Evaluation of Osseous Alterations of the Temporomandibular Joint Using Cone Beam Computed Tomography in Patients with Temporomandibular Joint Disorders: A Cross-Sectional Study

Abstract

Background: Osseous alterations of the temporomandibular joint (TMJ), including flattening, erosion, sclerosis, osteophytes, and subchondral changes, are frequently detected on cone beam computed tomography (CBCT) in patients with temporomandibular disorders (TMD), but their relationship with clinical pain remains unclear.

Aim: To evaluate and compare TMJ osseous alterations on CBCT between TMD patients with and without pain.

Materials and Methods: This cross-sectional study included 81 TMD patients (40 with pain, 41 without pain) examined at a tertiary dental institution. CBCT scans were assessed in sagittal and coronal sections for ten osseous parameters, scored as present/absent for each side. Clinical diagnosis followed DC/TMD Axis I criteria, and pain intensity was recorded using a visual analogue scale. Associations between radiographic findings and pain status were analyzed using Fisher's exact test.

Results: The sample comprised 63% females, with 59.3% aged 11–30 years. Condylar flattening was the most prevalent finding (88.9% right, 82.7% left) and showed no association with pain. Sclerosis was significantly more common in the pain-free group on both sides (right: 51.2% vs 20.0%, p=0.005; left: 56.1% vs 20.0%, p=0.001), as was osteophyte formation (right: 36.6% vs 10.0%, p=0.008; left: 39.0% vs 15.0%, p=0.024). Subchondral changes were significantly more frequent in the pain group on the left side (20.0% vs 2.4%, p=0.014). Erosion and joint-space alterations showed no significant association with pain.

Conclusion: Osseous alterations are highly prevalent in TMD irrespective of pain status. Sclerosis and osteophytes appear to represent stabilized, adaptive changes associated with the absence of pain, whereas subchondral changes may relate more closely to active symptomatic disease. CBCT findings should complement, not replace, clinical evaluation in TMD management.