Bony Changes of the Temporomandibular Joint in Symptomatic Versus Asymptomatic Individuals: Insights from CBCT Imaging

Introduction : Temporomandibular disorders (TMDs) are a leading cause of non-dental orofacial pain. Structural osseous changes of the temporomandibular joint (TMJ) can be observed in both symptomatic and asymptomatic individuals. This study compared bony changes in TMJs of patients with and without TMD symptoms using cone-beam computed tomography (CBCT). Materials and Methods : In this historical cohort, 138 patients with clinically diagnosed TMD (RDC/TMD) and 132 asymptomatic controls who underwent CBCT for dental or maxillofacial purposes were evaluated. Standardized criteria were used to assess erosion, osteophytes, flattening, Ely cysts, sclerosis (condylar head and temporal), ankylosis, condylar size alterations, and joint space changes. Data were analyzed with Chi-square and t-tests (p < 0.05). Results : Degenerative changes were more frequent in the TMD group. Erosion was the most common finding (52.2% vs. 13.6%, p < 0.001) and occurred across all age groups. Osteophytes (29.7% vs. 15.2%, p = 0.003) and flattening (27.5% vs. 7.6%, p < 0.001) were significantly higher, with age-related patterns. Temporal lobe sclerosis (12.3% vs. 0.8%, p < 0.001), condylar head sclerosis (10.9% vs. 3.8%, p = 0.022), and joint space changes (18.8% vs. 2.3%, p < 0.001) were strongly associated with TMD. Ely cysts differed only in the >41-year group. Rare findings showed no significant differences. Conclusion : CBCT revealed significantly more erosions, osteophytes, flattening, sclerosis, and joint space alterations in TMD patients compared to controls. Erosion may serve as an early diagnostic marker, while other features suggest chronic progression. CBCT is recommended in symptomatic TMD cases to facilitate early detection and guide management decisions.