|Year : 2021 | Volume
| Issue : 3 | Page : 129-138
Evaluation of condylar changes in relation to various malocclusions: A systematic review
Imed Ouni1, Sinda Ammar2, Abir Charfeddine1, Farah Chouchen1, Lamia Mansour1
1 Department of Prosthetic, Dental Clinic of Monastir, University of Monastir, Monastir, Tunisia
2 Department of Prosthetic, Hospital Taher Maamouri, Nabeul, Tunisia
|Date of Submission||06-May-2021|
|Date of Acceptance||24-Aug-2021|
|Date of Web Publication||30-Dec-2021|
Prof. Imed Ouni
Department of Prosthetic, Dental Clinic of Monastir, University of Monastir, Avicenna Avenue, Monastir 5019
Source of Support: None, Conflict of Interest: None
Introduction: Variability in the size and shape of mandibular condyles among individuals of different sexes and ages may appear as a remodeling process to accommodate malocclusion. Hence, the aim of this study was to assess whether or not associations exist between different types of malocclusions and morphological modifications of the mandibular condyle.
Materials and Methods: A systematic literature search was conducted on the Medline database via PubMed interface and supplemented by a manual search via Google Scholar to identify more articles reporting the subject of the review. A combination of controlled vocabulary was used in the search strategy and the final update was stopped on January 2021. The risk of bias was assessed based on the Newcastle–Ottawa Scale.
Results and Discussion: Considering the preestablished inclusion and exclusion criteria, 20 articles were retained with 2607 human subjects (967 males/1299 females and 341 not specified, age: 4–60 years). Eighty percent of the selected articles reported associations between malocclusion and morphological changes of the condylar head. Sagittal plane malocclusions produce more changes to the temporomandibular joint components (head of condyle and joint space) (71.93%), while vertical malocclusions lead to the most severe manifestations.
Conclusions: Cone-beam computed tomography is the most useful tool for the assessment of osseous morphology of mandibular head condyles and detection of cortical erosion (21.7%). Associations between morphological changes of the condylar head and specific types of malocclusions were proven. However, there is still a need for more clinical studies.
Keywords: Abnormalities, condylar head, dental occlusion, malocclusions, mandibular condyle
|How to cite this article:|
Ouni I, Ammar S, Charfeddine A, Chouchen F, Mansour L. Evaluation of condylar changes in relation to various malocclusions: A systematic review. Saudi J Oral Sci 2021;8:129-38
|How to cite this URL:|
Ouni I, Ammar S, Charfeddine A, Chouchen F, Mansour L. Evaluation of condylar changes in relation to various malocclusions: A systematic review. Saudi J Oral Sci [serial online] 2021 [cited 2022 Dec 5];8:129-38. Available from: https://www.saudijos.org/text.asp?2021/8/3/129/333550
| Introduction|| |
Mandibular condyle appearance varies widely both in shape and size among individuals of different sexes and ages., Yale et al. classified condylar head shape into four categories: Rounded, angled, flattened, and convex based on autopsy on dry skull and radiological observation.,
Morphologic condyle changes may appear as a remodeling process to accommodate malocclusion, trauma, and other developmental variability and abnormalities. Variability in the size and shape of mandibular condyles should be considered as an important causative factor in internal disorders of the temporomandibular joint (TMJ).
Various investigations have reported that condylar and disk position in the glenoid fossa varies depending on malocclusion type.,, However, the morphologic changes of the condylar head have not been well stated. The rationale of the study is to evaluate the possible association between malocclusion and morphologic changes of the condyle which has never been reviewed systematically, despite the importance to differentiate between abnormal variations and anatomical conditions of the condylar head as a diagnostic challenge for the practitioner. The current review aimed to clarify the relationship between malocclusion and morphological modification of the condylar head, type of malocclusions which leads to significant condylar changes, which changes in the condyle is associated with most serious manifestations, the location of these lesions in relation to types of malocclusion, and the most effective means of diagnosis used to detect the condylar changes.
| Materials and Methods|| |
Ethical committee clearance was not required since it is a systematic review and was exempted. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses 2020 guidelines. The literature medical search for relevant articles was conducted in MEDLINE database using PubMed. The following search query was used “malocclusion (MeSH term)” AND “mandibular condyle (MeSH term).” The data collection was started in October 2020 and the final update of the search was in January 2021. Filters were set to human studies, English language, and available abstract with a date of publication after 1990. Based on abstract and title evaluation, the studies that answer the issue in question were selected for full-text examination.
Additional studies were supplemented by a manual literature search in Google Scholar and Scopus databases and in the reference lists of relevant articles to identify more papers reporting the subject of the review.
The inclusion criteria included all human clinical studies assessing the association between mandibular condylar changes and various features of dental malocclusion, by means of radiological, clinical, or validated assessment approaches. Studies with unclear protocol, or involving population with orthodontic treatment, history of trauma, edentulism, TMJ disorders, and extensive stomatognathic surgery were excluded from the review.
Two reviewers performed data extraction independently using a preestablished checklist. In case of disagreement, the consensus decision was achieved by discussion.
Assessment of the risk of bias of selected studies was performed based on the Newcastle–Ottawa Scale (NOS) for nonrandomized studies, including cohort and case–control studies, that is recommended by the Cochrane collaboration. The NOS evaluates eight items in the reviewed article. A maximum of one star can be attributed for each item, except for the comparability category that can be given two stars. A maximum of nine stars can be awarded for a study.
| Results|| |
General characteristics of the included studies
The search query resulted in 1396 articles, 615 papers were excluded when search filters were applied, and then, 739 articles were considered not pertinent to the aim of the study based on title and abstracts. As shown in [Figure 1], the 42 remaining relevant articles in the full text were assessed using preestablished checklist. Thirty-one of the 42 papers were excluded for the reasons described in [Table 1].,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Manual search expansion allowed finding 9 additional studies, thus resulting in a total of 20 articles included in this review.,,,,,,,,,,,,,,,,,,,
Only four papers were awarded 7-star scores. The majority of studies received 3–6 stars. The most frequent gaps were the unclear representativeness of the cases, selection of controls was not endorsed for community samples, and unspecified nonresponse rate. The quality assessment of the included papers showed a poor to moderate level as well as methodological heterogeneity that prevents conducting meta-analysis [Table 2].
|Table 2: Quality assessment based on the Newcastle-Ottawa Scale of nonrandomized studies|
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The twenty included studies comprised 2607 human subjects, 37% (967) males, 49.8% (1299) females, and 13% (341) not specified. Their age ranged from four to 60 years old. Almost all subjects had a good general condition (98.61%) [Table 3].
|Table 3: Characteristics of the patients included in the selected studies|
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Thousand eight and thirty-one subjects (70.2%) had at least one type of malocclusion: 41.2% had sagittal plane malocclusions (10.23% angle Class III, 31% angle Class II), 16.56% had transversal plane malocclusions (12.65% unilateral posterior cross-bite, 3.9% bilateral posterior cross-bite), and 10.56% had vertical plane malocclusions (5.63% anterior open bite, 1.06% anterior deep bite, and 3.87% anterior cross-bite). The other subjects had normal occlusion (control group) [Table 4].
Methods of morphological change evaluation
Various techniques to evaluate the morphology of condyles were stated in different studies. Autopsies on dry skulls were performed in 1.98% of the study population. Two-dimensional imaging techniques were used in 68.75% of cases (lateral cephalometric radiograph [47.4%], panoramic radiography [53.8%], and corrected lateral tomograms [7%]).
Cone-beam computed tomography (CBCT) method was used in 21.7% of the cases for assessment of bone changes. Computerized tomography (CT) scan was performed on 3.75% of the subjects. Magnetic resonance imagery (MRI) was used in 0.6% of the study population mainly to evaluate soft tissue changes [Table 3].
Size and shape of condyle in relation to various malocclusions
Eighty percent of the included articles showed significant associations between malocclusion and different morphological aspects of condyles. However, other studies failed to identify positive associations.,,,,
The most frequent condylar changes were found in sagittal plane malocclusion (71.93%), followed by transversal malocclusion (49.3%) and vertical malocclusion (20.86%). Morphological changes are more important in CL II division 2 and anterior deep bite compared to other types of malocclusions [Table 4].
The morphological modifications described in the various articles are in relation to the size and/or inclination of the condylar head, anterior and posterior joint space, and the location of bone changes [Table 4].
| Discussion|| |
The aim of this review was to summarize the literature about osseous changes of the mandibular head condyle in relation to different kinds of morphologic or functional malocclusions and to identify whether the features of malocclusion influence the prevalence and severity of bone variations.
The study compromised 2607 human subjects, which is considered a great number to draw significant results and conclusions. The study sample in the majority of papers included only subjects without history of trauma, history of orthodontic treatment, history of temporomandibular disorder (TMD), edentulism, and defective dental restorations because all these factors have a high risk of producing morphological changes in the condylar head.
Different techniques were used to evaluate the morphology of the condyles. Two dimensional-imaging techniques were performed in 68.75% of cases. However, they are not a reliable method for accurately analyzing the shape of the mandibular condyle.,
CBCT is the most used tool for the assessment of osseous morphology of mandibular head condyles and detection of cortical erosion.,, Compared to CT-scan, Hintze et al. had found no statistically significant difference in diagnostic accuracy. They are both useful for bone scanning and early detection of biomechanical and functional osseous changes.
MRI is considered the examination of choice to evaluate juxta-condylar soft tissue changes.,
The present study showed a significant relationship between functional and parafunctional malocclusion and degenerative and adaptive changes in the loadbearing of the condylar head. Furthermore, the various morphological aspects of the condyles radiologically observed have been classified relative to the different types of malocclusion as follows [Table 4].
Sagittal plane malocclusions
They are more prevalent in the study population with dominance of patients with Class II malocclusion. The mandibular condyle presented linear erosive lesions in the anterosuperior part, they are characterized by small size, tapered, and thinned appearance with posterior tilt. It has been reported also that changes are more important in Class II division 2 (deep bite) than in Class II division 1 malocclusions. These findings coincide with those reported in previous studies showing that Class II division 2 subjects seem to be notably susceptible to higher intracapsular pressure leading to condylar bone changes and mandibular retrusion.,,
Patients with Class III malocclusion are characterized by visible changes on the anterior and superior surface of the condyle head (which usually undergo linear resorption) leading to an enlargement of the anterior and superior right and left joint space. Condyles are characterized by an increase in size, a globular and convex aspect, and wide in the frontal plane. This may reflect the continuous growth of the condylar head with the advancement of age in skeletal Class III, when such growth has stopped in Class II malocclusions.,
Transversal plane malocclusions
Specific morphological changes associated with transversal malocclusion are rare. For patients with unilateral cross-bite, the only finding was the presence of a small condyle on the cross-bite side. However, for patients with bilateral cross-bite, no specific morphological changes were noted.,,,,
The condylar head is generally sensitive to transversal malocclusion in growing subjects. However, these morphological changes are not statistically significant compared to the control group.
Vertical plane malocclusions
The results of this review showed that bone changes of the condylar head in patients with anterior open or deep bites are the most severe; they are characterized by an erosive appearance, poorly limited osteoarthritis, irregular, with blurred images up to the exposure of the spongy bone. Those osseous lesions are located mainly at the upper articular surface with flattening of the mandibular condyle., These arthritic changes may be best seen on CBCT.
Ari-Demirkaya et al. stated that anterior open bite is considered as a predictive sign of erosive bone changes.
Morphologic changes in the size and shape of the mandibular condyle may be one of the causative factors of internal derangement of TMJ by the loss of functional cohabitation between different TMJ components, and as consequence the development of signs and symptoms of TMD. This suggests an indirect relationship between various malocclusions and tendency for TMD.
For this reason, it is important to perform clinical and radiographic examinations of the TMJ for all patients with malocclusions before planning any treatment to prevent any unplanned complications during and after therapy.
However, morphologic changes of mandibular condyle are also influenced by multiple others factors such as genetic, age and ethnic groups, eating habits, and functional factors which are not well considered across included studies which is the limitation of the study. This risk of bias will simply compound the errors and produce a mislead result if meta-analysis was conducted.
| Conclusion|| |
There is a significant association between malocclusion and morphological changes of the mandibular condyle. These bone changes are more frequent in sagittal malocclusion and more severe in cases with vertical malocclusion. It is therefore essential to consider correcting these malocclusions as early as possible; especially in young subjects, to avoid these condylar changes and their consequences on TMJ. Among the different imaging techniques used for TMJ screening, CBCT images are accurate over others for the evaluation of the bony changes of mandibular condyles.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Driscoll P. Gray's Anatomy, 39th
edition. Emerg Med J 2006;23:492.
Hegde S, Bn P, Shetty S. Morphological and radiological variations of mandibular condyles in health and diseases: A systematic review. Dentistry 2013;3:1-5.
Yale SH, Ceballos M, Kresnoff CS, Hauptfuehrer JD. Some observations on the classification of mandibular condyle types. Oral Surg Oral Med Oral Pathol 1963;16:572-7.
Yale SH, Rosenberg HM, Ceballos M, Haupt-Fuehrer JD. Laminagraphic cephalometry in the analysis of mandibular condyle morphology. A preliminary report. Oral Surg Oral Med Oral Pathol 1961;14:793-805.
Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al.
Anatomy of the temporomandibular joint. Semin Ultrasound CT MR 2007;28:170-83.
Gökalp H. Magnetic resonance imaging assessment of positional relationship between the disk and condyle in asymptomatic young adult mandibular prognathism. Angle Orthod 2003;73:550-5.
Pullinger AG, Solberg WK, Hollender L, Petersson A. Relationship of mandibular condylar position to dental occlusion factors in an asymptomatic population. Am J Orthod Dentofacial Orthop 1987;91:200-6.
Loiselle RJ. Relation of occlusion to temporomandibular joint dysfunction: The prosthodontic viewpoint. J Am Dent Assoc 1969;79:145-6.
Perry HT Jr. Relation of occlusion to temporomandibular joint dysfunction: The orthodontic viewpoint. J Am Dent Assoc 1969;79:137-41.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al.
The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Syst Rev 2021;10:89.
Lo CK-L, Mertz D, Loeb M. Newcastle-Ottawa Scale: Comparing reviewers' to authors' assessments. BMC Medical Research Methodology 2014;14:45.
Nagata M, Yamasaki Y, Hayasaki H, Nakata M. Incisal and condylar paths during habitual mouth opening movement of children with anterior reverse bite in the primary dentition. J Oral Rehabil 2002;29:64-71.
Kim J, Nielsen IL. A longitudinal study of condylar growth and mandibular rotation in untreated subjects with Class II malocclusion. Angle Orthod 2002;72:105-11.
Hidaka O, Adachi S, Takada K. The difference in condylar position between centric relation and centric occlusion in pretreatment Japanese orthodontic patients. Angle Orthod 2002;72:295-301.
Yamada K, Fukui T, Tsuruta A, Hanada K, Hosogai A, Kohno S, et al.
The relationship between retruded contact position and intercuspal position in patients with TMJ osteoarthritis. Cranio 2003;21:240-7.
Darendeliler N, Dinçer M, Soylu R. The biomechanical relationship between incisor and condylar guidances in deep bite and normal cases. J Oral Rehabil 2004;31:430-7.
Miyawaki S, Tanimoto Y, Araki Y, Katayama A, Kuboki T, Takano-Yamamoto T. Movement of the lateral and medial poles of the working condyle during mastication in patients with unilateral posterior crossbite. Am J Orthod Dentofacial Orthop 2004;126:549-54.
Fantini SM, Paiva JB, Rino Neto J, Dominguez GC, Abrão J, Vigoritto JW. Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy. Braz Oral Res 2005;19:176-82.
Bowbeer GR. The four dimensions of orthodontic diagnosis – Part 1. Funct Orthod 2006;23:4-6, 8-10, 12-4.
Kiki A, Kiliç N, Oktay H. Condylar asymmetry in bilateral posterior crossbite patients. Angle Orthod 2007;77:77-81.
Rodrigues AF, Fraga MR, Vitral RW. Computed tomography evaluation of the temporomandibular joint in Class II division 1 and Class III malocclusion patients: Condylar symmetry and condyle-fossa relationship. Am J Orthod Dentofacial Orthop 2009;136:199-206.
Padala S, Padmanabhan S, Chithranjan AB. Comparative evaluation of condylar position in symptomatic (TMJ dysfunction) and asymptomatic individuals. Indian J Dent Res 2012;23:122. [Full text]
Barrera-Mora JM, Espinar Escalona E, Abalos Labruzzi C, Llamas Carrera JM, Ballesteros EJ, Solano Reina E, et al.
The relationship between malocclusion, benign joint hypermobility syndrome, condylar position and TMD symptoms. Cranio 2012;30:121-30.
Krisjane Z, Urtane I, Krumina G, Neimane L, Ragovska I. The prevalence of TMJ osteoarthritis in asymptomatic patients with dentofacial deformities: A cone-beam CT study. Int J Oral Maxillofac Surg 2012;41:690-5.
Magnusson C, Nilsson M, Magnusson T. Degenerative changes of the temporomandibular joint. Relationship to ethnicity, sex and occlusal supporting zones based on a skull material. Acta Odontol Scand 2012;70:207-12.
Savakkanavar MB, Sridhar S, Dinesh D, Girish KS, Ramesh GC. Association of temporomandibular joint dysfunction, condylar position and dental malocclusions in Davangere population. J Contemp Dent Pract 2012;13:528-33.
Ooi K, Yura S, Inoue N, Totsuka Y. Factors related to the incidence of anterior disc displacement without reduction and bony changes of the temporomandibular joint in patients with anterior open bite. Oral Maxillofac Surg 2014;18:397-401.
Kasimoglu Y, Tuna EB, Rahimi B, Marsan G, Gencay K. Condylar asymmetry in different occlusion types. Cranio 2015;33:10-4.
Goulart DR, Muñoz P, Olate S, de Moraes M, Fariña R. No differences in morphological characteristics between hyperplastic condyle and class III condyle. Int J Oral Maxillofac Surg 2015;44:1281-6.
Illipronti-Filho E, Fantini SM, Chilvarquer I. Evaluation of mandibular condyles in children with unilateral posterior crossbite. Braz Oral Res 2015;29:49.
Wen L, Yan W, Yue Z, Bo D, Xiao Y, Chun-Ling W. Study of condylar asymmetry in angle Class III malocclusion with mandibular deviation. J Craniofac Surg 2015;26:e264-8.
Yashiro K, Iwata A, Takada K, Murakami S, Uchiyama Y, Furukawa S. Temporomandibular joint articulations on working side during chewing in adult females with cross-bite and mandibular asymmetry. J Oral Rehabil 2015;42:163-72.
Goulart DR, Muñoz P, Cantín López MG, de Moraes M, Olate S. Comparative evaluation of condylar volume between patients with unilateral condylar hyperplasia and Class III dentofacial deformity. J Oral Maxillofac Surg 2017;75:180-8.
Vásquez B, Olate S, Cantín M, Sandoval C, Del Sol M, de Moraes M. Histomorphometric analysis of unilateral condylar hyperplasia in the temporomandibular joint: The value of the condylar layer and cartilage island. Int J Oral Maxillofac Surg 2017;46:861-6.
Ugolini A, Mapelli A, Segù M, Zago M, Codari M, Sforza C. Three-dimensional mandibular motion in skeletal Class III patients. Cranio 2018;36:113-20.
Ueki K, Yoshizawa K, Moroi A, Tsutsui T, Hotta A, Hiraide R, et al.
Relationship between occlusal force and condylar morphology in Class II and III after bi-maxillary osteotomy. J Craniomaxillofac Surg 2018;46:2103-7.
Cardinal L, Martins I, Gribel BF, Dominguez GC. Is there an asymmetry of the condylar and coronoid processes of the mandible in individuals with unilateral crossbite? Angle Orthod 2019;89:464-9.
Kajii TS, Fujita T, Sakaguchi Y, Shimada K. Osseous changes of the mandibular condyle affect backward-rotation of the mandibular ramus in Angle Class II orthodontic patients with idiopathic condylar resorption of the temporomandibular joint. Cranio 2019;37:264-71.
Lobo F, Tolentino ES, Iwaki LC, Walewski LÂ, Takeshita WM, Chicarelli M. Imaginology tridimensional study of temporomandibular joint osseous components according to sagittal skeletal relationship, sex, and age. J Craniofac Surg 2019;30:1462-5.
Yalcin ED, Ararat E. Cone-beam computed tomography study of mandibular condylar morphology. J Craniofac Surg 2019;30:2621-4.
Evangelista K, Valladares-Neto J, Garcia Silva MA, Soares Cevidanes LH, de Oliveira Ruellas AC. Three-dimensional assessment of mandibular asymmetry in skeletal Class I and unilateral crossbite malocclusion in 3 different age groups. Am J Orthod Dentofacial Orthop 2020;158:209-20.
John ZA, Shrivastav SS, Kamble R, Jaiswal E, Dhande R. Three-dimensional comparative evaluation of articular disc position and other temporomandibular joint morphology in Class II horizontal and vertical cases with Class I malocclusion. Angle Orthod 2020;90:707-14.
Seren E, Akan H, Toller MO, Akyar S. An evaluation of the condylar position of the temporomandibular joint by computerized tomography in Class III malocclusions: A preliminary study. Am J Orthod Dentofacial Orthop 1994;105:483-8.
O'Byrn BL, Sadowsky C, Schneider B, BeGole EA. An evaluation of mandibular asymmetry in adults with unilateral posterior crossbite. Am J Orthod Dentofacial Orthop 1995;107:394-400.
Peltola JS, Könönen M, Nyström M. Radiographic characteristics in mandibular condyles of orthodontic patients before treatment. Eur J Orthod 1995;17:69-77.
Matsumoto MA, Bolognese AM. Bone morphology of the temporomandibular joint and its relation to dental occlusion. Braz Dent J 1995;6:115-22.
Burke G, Major P, Glover K, Prasad N. Correlations between condylar characteristics and facial morphology in Class II preadolescent patients. Am J Orthod Dentofacial Orthop 1998;114:328-36.
Akahane Y, Deguchi T, Hunt NP. Morphology of the temporomandibular joint in skeletal Class III symmetrical and asymmetrical cases: A study by cephalometric laminography. J Orthod 2001;28:119-28.
Vitral RW, Telles Cde S. Computed tomography evaluation of temporomandibular joint alterations in Class II Division 1 subdivision patients: Condylar symmetry. Am J Orthod Dentofacial Orthop 2002;121:369-75.
Ari-Demirkaya A, Biren S, Ozkan H, Küçükkeleş N. Comparison of deep bite and open bite cases: Normative data for condylar positions, paths and radiographic appearances. J Oral Rehabil 2004;31:213-24.
Katsavrias EG, Halazonetis DJ. Condyle and fossa shape in Class II and Class III skeletal patterns: A morphometric tomographic study. Am J Orthod Dentofacial Orthop 2005;128:337-46.
Katsavrias EG. Morphology of the temporomandibular joint in subjects with Class II division 2 malocclusions. Am J Orthod Dentofacial Orthop 2006;129:470-8.
Kilic N, Kiki A, Oktay H. Condylar asymmetry in unilateral posterior crossbite patients. Am J Orthod Dentofacial Orthop 2008;133:382-7.
Krisjane Z, Urtane I, Krumina G, Zepa K. Three-dimensional evaluation of TMJ parameters in Class II and Class III patients. Stomatologija 2009;11:32-6.
Uysal T, Sisman Y, Kurt G, Ramoglu SI. Condylar and ramal vertical asymmetry in unilateral and bilateral posterior crossbite patients and a normal occlusion sample. Am J Orthod Dentofacial Orthop 2009;136:37-43.
Wang MQ, He JJ, Chen CS, Widmalm SE. A preliminary anatomical study on the association of condylar and occlusal asymmetry. Cranio 2011;29:111-6.
Saccucci M, D'Attilio M, Rodolfino D, Festa F, Polimeni A, Tecco S. Condylar volume and condylar area in Class I, Class II and Class III young adult subjects. Head Face Med 2012;8:34.
Halicioglu K, Celikoglu M, Yavuz I, Sekerci AE, Buyuk SK. An evaluation of condylar and ramal vertical asymmetry in adolescents with unilateral and bilateral posterior crossbite using cone beam computed tomography (CBCT). Aust Orthod J 2014;30:11-8.
Merigue LF, Conti AC, Oltramari-Navarro PV, Navarro Rde L, Almeida MR. Tomographic evaluation of the temporomandibular joint in malocclusion subjects: Condylar morphology and position. Braz Oral Res 2016;30:S1806-83242016000100222.
Leonardi R, Muraglie S, Bennici O, Cavallini C, Spampinato C. Three-dimensional analysis of mandibular functional units in adult patients with unilateral posterior crossbite: A cone beam study with the use of mirroring and surface-to-surface matching techniques. Angle Orthod 2019;89:590-6.
Song J, Cheng M, Qian Y, Chu F. Cone-beam CT evaluation of temporomandibular joint in permanent dentition according to Angle's classification. Oral Radiol 2020;36:261-6.
Schmitter M, Gabbert O, Ohlmann B, Hassel A, Wolff D, Rammelsberg P, et al.
Assessment of the reliability and validity of panoramic imaging for assessment of mandibular condyle morphology using both MRI and clinical examination as the gold standard. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:220-4.
Valladares-Neto J, Estrela C, Bueno M, Guedes O, Porto O, Pécora J. Mandibular condyle dimensional changes in subjects from 3 to 20 years of age using cone-beam computed tomography: A preliminary study. Dent Press J Orthod 2010;15:172-81.
Katakami K, Shimoda S, Kobayashi K, Kawasaki K. Histological investigation of osseous changes of mandibular condyles with backscattered electron images. Dentomaxillofac Radiol 2008;37:330-9.
Ludlow JB, Laster WS, See M, Bailey LJ, Hershey HG. Accuracy of measurements of mandibular anatomy in cone beam computed tomography images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:534-42.
Hintze H, Wiese M, Wenzel A. Cone beam CT and conventional tomography for the detection of morphological temporomandibular joint changes. Dentomaxillofac Radiol 2007;36:192-7.
Helms CA, Kaplan P. Diagnostic imaging of the temporomandibular joint: Recommendations for use of the various techniques. AJR Am J Roentgenol 1990;154:319-22.
Aiken A, Bouloux G, Hudgins P. MR imaging of the temporomandibular joint. Magn Reson Imaging Clin N Am 2012;20:397-412.
Arnett GW, Milam SB, Gottesman L. Progressive mandibular retrusion-idiopathic condylar resorption. Part I. Am J Orthod Dentofacial Orthop 1996;110:8-15.
Arnett GW, Milam SB, Gottesman L. Progressive mandibular retrusion-idiopathic condylar resorption. Part II. Am J Orthod Dentofacial Orthop 1996;110:117-27.
Arnett GW, Gunson MJ. Risk factors in the initiation of condylar resorption. Sem Orthod 2013;19:81-8.
Kurita H, Kojima Y, Nakatsuka A, Koike T, Kobayashi H, Kurashina K. Relationship between temporomandibular joint (TMJ)-related pain and morphological changes of the TMJ condyle in patients with temporomandibular disorders. Dentomaxillofac Radiol 2004;33:329-33.
Akerman S, Kopp S, Rohlin M. Macroscopic and microscopic appearance of radiologic findings in temporomandibular joints from elderly individuals. An autopsy study. Int J Oral Maxillofac Surg 1988;17:58-63.
Tadej G, Engstrom C, Borrman H, Christiansen EL. Mandibular condyle morphology in relation to malocclusions in children. Angle Orthod 1989;59:187-94.
Ong TK, Franklin CD. A clinical and histopathological study of osteoarthrosis of the temporomandibular joint. Br J Oral Maxillofac Surg 1996;34:186-92.
[Table 1], [Table 2], [Table 3], [Table 4]