 40 years old with a mean age of 28.52 years. Regarding gender wise distribution, in bruxers group, female participants were more i.e., 28(56%) and male participants were 22(44%). In non-bruxers group, male participants were more in number as compared to females with a frequency of 24(48%) while male participants were 26(52%). All patients were clinically evaluated for tooth structure loss and scores were assigned based on tooth wear index. Out of the 50 bruxers, the score 0 and score 1 were not found in any patient, score 2 was found in 8(16%) patients, score 3 in 24(48%) patients and score 4 was found in 18 (36%) patients. Out of 50 non bruxers, score 0 was not found in any patient, score 1 was found in 38(76%) patients, score 2 in 12(24%) patients and score 3 and score 4 were not found in any patient (Table 1). On comparison of bilateral condylar morphology on coronal, sagittal and axial sections of CBCT in both the groups, it was inferred that difference in condylar morphology in both groups was not statistically significant as shown in Table 2. Figure 1,2,3 depicts observed morphology of mandibular condyle in both the groups on coronal, sagittal and axial sections of CBCT. Based on the observations of pathologic alteration in condylar morphology on right and left side on coronal section of CBCT, the results were statistically significant in bruxer group (p=0.0001), while not significant in non-bruxer group as shown in Table 3. Figure 4 shows pathologic alterations in condylar morphology on coronal and sagittal sections of CBCT. The present study performed correlation analysis to evaluate presence of pathologic alteration in single or both the joints using coronal and sagittal sections of CBCT (Graph 1 and Graph 2). The correlation analysis for presence of flattening and sclerosis in single or both the joints and its comparison between both the groups on coronal and sagittal section of CBCT revealed statistically significant difference (p=0.0001). However, the correlation analysis for presence of osteophytes and surface erosion in single or both the joints and its comparison between both the groups on coronal and sagittal section of CBCT revealed no statistically significant difference (p=0.67) and (p=20) respectively. Score of tooth wear index Bruxers Non Bruxers ꭓ2-value Score 0 0(0%) 0(0%) 61.83 P=0.0001, S Score 1 0(0%) 38(76%) Score 2 8(16%) 12(24%) Score 3 24(48%) 0(0%) Score 4 18(36%) 0(0%) Total 50(100%) 50(100%) Table 1: Score of tooth wear index in both the groups Condylar morphology on coronal section Bruxers Non Bruxers ꭓ2-value Right side Left side Right side Left side 2.49 P=0.47, NS Convex 17(34%) 19(38%) 14(28%) 15(30%) Angled 10(20%) 15(30%) 17(34%) 18(36%) Flat 16(32%) 11(22%) 13(26%) 10(20%) Round 7(14%) 5(10%) 6(12%) 7(14%) Total 50(100%) 50(100%) 50(100%) 50(100%) ꭓ2-value 2.37, p=0.49, NS 0.53, p=0.91, NS Condylar morphology on sagittal section Bruxers Non Bruxers ꭓ2-value Right side Left side Right side Left side 12.04 P=0.21, NS Normal 16(32%) 23(46%) 23(46%) 21(42%) Flat 19(38%) 13(23%) 12(24%) 14(28%) Beak Shaped 15(30%) 14(28%) 15(30%) 15(30%) Erosion 4(8%) 0(0%) 6(12%) 3(6%) Total 50(100%) 50(100%) 50(100%) 50(100%) ꭓ2-value 5.44, p=0.14, NS 1.18, p=0.75, NS Condylar morphology on axial section Bruxers Non Bruxers ꭓ2-value Right side Left side Right side Left side 0.73 P=0.69, NS Oval 22(44%) 23(46%) 19(38%) 21(42%) Conical 15(30%) 16(32%) 19(38%) 15(30%) Bean Shaped 13(26%) 11(22%) 12(24%) 14(28%) Total 50(100%) 50(100%) 50(100%) 50(100%) ꭓ2-value 0.22, p=0.89, NS 0.72, p=0.69, NS Table 2: Condylar morphology on coronal, sagittal and axial sections of CBCT Pathological alteration on condylar morphology Bruxers Non Bruxers ꭓ2-value Right Left Right Left Flattening 16(32%) 10(20%) 4(8%) 2(4%) 51.80 P=0.0001, S Sclerosis 19(38%) 12(24%) 1(2%) 0(0%) Osteophyte 11(22%) 3(6%) 11(22%) 5(10%) Erosion 4(8%) 0(0%) 6(12%) 3(6%) Normal 0(0%) 25(50%) 28(56%) 40(80%) Total 50(100%) 50(100%) 50(100%) 50(100%) ꭓ2-value 36.54, p=0.0001, S 7.03, p=0.13, NS Table 3: Pathologic alterations in condylar morphology of both the groups on coronal and sagittal section of CBCT Discussion The present study meticulously delves into the morphology of mandibular condyle using CBCT as a modality to investigate its noteworthy relationship with BX by correlating with non-bruxers. The target population in this study was young adults (18–40 years old) pertaining to the fact that BX is more common in this age range because of high levels of stress associated with marriage, schooling, job searching, and financial strains. The age distribution is consistent with research by Kumar et al. (2022) [ 11 ] and Magat & Uzun (2024) [ 14 ]. Similarly, the gender distribution with more female participants than males is aligning with studies by Magat & Uzun (2024) [ 14 ] and Kapusevska et al. (2013) [ 15 ], reflecting the literature's indication of a slightly higher prevalence of BX among females. Parafunctional behaviors, including bruxism (BX), impose undue strain on the components of the TMJ. To define, BX is a recurrent jaw muscular action that includes mandibular thrusting, clenching, or teeth grinding. These behaviors have become more common as a result of rising levels of stress, anxiety, mental health conditions, and some drugs [ 16 ]. There are two types of bruxism: awake bruxism and sleep bruxism. Both kinds impair masticatory function and occlusal harmony. If left untreated, they can cause morphological abnormalities in the TMJ, particularly the mandibular condyle, resulting in initiation of TMDs, which may be completely asymptomatic in early stage and thus might remain unnoticed/undiagnosed [ 17 ]. Once initiated, TMDs may present with pre-auricular pain, pain on mastication, joint noises (clicking, crepitus, grinding), and joint locking—all of which frequently impair jaw movement. Tinnitus, ear ache, psychological disturbance, and stiffness in the muscles of the face, neck, and shoulders are further symptoms [ 18 ]. All bruxers in this study reported symptoms, with pre-auricular discomfort and pain on mastication being the most prevalent, whereas non-bruxers were completely asymptomatic. Underlying alterations in the mandibular condyle and other TMJ components may be the cause of these clinical symptoms [ 19 ]. Yáñez-Vico et al. (2012) [ 20 ] discovered that people with TMDs had notable mediolateral, sagittal, and vertical asymmetries in their condylar processes. Likewise, dos Anjos Pontual et al. (2012) [ 21 ] connected the onset of TMDs to morphological alterations in the TMJ, particularly the condyles. The impact of grinding patterns on condylar form was further highlighted by Sritara et al. (2023) [ 22 ], who found that bilateral grinding produced a flatter condyle in the anteroposterior dimension and unilateral grinding was linked to a more rounded condyle. Diagnosis of Bruxism (BX): Bruxism (BX) is ambiguous to diagnose attributed to its subjective and complex nature, and no universally accepted diagnostic technique currently exists [ 23 ]. Clinical signs may reveal significant tooth structure loss (TSL) and tenderness of masticatory muscles [ 11 ]. TSL can be measured using standardized indices that define scores based on the extent of wear. A scoping review by Bronkhorst et al. (2024) [ 24 ] confirmed the association between tooth wear and BX, suggesting that wear indices can help assess BX severity. However, they emphasized that TSL alone should not be used as a definitive diagnostic tool, as other factors may contribute to tooth wear. In this study, bruxers were categorized based on severity of tooth wear index score. Indicating that BX causes substantial and clinically noticeable tooth structural loss (TSL), bruxers had higher average scores (3–4) compared to non-bruxers, who had lower average scores (1–2). These results are consistent with those of Kumar et al. (2022) [ 11 ], who similarly reported higher scores in symptomatic bruxers using the index to evaluate condylar alterations using CBCT. In order to diagnose and determine the kind of bruxism, non-instrumental methods such as verbal reports and questionnaires are frequently employed in conjunction with clinical examinations [ 3 ]. The gold standards for diagnosing bruxism are still instrumental techniques like electromyography (EMG) for awake bruxism and polysomnography for sleep bruxism. Rompré et al. (2007) [ 25 ] established clinical criteria based on masseter hypertrophy, TSL, and clenching frequency and employed polysomnography to diagnose bruxism. Portable EMG devices such as Bruxoff [ 26 ], MOOMIN-KEI [ 27 ], and ProComp5 [ 28 ] have been developed for at-home monitoring. Studies by Winocur et al. (2010) [ 29 ], Bahammam (2022) [ 30 ], and Chanteux et al. (2024) [ 31 ] have also successfully employed questionnaires. Once bruxism is clinically confirmed, radiological evaluation of the TMJ—particularly the mandibular condyles—is essential to detect potential morphological changes. Radiographic evaluation of condylar morphology: The condylar morphologies in this study were classified as convex, angled, flat, and round by CBCT coronal sections. Although flat and round shapes varied, the results indicated that convex and angled forms were more common in both bruxers and non-bruxers, which is consistent with study results of Shubhasini AR et al. (2016) [ 12 ]. Adaptive modifications brought on by internal derangement were associated with flattening. Normal and beak-shaped condyles were frequently seen in sagittal views, however variations in erosion and flattening indicated the onset of osteoarthritic or degenerative alterations. These results are somewhat consistent with research by Singh et al. (2020) [ 32 ] and Shubhasini AR (2016) [ 12 ], who linked alterations to joint stress, age, and dentition. According to Daneshmehr S et al. (2022) [ 13 ], axial sections revealed a prominent oval form that reflected common morphological patterns driven by age, gender, and dental status. Pathologic Alterations in Condylar Morphology: Condylar pathologic abnormalities in bruxers, including sclerosis and flattening, were in line with findings by Kumar et al. (2022) [ 11 ], indicating that degenerative changes were caused by continuous overload on the TMJ as a result of bruxism. Since all bruxers were symptomatic, our results support a relationship between bruxism and condylar morphology, in contrast to Mortazavi et al. (2023) [ 19 ], who observed no significant link. On the other hand, both symptomatic and asymptomatic bruxers were included in Kumar et al.'s study [ 11 ], which may account for the disparate findings in non-bruxers. Even though they were asymptomatic, non-bruxers in this study also displayed pathologic alterations such as erosion and osteophytes. These could be the result of unidentified systemic causes or early TMJ degeneration. Osteophytes have been connected to early osteoarthritis and joint misalignment in studies by Bechtold et al. (2016) [ 33 ], Derwich et al. (2020) [ 34 ], and Sadaksharam et al. (2016) [ 35 ]. According to Tanaka et al. (2022) [ 36 ], Jiang et al. (2017) [ 37 ], and Shibusaka et al. (2025) [ 38 ], erosion has been linked to discomfort, malocclusion, and hormonal or drug-induced bone alterations. The significance of hormonal imbalance in idiopathic condylar resorption was also emphasized by Zarour et al. (2020) [ 39 ]. Furthermore, although the majority of research defined condyles as convex, round, or flat, certain studies, such as Magat & Uzun (2024) [ 14 ] and Onem Ozbilen et al. (2023) [ 40 ], found a variety of morphologies, including crooked fingers, bird beaks, bifid, and diamond-shaped condyles, which were influenced by occlusion, age, and sex. Correlation analysis of pathologic alterations in bruxers and non-bruxers: Although Kumar et al. (2022) [ 11 ] reported significant unilateral alterations in condylar morphology, correlation analysis in this study showed considerable bilateral flattening and sclerosis in the bruxers' condyles. Our study's bilateral alterations points to a more severe, most likely bilateral bruxism grinding pattern. Six percent of bruxers showed osteophytes. These results corroborate those of Sagl et al. (2022) [ 41 ], who connected elevated TMJ stress to specific grinding habits (mediotrusive, for example). Curiously, some non-bruxers also showed condylar alterations, which could be brought on by occlusal problems, hormone abnormalities, or other systemic illnesses. This emphasizes how crucial early diagnosis of condylar changes is for determining other underlying causes as well as for diagnosing TMDs linked to bruxism. Early management, patient education, and prompt inquiry can help stop more joint degeneration. Conclusion The present study inferred that, bruxism caused significant pathologic alterations in mandibular condyle like flattening, sclerosis, osteophyte and surface erosion in almost 75% of bruxers. Notably, pathologic changes were also observed in asymptomatic non-bruxers, highlighting the potential for missed early diagnosis. This underscores the importance of combining clinical and radiological assessments for comprehensive evaluation and the need to investigate other possible causes of condylar alterations to enable timely intervention and prevent progression. Limitations: The other condylar morphologies listed in the available literature like bifid condyle, crooked finger, bird’s beak and diamond shaped were not observed in this study. Future perspective: Similar studies with larger sample size can be conducted for various morphological alterations in mandibular condyle. Studies can be undertaken to evaluate possible causes of condylar morphological alterations other than parafunctional habits, in normal asymptomatic subjects. Abbreviations 1. CBCT- Cone Beam Computed tomography 2. OPG – Orthopantomogram 3. CT – Computed Tomography 4. MRI – Magnetic Resonance Imaging 5. DVT – Digital Volumetric Tomography 6. 2D – 2 Dimensional 7. 3D- 3 Dimensional 8. TMJ – Temporomandibular joint 9. TMD – Temporomandibular disorder 10. DC/TMD – Diagnostic criteria for temporomandibular disorders 11. JIA – Juvenile Idiopathic Osteoarthritis 12. Bruxism – BX 13. MMA – Masticatory muscle apparatus 14. EMG - Electromyography 15. TSL – Tooth structure loss Declarations Ethics approval and consent to participate - The Ethical Approval has been received from “INSTITUTIONAL ETHICS COMMITTEE (IEC)” of Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha (Approval number DMIMS (DU)/IEC/2023/567 Dated 06/02/2023). Consent for publication – Written informed consent was obtained from all the participants in bruxer group for inclusion in the study and for publication of the data. Availability of data and materials - The datasets supporting the conclusions of this article are included within the article (and its additional files). Competing interests - The authors declare that they have no competing interests Funding – No external funding received for the study Authors' contributions – A.T. and S.D.K. performed conceptualization of the study; A.T. performed drafting and protocol making; S.D.K. supervised and overviewed the drafting and protocol; A.T. performed data collection and data organization; S.D.K. evaluated the collected and organized data; A.T. performed final writing of report; S.D.K. performed final editing and evaluation of report Acknowledgements – Not applicable References Petscavage-Thomas JM, Walker EA. Unlocking the Jaw: Advanced Imaging of the Temporomandibular Joint. 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Validation of Sleep Bruxism Questionnaire Toward the Experience of Jaw Pain and Limitation of Jaw Movement in Saudi Arabian Adolescents. Cureus. 2022;14(6):e26120. Chanteux S, Manuela Taut C, Bacali A, Kui MZ, Zuaiter O, Almasan et al. Self-assessment questionnaire and clinical evaluation of bruxism in correlation with perceived stress. 2024;70(1):46–51. Singh B, Kumar NR, Balan A, Nishan M, Haris PS, Jinisha M, et al. Evaluation of Normal Morphology of Mandibular Condyle: A Radiographic Survey. J Clin Imaging Sci. 2020;10:51–67. Bechtold TE, Saunders C, Decker RS, Um HB, Cottingham N, Salhab I, et al. Osteophyte formation and matrix mineralization in a TMJ osteoarthritis mouse model are associated with ectopic hedgehog signaling. Matrix Biol. 2016;52–54:339–54. Derwich M, Mitus-Kenig M, Pawlowska E. Morphology of the Temporomandibular Joints Regarding the Presence of Osteoarthritic Changes. Int J Environ Res Public Health. 2020;17(8):2923. Sadaksharam J, Khobre P. Osteophytes in temporomandibular joint, a spectrum of appearance in cone-beam computed tomography: Report of four cases. J Indian Acad Oral Med Radiol. 2016;28(3):289. Tanaka S, Ikeda K. A cyst-like erosion in the mandibular condyle associated with malocclusion and its healing process in an 8-year-old patient: A case report. AJO- Clin Companion. 2022;2(3):252–61. Jiang L, Shen X, Wei L, Zhou Q, Gao Y. Effects of bisphosphonates on mandibular condyle of ovariectomized osteoporotic rats using micro-ct and histomorphometric analysis. J Oral Pathol Med. 2017;46(5):398–404. Shibusaka K, Negishi S, Sakai N, Kim Y, Okada H, Yano F. Synergistic effects of estrogen deficiency and articular disk derangement on condylar bone loss. J Oral Biosci. 2025;67(1):100616. Zarour CC, Robinson C, Mian A, Al-Hameed M, Vempala M. Idiopathic Mandibular Condyle Resorption. Cureus [Internet]. 2020 Nov 6 [cited 2025 Jan 27]; Available from: https://www.cureus.com/articles/41779-idiopathic-mandibular-condyle-resorption Onem Ozbi̇Len E, Turan B, Başal E, Yildirim G. Evaluation of Mandibular Condyle Shape Distribution Using Digital Panoramic Images. Eur J Res Dent. 2023;Cilt:7 Sayı:2(Cilt:7 Sayı:2):88–93. Sagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. The effect of tooth cusp morphology and grinding direction on TMJ loading during bruxism. Front Physiol. 2022;13:964930. Graphs Graphs 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Graph12.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-6511533","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458244845,"identity":"0a0a7afa-1a0b-4cde-93cc-764c8abc0b0d","order_by":0,"name":"Dr. Aakanksha Tiwari Aakanksha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYJCCA0DMw8/e//EBiMFHWAMzRItkzwFjAxCDjRgtYGBwI8FMAsQgqIV/Rv7Bwzw192SAWtIqv+bYybAxMD98dAOPFokbyQyHeY4V80ieeXDstuy2ZKDD2IyNc/BZc+Yww+EctgQevuOJbbcltzEDtfCwSePTIg/W8i+Bh+FAMlux5LZ6wloMjjczHM5tS+AROJHGxvhx22HCWgyPNxsc/tuXAAzkM8zSjNuO87AxE/CL3GHGxx9nfEuw52fvYfz4c1s1kNH88DFe7yMDZh4wSaxyEGD8QYrqUTAKRsEoGDEAAImtR522Y6HGAAAAAElFTkSuQmCC","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":true,"prefix":"Dr.","firstName":"Aakanksha","middleName":"Tiwari","lastName":"Aakanksha","suffix":""},{"id":458244846,"identity":"e838e340-4c9c-48c0-a708-dbf88a35dbfd","order_by":1,"name":"Dr. Suwarna Dangore-Khasbage Suwarna","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr.","firstName":"Suwarna","middleName":"Dangore-Khasbage","lastName":"Suwarna","suffix":""}],"badges":[],"createdAt":"2025-04-23 10:08:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6511533/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6511533/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83158736,"identity":"0a123956-0010-408d-88f9-e2c7e05452a4","added_by":"auto","created_at":"2025-05-20 14:56:03","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":86232,"visible":true,"origin":"","legend":"\u003cp\u003eCondylar morphology on coronal section depicting convex, round, flat and angled morphology\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6511533/v1/d2468c3c0763675f81336360.jpeg"},{"id":83158740,"identity":"c0de8deb-3a43-4464-a9f8-ecb0da157720","added_by":"auto","created_at":"2025-05-20 14:56:04","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":87332,"visible":true,"origin":"","legend":"\u003cp\u003eCondylar morphology on sagittal section depicting normal, flat, erosion and beak shaped morphology\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6511533/v1/65841c3f1e0c427f1a882f7f.jpeg"},{"id":83158738,"identity":"337e6631-0e6c-4a80-af23-cef9432fb9c4","added_by":"auto","created_at":"2025-05-20 14:56:04","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":80830,"visible":true,"origin":"","legend":"\u003cp\u003eCondylar morphology on sagittal section depicting oval, bean shaped and conical morphology\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6511533/v1/1bf5b28f4e4efc65294c203a.jpeg"},{"id":83160862,"identity":"8813ded7-ad42-448d-ad21-fbaabe7c47da","added_by":"auto","created_at":"2025-05-20 15:12:04","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":154830,"visible":true,"origin":"","legend":"\u003cp\u003ePathologic alterations in condylar morphology on coronal and sagittal section of CBCT\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6511533/v1/ed917eb0403dea4767dd54ad.jpeg"},{"id":91148189,"identity":"6890f37e-86e9-489c-9c61-231a9079688b","added_by":"auto","created_at":"2025-09-12 06:43:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1292536,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6511533/v1/fd528943-49c0-456d-9c33-5fd30b2c739c.pdf"},{"id":83159576,"identity":"952cd751-79db-4915-a3fc-ded9314f7f20","added_by":"auto","created_at":"2025-05-20 15:04:03","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24142,"visible":true,"origin":"","legend":"","description":"","filename":"Graph12.docx","url":"https://assets-eu.researchsquare.com/files/rs-6511533/v1/e02484cfbe028a91fd7381a3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation of condylar morphology in bruxers and non-bruxers using cone beam computed tomography","fulltext":[{"header":"Background","content":"\u003cp\u003eThe temporomandibular joint (TMJ) also referred to as \u0026ldquo;ginglymo diarthrodial joint\u0026rdquo; is one of the most intricate articulations of human body that ensures smooth and synchronous mandibular movements to facilitate proper mastication, deglutition, maintain stable mandibular position and prevents dislocation due to unexpected external stresses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMandibular condyle is the center of growth in development of mandible which is broadly ovoid in shape. However, its morphology significantly fluctuates attributed to simple developmental variability, condylar remodeling to accommodate developmental variances, trauma, malocclusion, and disorders of TMJ. Rather, one of the highly prevalent factors linked to condylar morphological alteration and initiation of TMDs is parafunctional habits, including BX [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBruxism (BX) is defined as repetitive activity of masticatory muscle apparatus (MMA), clinically characterized by clenching and grinding of teeth as well as contraction, immobilization (\u0026ldquo;bracing\u0026rdquo;) and projection of jaw during either wakefulness (awake BX) or sleep (sleep BX) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Usually, the bruxers present with diverse clinical manifestations such as pain in pre-auricular region, pain during mastication, pain in MMA, etc.; many a times being asymptomatic. Thus, the presence of clinical manifestations and clinical examination alone is not enough for arriving at a diagnosis. It has to be complemented by radiological correlation to assess its effect on hard tissues including mandibular condyle [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditionally, the condylar morphology is evaluated using conventional radiographic techniques like orthopantomogram (OPG). Similarly, various other 2D conventional views can be considered for TMJ evaluation like reverse Towne\u0026rsquo;s projection, submentovertex, transpharyngeal, transorbital and transcranial views. Nevertheless, all these conventional imaging modalities have significant limitations such as being two dimensional techniques and superimposition of structures [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Hence, the present study attempted to evaluate and correlate condylar morphological alterations in bruxers and non-bruxers using advanced 3D imaging modality i.e., CBCT. The usefulness of CBCT in evaluating condylar morphology is supported by studies by Arayapisit et al. (2023) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], Patil et al. (2024) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Feng et al. (2023) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and Zingin et al. (2025) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] in various growth patterns, skeletal class, in different parafunctional behaviors, in osteoarthritis and in breathing disturbances.\u003c/p\u003e \u003cp\u003eThough there are quite enough studies performed to correlate condylar morphological alterations in above mentioned conditions, but on detailed search of available literature suggesting correlation of condylar morphological alteration in bruxers and non-bruxers, it was found that the evidence was scanty. Hence, the present study aimed to explore the unique relationship of BX with condylar morphological alterations and to correlate it with those of non-bruxers using CBCT.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This hospital based combined cohort study was conducted in the Oral Medicine and Radiology department of Sharad Pawar Dental college and Hospital, Sawangi (Meghe), Wardha. The Ethical Approval has been received from \u0026ldquo;INSTITUTIONAL ETHICS COMMITTEE (IEC)\u0026rdquo; of Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha (Approval number DMIMS (DU)/IEC/2023/567 Dated 06/02/2023). It included 100 participants (200 mandibular condyles) which were divided into two equal groups.\u003c/p\u003e \u003cp\u003eInclusion criteria:\u003c/p\u003e \u003cp\u003ePatients in age range of 18\u0026ndash;40 years, with complete set of dentitions (except third molars), history of bruxism diagnosed based on questionnaire data and clinical examination, bruxers presenting with symptoms of orofacial pain, considerable attrition of teeth and reduced vertical height on clinical examination, the control group consisted of patients with complete set of dentitions (except third molars) with no history of bruxism, no history of orofacial pain, no evidence of attrition of teeth or reduced vertical height on clinical examination.\u003c/p\u003e \u003cp\u003eExclusion criteria:\u003c/p\u003e \u003cp\u003ePatients who presented with congenital anomalies of TMJ, patients who presented with trauma or fracture involving TMJ, patients who had history of systemic diseases affecting the TMJ (osteoporosis, osteoarthritis etc), patients who had history of consumption of medications affecting the bone, patients who had history of any pathology affecting the TMJ, patient who had history of adverse habits like kharra and betel nut chewing.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eAll the patients were recruited based on inclusion and exclusion criteria. A written informed consent was taken from each patient to make sure their willingness to participate in the study. The diagnosis and type of BX was confirmed based on replies to questionnaire [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. After performing thorough clinical examination all diagnosed bruxers irrespective of their type were evaluated for tooth wear index score. A detailed intra-oral examination was done to evaluate the loss of tooth structure on incisal and occlusal surfaces of maxillary and mandibular teeth and scores were assigned to all patients of study group [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. All the findings were recorded using case history proforma.\u003c/p\u003e \u003cp\u003eThen each participant was evaluated using CBCT (Planmeca Promax 3D, manufactured by M/s Planmeca OY, Finland with equipment ID G-XR-109125. 90 kV. Parameters were adjusted as current 6.3 mA, exposure time 12.056 sec, field of view \u0026ndash; reduced to 5x5 mm, 447 DAP (mGy x cm2), number of slices: 251, voxel Size: 200\u0026micro;m, rotation angle 0, pixel size:200, software version 3.9.6.152).\u003c/p\u003e \u003cp\u003eCBCT evaluation was done in coronal, sagittal and axial sections for morphological alterations. The morphology was classified as convex, round, flat and angled on coronal section [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], as normal, flattening, surface erosion and beak shaped on sagittal section [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], as conical, bean shaped and oval on axial section [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. While flattening, sclerosis, osteophyte and surface erosion were evaluated on coronal and sagittal sections of CBCT and were considered to be pathologic alterations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStatistical Analysis: The data was collected and Statistical analysis was done by using descriptive and inferential statistics using Chi square test. The software used in the analysis were SPSS 27.0 version and GraphPad Prism 7.0 version. The p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 value is considered as level of significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAge wise distribution of the participants showed the mean age of 28.24 years in bruxers, the youngest being 21 years and the eldest being 38 years old while in non-bruxers youngest was 19 years and the eldest was 40 years old with a mean age of 28.52 years. Regarding gender wise distribution, in bruxers group, female participants were more i.e., 28(56%) and male participants were 22(44%). In non-bruxers group, male participants were more in number as compared to females with a frequency of 24(48%) while male participants were 26(52%).\u003c/p\u003e\n\u003cp\u003eAll patients were clinically evaluated for tooth structure loss and scores were assigned based on tooth wear index. Out of the 50 bruxers, the score 0 and score 1 were not found in any patient, score 2 was found in 8(16%) patients, score 3 in 24(48%) patients and score 4 was found in 18 (36%) patients. Out of 50 non bruxers, score 0 was not found in any patient, score 1 was found in 38(76%) patients, score 2 in 12(24%) patients and score 3 and score 4 were not found in any patient (Table 1).\u003c/p\u003e\n\u003cp\u003eOn comparison of bilateral condylar morphology on coronal, sagittal and axial sections of CBCT in both the groups, it was inferred that difference in condylar morphology in both groups was not statistically significant as shown in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1,2,3 depicts observed morphology of mandibular condyle in both the groups on coronal, sagittal and axial sections of CBCT.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the observations of pathologic alteration in condylar morphology on right and left side on coronal section of CBCT, the results were statistically significant in bruxer group (p=0.0001), while not significant in non-bruxer group as shown in Table 3. Figure 4 shows pathologic alterations in condylar morphology on coronal and sagittal sections of CBCT.\u003c/p\u003e\n\u003cp\u003eThe present study performed correlation analysis to evaluate presence of pathologic alteration in single or both the joints using coronal and sagittal sections of CBCT (Graph 1 and Graph 2). The correlation analysis for presence of flattening and sclerosis in single or both the joints and its comparison between both the groups on coronal and sagittal section of CBCT revealed statistically significant difference (p=0.0001). However, the correlation analysis for presence of osteophytes and surface erosion in single or both the joints and its comparison between both the groups on coronal and sagittal section of CBCT revealed no statistically significant difference (p=0.67) and (p=20) respectively.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore of tooth wear index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon Bruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eꭓ2-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eScore 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 138px;\"\u003e\n \u003cp\u003e61.83\u003c/p\u003e\n \u003cp\u003eP=0.0001, S\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eScore 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38(76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eScore 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8(16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e12(24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eScore 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e24(48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eScore 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e18(36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003eTable 1: Score of tooth wear index in both the groups\u003c/sup\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondylar morphology on coronal section\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon Bruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eꭓ2-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.49\u003c/p\u003e\n \u003cp\u003eP=0.47, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eConvex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e17(34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e19(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e14(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eAngled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e10(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e17(34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e18(36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFlat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e16(32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11(22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13(26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e10(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eRound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7(14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e6(12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e7(14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eꭓ2-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e2.37, p=0.49, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e0.53, p=0.91, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondylar morphology on sagittal section\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon Bruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eꭓ2-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.04\u003c/p\u003e\n \u003cp\u003eP=0.21, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e16(32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e23(46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e23(46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e21(42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFlat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e19(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13(23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e12(24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e14(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eBeak Shaped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e14(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eErosion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4(8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e6(12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3(6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eꭓ2-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e5.44, p=0.14, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e1.18, p=0.75, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondylar morphology on axial section\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon Bruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eꭓ2-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003cp\u003eP=0.69, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e22(44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e23(46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e19(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e21(42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eConical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e16(32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e19(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eBean Shaped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e13(26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11(22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e12(24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e14(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eꭓ2-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e0.22, p=0.89, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e0.72, p=0.69, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003eTable 2: Condylar morphology on coronal, sagittal and axial sections of CBCT\u003c/sup\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathological alteration on condylar morphology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon Bruxers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eꭓ2-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eFlattening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e16(32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e10(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4(8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2(4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 96px;\"\u003e\n \u003cp\u003e51.80\u003c/p\u003e\n \u003cp\u003eP=0.0001, S\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eSclerosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e19(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e12(24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eOsteophyte\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e11(22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3(6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11(22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eErosion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e4(8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6(12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3(6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e25(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e28(56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e40(80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e50(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eꭓ2-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e36.54, p=0.0001, S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e7.03, p=0.13, NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003eTable 3: Pathologic alterations in condylar morphology of both the groups on coronal and sagittal section of CBCT\u003c/sup\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study meticulously delves into the morphology of mandibular condyle using CBCT as a modality to investigate its noteworthy relationship with BX by correlating with non-bruxers.\u003c/p\u003e \u003cp\u003eThe target population in this study was young adults (18\u0026ndash;40 years old) pertaining to the fact that BX is more common in this age range because of high levels of stress associated with marriage, schooling, job searching, and financial strains. The age distribution is consistent with research by Kumar et al. (2022) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and Magat \u0026amp; Uzun (2024) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, the gender distribution with more female participants than males is aligning with studies by Magat \u0026amp; Uzun (2024) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Kapusevska et al. (2013) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], reflecting the literature's indication of a slightly higher prevalence of BX among females.\u003c/p\u003e \u003cp\u003eParafunctional behaviors, including bruxism (BX), impose undue strain on the components of the TMJ. To define, BX is a recurrent jaw muscular action that includes mandibular thrusting, clenching, or teeth grinding. These behaviors have become more common as a result of rising levels of stress, anxiety, mental health conditions, and some drugs [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. There are two types of bruxism: awake bruxism and sleep bruxism. Both kinds impair masticatory function and occlusal harmony. If left untreated, they can cause morphological abnormalities in the TMJ, particularly the mandibular condyle, resulting in initiation of TMDs, which may be completely asymptomatic in early stage and thus might remain unnoticed/undiagnosed [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOnce initiated, TMDs may present with pre-auricular pain, pain on mastication, joint noises (clicking, crepitus, grinding), and joint locking\u0026mdash;all of which frequently impair jaw movement. Tinnitus, ear ache, psychological disturbance, and stiffness in the muscles of the face, neck, and shoulders are further symptoms [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. All bruxers in this study reported symptoms, with pre-auricular discomfort and pain on mastication being the most prevalent, whereas non-bruxers were completely asymptomatic. Underlying alterations in the mandibular condyle and other TMJ components may be the cause of these clinical symptoms [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eY\u0026aacute;\u0026ntilde;ez-Vico et al. (2012) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] discovered that people with TMDs had notable mediolateral, sagittal, and vertical asymmetries in their condylar processes. Likewise, dos Anjos Pontual et al. (2012) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] connected the onset of TMDs to morphological alterations in the TMJ, particularly the condyles. The impact of grinding patterns on condylar form was further highlighted by Sritara et al. (2023) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], who found that bilateral grinding produced a flatter condyle in the anteroposterior dimension and unilateral grinding was linked to a more rounded condyle.\u003c/p\u003e\n\u003ch3\u003eDiagnosis of Bruxism (BX):\u003c/h3\u003e\n\u003cp\u003eBruxism (BX) is ambiguous to diagnose attributed to its subjective and complex nature, and no universally accepted diagnostic technique currently exists [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Clinical signs may reveal significant tooth structure loss (TSL) and tenderness of masticatory muscles [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. TSL can be measured using standardized indices that define scores based on the extent of wear. A scoping review by Bronkhorst et al. (2024) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] confirmed the association between tooth wear and BX, suggesting that wear indices can help assess BX severity. However, they emphasized that TSL alone should not be used as a definitive diagnostic tool, as other factors may contribute to tooth wear.\u003c/p\u003e \u003cp\u003eIn this study, bruxers were categorized based on severity of tooth wear index score. Indicating that BX causes substantial and clinically noticeable tooth structural loss (TSL), bruxers had higher average scores (3\u0026ndash;4) compared to non-bruxers, who had lower average scores (1\u0026ndash;2). These results are consistent with those of Kumar et al. (2022) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], who similarly reported higher scores in symptomatic bruxers using the index to evaluate condylar alterations using CBCT.\u003c/p\u003e \u003cp\u003eIn order to diagnose and determine the kind of bruxism, non-instrumental methods such as verbal reports and questionnaires are frequently employed in conjunction with clinical examinations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The gold standards for diagnosing bruxism are still instrumental techniques like electromyography (EMG) for awake bruxism and polysomnography for sleep bruxism. Rompr\u0026eacute; et al. (2007) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] established clinical criteria based on masseter hypertrophy, TSL, and clenching frequency and employed polysomnography to diagnose bruxism. Portable EMG devices such as Bruxoff [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], MOOMIN-KEI [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and ProComp5 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] have been developed for at-home monitoring. Studies by Winocur et al. (2010) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Bahammam (2022) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and Chanteux et al. (2024) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] have also successfully employed questionnaires.\u003c/p\u003e \u003cp\u003eOnce bruxism is clinically confirmed, radiological evaluation of the TMJ\u0026mdash;particularly the mandibular condyles\u0026mdash;is essential to detect potential morphological changes.\u003c/p\u003e\n\u003ch3\u003eRadiographic evaluation of condylar morphology:\u003c/h3\u003e\n\u003cp\u003eThe condylar morphologies in this study were classified as convex, angled, flat, and round by CBCT coronal sections. Although flat and round shapes varied, the results indicated that convex and angled forms were more common in both bruxers and non-bruxers, which is consistent with study results of Shubhasini AR et al. (2016) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Adaptive modifications brought on by internal derangement were associated with flattening. Normal and beak-shaped condyles were frequently seen in sagittal views, however variations in erosion and flattening indicated the onset of osteoarthritic or degenerative alterations. These results are somewhat consistent with research by Singh et al. (2020) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and Shubhasini AR (2016) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], who linked alterations to joint stress, age, and dentition. According to Daneshmehr S et al. (2022) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], axial sections revealed a prominent oval form that reflected common morphological patterns driven by age, gender, and dental status.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePathologic Alterations in Condylar Morphology:\u003c/h2\u003e \u003cp\u003eCondylar pathologic abnormalities in bruxers, including sclerosis and flattening, were in line with findings by Kumar et al. (2022) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], indicating that degenerative changes were caused by continuous overload on the TMJ as a result of bruxism. Since all bruxers were symptomatic, our results support a relationship between bruxism and condylar morphology, in contrast to Mortazavi et al. (2023) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], who observed no significant link. On the other hand, both symptomatic and asymptomatic bruxers were included in Kumar et al.'s study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which may account for the disparate findings in non-bruxers.\u003c/p\u003e \u003cp\u003eEven though they were asymptomatic, non-bruxers in this study also displayed pathologic alterations such as erosion and osteophytes. These could be the result of unidentified systemic causes or early TMJ degeneration. Osteophytes have been connected to early osteoarthritis and joint misalignment in studies by Bechtold et al. (2016) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], Derwich et al. (2020) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and Sadaksharam et al. (2016) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. According to Tanaka et al. (2022) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], Jiang et al. (2017) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and Shibusaka et al. (2025) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], erosion has been linked to discomfort, malocclusion, and hormonal or drug-induced bone alterations. The significance of hormonal imbalance in idiopathic condylar resorption was also emphasized by Zarour et al. (2020) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, although the majority of research defined condyles as convex, round, or flat, certain studies, such as Magat \u0026amp; Uzun (2024) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Onem Ozbilen et al. (2023) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], found a variety of morphologies, including crooked fingers, bird beaks, bifid, and diamond-shaped condyles, which were influenced by occlusion, age, and sex.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCorrelation analysis of pathologic alterations in bruxers and non-bruxers:\u003c/h3\u003e\n\u003cp\u003eAlthough Kumar et al. (2022) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported significant unilateral alterations in condylar morphology, correlation analysis in this study showed considerable bilateral flattening and sclerosis in the bruxers' condyles. Our study's bilateral alterations points to a more severe, most likely bilateral bruxism grinding pattern. Six percent of bruxers showed osteophytes. These results corroborate those of Sagl et al. (2022) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], who connected elevated TMJ stress to specific grinding habits (mediotrusive, for example).\u003c/p\u003e \u003cp\u003eCuriously, some non-bruxers also showed condylar alterations, which could be brought on by occlusal problems, hormone abnormalities, or other systemic illnesses. This emphasizes how crucial early diagnosis of condylar changes is for determining other underlying causes as well as for diagnosing TMDs linked to bruxism. Early management, patient education, and prompt inquiry can help stop more joint degeneration.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study inferred that, bruxism caused significant pathologic alterations in mandibular condyle like flattening, sclerosis, osteophyte and surface erosion in almost 75% of bruxers. Notably, pathologic changes were also observed in asymptomatic non-bruxers, highlighting the potential for missed early diagnosis. This underscores the importance of combining clinical and radiological assessments for comprehensive evaluation and the need to investigate other possible causes of condylar alterations to enable timely intervention and prevent progression.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eThe other condylar morphologies listed in the available literature like bifid condyle, crooked finger, bird\u0026rsquo;s beak and diamond shaped were not observed in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFuture perspective:\u003c/h2\u003e \u003cp\u003eSimilar studies with larger sample size can be conducted for various morphological alterations in mandibular condyle.\u003c/p\u003e \u003cp\u003eStudies can be undertaken to evaluate possible causes of condylar morphological alterations other than parafunctional habits, in normal asymptomatic subjects.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e1. CBCT- Cone Beam Computed tomography 2. OPG \u0026ndash; Orthopantomogram 3. CT \u0026ndash; Computed Tomography 4. MRI \u0026ndash; Magnetic Resonance Imaging 5. DVT \u0026ndash; Digital Volumetric Tomography 6. 2D \u0026ndash; 2 Dimensional 7. 3D- 3 Dimensional 8. TMJ \u0026ndash; Temporomandibular joint 9. TMD \u0026ndash; Temporomandibular disorder 10. DC/TMD \u0026ndash; Diagnostic criteria for temporomandibular disorders 11. JIA \u0026ndash; Juvenile Idiopathic Osteoarthritis 12. Bruxism \u0026ndash; BX 13. MMA \u0026ndash; Masticatory muscle apparatus 14. EMG - Electromyography 15. TSL \u0026ndash; Tooth structure loss\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate -\u0026nbsp;\u003c/strong\u003eThe Ethical Approval has been received from “INSTITUTIONAL ETHICS COMMITTEE (IEC)” of Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha (Approval number DMIMS (DU)/IEC/2023/567 Dated 06/02/2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication –\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from all the participants in bruxer group for inclusion in the study and for publication of the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials -\u0026nbsp;\u003c/strong\u003eThe datasets supporting the conclusions of this article are included within the article (and its additional files).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests -\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding –\u0026nbsp;\u003c/strong\u003eNo external funding received for the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions –\u0026nbsp;\u003c/strong\u003eA.T. and S.D.K. performed conceptualization of the study; A.T. \u0026nbsp;performed drafting and protocol making; S.D.K. supervised and overviewed the drafting and protocol; A.T. performed data collection and data organization; S.D.K. evaluated the collected and organized data; A.T. performed final writing of report; S.D.K. performed final editing and evaluation of report\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements –\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePetscavage-Thomas JM, Walker EA. 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Evaluation of bone changes in the temporomandibular joint using cone beam CT. Dentomaxillofacial Radiol. 2012;41(1):24\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSritara S, Matsumoto Y, Lou Y, Qi J, Aida J, Ono T. Association between the Temporomandibular Joint Morphology and Chewing Pattern. Diagnostics. 2023;13(13):2177.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoyama J, Nishiyama H, Hayashi T. Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder. Dentomaxillofacial Radiol. 2007;36(8):472\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBronkhorst H, Kalaykova S, Huysmans MC, Loomans B, Pereira-Cenci T. Tooth wear and bruxism: A scoping review. J Dent. 2024;145:104983.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRompr\u0026eacute; PH, Daigle-Landry D, Guitard F, Montplaisir JY, Lavigne GJ. 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Self-assessment questionnaire and clinical evaluation of bruxism in correlation with perceived stress. 2024;70(1):46\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh B, Kumar NR, Balan A, Nishan M, Haris PS, Jinisha M, et al. Evaluation of Normal Morphology of Mandibular Condyle: A Radiographic Survey. J Clin Imaging Sci. 2020;10:51\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBechtold TE, Saunders C, Decker RS, Um HB, Cottingham N, Salhab I, et al. Osteophyte formation and matrix mineralization in a TMJ osteoarthritis mouse model are associated with ectopic hedgehog signaling. Matrix Biol. 2016;52\u0026ndash;54:339\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDerwich M, Mitus-Kenig M, Pawlowska E. Morphology of the Temporomandibular Joints Regarding the Presence of Osteoarthritic Changes. Int J Environ Res Public Health. 2020;17(8):2923.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadaksharam J, Khobre P. Osteophytes in temporomandibular joint, a spectrum of appearance in cone-beam computed tomography: Report of four cases. J Indian Acad Oral Med Radiol. 2016;28(3):289.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanaka S, Ikeda K. A cyst-like erosion in the mandibular condyle associated with malocclusion and its healing process in an 8-year-old patient: A case report. AJO- Clin Companion. 2022;2(3):252\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang L, Shen X, Wei L, Zhou Q, Gao Y. Effects of bisphosphonates on mandibular condyle of ovariectomized osteoporotic rats using micro-ct and histomorphometric analysis. J Oral Pathol Med. 2017;46(5):398\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShibusaka K, Negishi S, Sakai N, Kim Y, Okada H, Yano F. Synergistic effects of estrogen deficiency and articular disk derangement on condylar bone loss. J Oral Biosci. 2025;67(1):100616.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarour CC, Robinson C, Mian A, Al-Hameed M, Vempala M. Idiopathic Mandibular Condyle Resorption. Cureus [Internet]. 2020 Nov 6 [cited 2025 Jan 27]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cureus.com/articles/41779-idiopathic-mandibular-condyle-resorption\u003c/span\u003e\u003cspan address=\"https://www.cureus.com/articles/41779-idiopathic-mandibular-condyle-resorption\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnem Ozbi̇Len E, Turan B, Başal E, Yildirim G. Evaluation of Mandibular Condyle Shape Distribution Using Digital Panoramic Images. Eur J Res Dent. 2023;Cilt:7 Sayı:2(Cilt:7 Sayı:2):88\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. The effect of tooth cusp morphology and grinding direction on TMJ loading during bruxism. Front Physiol. 2022;13:964930.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Graphs","content":"\u003cp\u003eGraphs 1 and 2 are available in the Supplementary Files section.\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, temporomandibular disorders, condyle, cone beam computed tomography, bruxism","lastPublishedDoi":"10.21203/rs.3.rs-6511533/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6511533/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground – \u003c/strong\u003eBruxism (BX), the most common parafunctional habit, is reported widely in young adults due to excessive stress and sleep abnormalities. BX, if left undiagnosed and untreated, over a period of time may cause pathologic alteration in morphology of mandibular condyle leading to temporomandibular disorders (TMDs). Hence, this study aims to evaluate and correlate condylar morphology in bruxers and non-bruxers using cone beam computed tomography (CBCT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e – This Institutional Ethics Committee approved combined cohort study comprised of 100 patients which were equally divided into groups. The study group involved the patients with habit of BX who were diagnosed based on the questionnaire while control group patients were recruited retrospectively whose all clinical and radiologic data was available. The patients were evaluated using CBCT for condylar morphological alterations which included flattening, sclerosis, surface erosion and osteophytes\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003e– Regarding the pathologic alterations, flattening 26(52%) and sclerosis 31(62%) were observed in bruxers which was found to be statistically significant on comparison with non-bruxers. Similarly, surface erosion 4(8%) and osteophytes 14(28%) were also noted in bruxers, however on comparison between two groups the results were statistically not significant. Interestingly, non-bruxers also showed pathologic alterations like osteophytes 16(32%) and surface erosion 9(18%), though asymptomatic which became the point to be focused on.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e – BX leads to alteration in morphology of mandibular condyle which can lead to onset of TMDs. The evaluation of these alterations can greatly help to recognize TMDs at their early stage. The prompt intervention with patient education, and conservative approach can be inculcated at this stage so as to halt the progress of the condition. Nevertheless, the present study described the possible causes for morphological alterations in mandibular condyle as observed in non-bruxers in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration: \u003c/strong\u003eThe study has been registered under Clinical trial registry - India \u003cstrong\u003e(CTRI registration number: CTRI/2023/05/052782) \u003c/strong\u003eon 17/05/2023.\u003c/p\u003e","manuscriptTitle":"Correlation of condylar morphology in bruxers and non-bruxers using cone beam computed tomography","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-20 14:55:59","doi":"10.21203/rs.3.rs-6511533/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":"0e31d67b-1302-4232-bf29-1b1d1a25caff","owner":[],"postedDate":"May 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-05T05:08:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-20 14:55:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6511533","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6511533","identity":"rs-6511533","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}