Evaluation of the sagittal position of the mandibular condyle in patients with temporomandibular disorders

Abstract

Background. Temporomandibular disorders (TMD) comprise a heterogeneous group of conditions affecting the temporomandibular joint and related structures, in which imaging complements the clinical examination and contributes to the definition of the morphologic substrate of dysfunction. For the assessment of osseous joint components, cone-beam computed tomography (CBCT) provides useful information on the condylefossa relationship and joint-space dimensions, allowing appraisal of the sagittal position of the mandibular condyle. Objective of the study. To evaluate the sagittal position of the mandibular condyle in patients with temporomandibular disorders and to assess the distribution of bilateral condylar patterns in relation to gender, the clinical form of TMD and the severity of clinical and functional manifestations. Material and methods. This observational, analytical, cross-sectional study included 50 patients with TMD. CBCT examination was used to measure the anterior, superior, and posterior joint spaces bilaterally on the central sagittal section. The sagittal condylar position was assessed using the Pullinger-Hollender index, allowing classification of cases as centric, anterior, or posterior. Results. The sample showed a clear female predominance, with a mean age of 31.6±8.8 years and no significant age differences between sexes; the 21-30-year group was the most represented. Categorical analysis showed predominance of the anterior condylar position on both sides. At the patient level, the most frequent symmetric configuration was bilateral anteriorization, while half of the cases displayed asymmetric patterns, most commonly anterior-centric and centric-anterior. No statistically significant associations were found between condylar pattern distribution and sex, clinical form of TMD, severity of dysfunction, or severity of functional limitation. Conclusions. In patients with TMD, the sagittal condylar position assessed by CBCT was characterized mainly by bilateral anteriorization and by a high frequency of right-left asymmetric configurations. The condylar pattern did not vary significantly across the analyzed clinical subgroups.