Clinical, imaging and functional features of condylar malposition in patients with temporomandibular disorders: Summary of the doctoral thesis in medical sciences: 323.01 Dentistry

Abstract

Thesis volume. The thesis is presented on 129 pages of basic text and includes an introduction, 4 chapters, general conclusions and practical recommendations. The bibliography includes 293 sources. The work is completed with annexes, a list of publications and participation in scientific forums, a statement on assuming personal responsibility, annotation in Romanian/English and the author's CV. The basic text is illustrated with 24 tables, 2 figures and 13 formulas. Field of study: 323.01 – Dentistry Aim of the thesis: characterization of the clinical, functional, imaging-structural and kinematic expression in patients with temporomandibular disorders and condylar malposition, in order to identify specific characteristics. Study objectives: 1. Evaluation of the clinical picture and functionality of patients with TMD and condylar malposition based on the DC/TMD protocol, regarding the distribution of orofacial pain, the degree of functional limitation, the intensity and chronicity of pain and indicators of psycho-emotional impairment. 2. Qualitative and quantitative imaging examination of the morphology of the condyle, glenoid fossa and articular eminence, as well as the distribution of sagittal and coronal joint spaces in patients with TMD and condylar malposition. 3. Highlighting the cephalometric particularities of the investigated group, based on the distribution of skeletal classes and analyses by authors (Downs-Graber, Sato, Slavicek, Kim). 4. Threedimensional assessment of mandibular kinematics in opening, protrusion and mediotrusion by condylography, using both standard indices (X, Y, Z displacements, SCI, TCI) and derived parameters, to assess the organization of condylar movements. 5. Integrated analysis of clinical, imaging and functional data in patients with temporomandibular disorders and condylar malpositions. Scientific novelty and originality: An element of novelty consists in the integrated evaluation, on the same group of patients with TMD and condylar malpositions, of the condyle–fossa relationship by CBCT, condylar kinematics by 3D condylography, and the clinical, functional and psychobehavioral profile by DC/TMD and Axis II instruments. Morphometric variations of the glenoid fossa, articular eminence, condyle and joint spaces were identified, with deviations of linear and composite indices, including DIkeda, from conventionally centric reference values, revealing the multidimensional expression of condylar malposition in the sagittal, vertical and coronal planes. The originality of the study is supported by the definition and application of derived condylographic indices of amplitude, orientation and curvature, calculated separately for the balancing condyle and the working-side condyle. Stable groups of sagittal and transverse variables were identified, including the SCI–SagAng and TCI–TransAng pairs, as well as kinematic differences between the balancing and working-side condyles, the latter showing greater numerical variability during movements with reduced excursion. The study also reveals the association of condylar malposition with high pain and functional burden, mobility limitations, extensive muscle tenderness and increased GAD-7/PHQ-9 scores, outlining a complex clinical-imaging and psychobehavioral profile. Applicative value. By configuring a unified protocol combining DC/TMD Axis I and Axis II, additional clinical indices, CBCT assessment of the condyle–fossa relationship and 3D condylography, the study provides a clinically applicable framework for diagnosing and monitoring patients with TMD and condylar malposition. The described parameters can be integrated into standardized examination forms and followup protocols, facilitating longitudinal comparison of cases and objective assessment of treatment response. CBCT and condylographic indices may serve as references for imaging and functional interpretation, including in cases of condylar repositioning guided by splints or other devices. Data on psychological burden and functional limitations may guide referral to specialists in orofacial pain, psychology or rehabilitation medicine, supporting interdisciplinary management of these patients. Implementation of results: The results were consolidated through 5 innovator certificates (methods/indicators for assessing condylar position and kinematics) and implemented in the clinical activity of the “OrtoClinic” SRL Dental Clinic and the Department of Interdisciplinary Dentistry and Oral Rehabilitation of Nicolae Testemitanu State University of Medicine and Pharmacy.