Clinical symptoms and cone beam computed tomography imaging analysis of patients with temporomandibular joint osteoarthritis with chewing side preference before and after treatment of stabilization splint

doi:10.7518/hxkq.2026.2025360

Abstract

Abstract:

Objective This study aimed to explore the clinical efficacy of stabilization splint (SS) and the characteristics of cone beam computed tomography (CBCT) imaging changes by analyzing the CBCT images and clinical symptoms of patients with temporomandibular joint osteoarthritis (TMJOA) complicated with chewing side preference before and after treatment with SS. Me⁃thods　A retrospective analysis was conducted on 74 TMJOA patients (aged 18-40 years) who visited the Department of Stomatology, First Medical Center, Chinese PLA General Hospital from June 2021 to January 2025. Among them, 31 patients had no chewing side preference (mean age: 29.81±2.99 years), and 43 patients had chewing side preference (mean age: 30.88±5.65 years). The CBCT imaging features and clinical symptoms of the two groups at the initial visit and follow-up (6 months later) were observed and analyzed. SPSS 27.0 software was used for data analysis. Results Comparison of patients without chewing side preference before and after SS treatment: the incidence of pain decreased from 100% to 3.23%, limited mouth opening from 96.77% to 3.23%, and joint noise from 80.65% to 38.71%, with statistically significant differences (P<0.05). CBCT showed that the ipsilateral posterior joint space and superior joint space increased significantly (P<0.05), whereas no significant differences were observed in the temporomandibular joint (TMJ) indices between the two sides (P>0.05). Comparison of patients with chewing side preference before and after SS treatment: the incidence of pain decreased from 100% to 4.65%, limited mouth opening from 88.37% to 2.33%, and joint noise from 79.07% to 39.53%, with statistically significant differences (P<0.05). CBCT showed that the medial-lateral diameter of the condyle, anterior-posterior diameter of the condyle, intra-articular space, posterior joint space, superior joint space, slope of the articular eminence, and condylar height on the habitual chewing side increased significantly (P<0.05). Moreover, the medial-lateral diameter of the condyle, anterior-posterior diameter of the condyle, intra-articular space, posterior joint space, and superior joint space on the non-habitual chewing side increased significantly (P<0.05). The posterior joint space, intra-articular space, and condylar height on the habitual chewing side were significantly larger than those on the non-habitual chewing side (P<0.05). Comparison between patients with and without chewing side preference after SS treatment: no significant differences were found in pain, limited mouth opening, and joint noise between the two groups (P>0.05). Conclusion SS is effective in treating patients suffering from TMJOA with or without chewing side preference because it can effectively relieve joint pain, significantly improve mouth opening, and reduce the incidence of joint noise to a certain extent. Chewing side preference is closely related to the progression of TMJOA. Patients with TMJOA are recommended to receive early intervention with SS treatment, which is particularly important for those cases complicated with chewing side preference.

Key words: chewing side preference, temporomandibular joint osteoarthritis, stabilization splint, cone beam computed tomography

CLC Number:

R782.6

Li Xiaoxing, Wang Jiazhu, Xu Laiqing, Xu Xinyu, Li Hongbo, Hu Min, Liu Hongchen, Jiang Hua. Clinical symptoms and cone beam computed tomography imaging analysis of patients with temporomandibular joint osteoarthritis with chewing side preference before and after treatment of stabilization splint[J]. West China Journal of Stomatology, 2026, 44(2): 266-276.

Figures/Tables 9

Fig 1

Fig 2

Fig 3

Fig 4

Tab 1

Tab 2

Tab 3

Tab 4

Fig 5

References 35

[1]	Badel T, Zadravec D, Bašić Kes V, et al. Orofacial paindiagnostic and therapeutic challenges[J]. Acta Clin Croat, 2019, 58(): 82-89.
[2]	孟娟红, 甘业华, 马绪臣. 颞下颌关节骨关节炎发病的分子机制及相关治疗的实验研究[J]. 北京大学学报(医学版), 2013, 45(1): 5-8.
	Meng JH, Gan YH, Ma XC. Molecular mechanisms and related experimental therapeutic studies of temporomandibular joint osteoarthritis[J]. J Peking Univ (Health Sci), 2013, 45(1): 5-8.
[3]	傅开元, 雷杰. 颞下颌关节紊乱病的分类、诊断及治疗进展[J]. 口腔医学, 2024, 44(1): 6-10.
	Fu KY, Lei J. Advances in classification, diagnosis and treatment of temporomandibular disorders[J]. Stomatology, 2024, 44(1): 6-10.
[4]	Su N, Liu Y, Yang X, et al. Association of malocclusion, self-reported bruxism and chewing-side preference with oral health-related quality of life in patients with temporomandibular joint osteoarthritis[J]. Int Dent J, 2018, 68(2): 97-104.
[5]	Ma J, Wang J, Huang D, et al. A comparative study of condyle position in temporomandibular disorder patients with chewing side preference using cone-beam compu-ted tomography[J]. J Oral Rehabil, 2022, 49(2): 265-271.
[6]	姜华, 刘洪臣. 偏侧咀嚼对口颌系统的影响[J]. 中华老年口腔医学杂志, 2006, 4(4): 235-237, 234.
	Jiang H, Liu HC. Effects of unilateral mastication on the stomatognathic system[J]. Chin J Geriatr Dent, 2006, 4(4): 235-237, 234.
[7]	Shu JH, Yao J, Zhang YL, et al. The influence of bilate-ral sagittal split ramus osteotomy on the stress distributions in the temporomandibular joints of the patients with facial asymmetry under symmetric occlusions[J]. Medicine (Baltimore), 2018, 97(25): e11204.
[8]	Jiang H, Yin H, Wang L, et al. Memory impairment of chewing-side reference mice is associated with 5-HT-BDNF signal pathway[J]. Mol Cell Biochem, 2021, 476(1): 303-310.
[9]	Alkhutari AS, Alyahya A, Rodrigues Conti PC, et al. Is the therapeutic effect of occlusal stabilization appliances more than just placebo effect in the management of painful temporomandibular disorders? A network meta-ana-lysis of randomized clinical trials[J]. J Prosthet Dent, 2021, 126(1): 24-32.
[10]	Mapelli A, Zanandrea Machado BC, Giglio LD, et al. Reorganization of muscle activity in patients with chro-nic temporomandibular disorders[J]. Arch Oral Biol, 2016, 72(1): 164-171.
[11]	Lee YH, Lee KM, Auh QS, et al. Magnetic resonance imaging-based prediction of the relationship between whiplash injury and temporomandibular disorders[J]. Front Neurol, 2017, 8: 725.
[12]	Almashraqi AA, Ahmed EA, Mohamed NS, et al. Eva-luation of the effects of chronic qat chewing on lateral pterygoid muscle using MRI[J]. Cranio, 2022, 40(2): 135-143.
[13]	Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for emporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Groupdagger[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
[14]	安靖, 陈洁, 杨文静. 偏侧咀嚼患者颞下颌关节盘位置及临床症状的影响[J]. 口腔颌面修复学杂志, 2014, 15(5): 285-288.
	An J, Chen J, Yang WJ. Effects of unilateral mastication on TMJ disc position and clinical symptoms[J]. Chin J Prosthodont, 2014, 15(5): 285-288.
[15]	傅开元, 胡敏, 余强, 等. 颞下颌关节紊乱病锥形束CT检查规范及诊断标准的专家共识[J]. 中华口腔医学杂志, 2020, 55(9): 613-616.
	Fu KY, Hu M, Yu Q, et al. Experts consensus on cone-beam CT examination specification and diagnostic criteria of temporomandibular disorders[J]. Chin J Stomatol, 2020, 55(9): 613-616.
[16]	Kazazoglu E, Heath MR, Müller F. A simple test for determination of the preferred chewing side[J]. J Oral Rehabil, 1994, 21(6): 723.
[17]	Diernberger S, Bernhardt O, Schwahn C, et al. Self-reported chewing side preference and its associations with occlusal, temporomandibular and prosthodontic factors: results from the population-based Study of Health in Pomerania (SHIP-0) [J]. J Oral Rehabil, 2008, 35(8): 613-620.
[18]	Ikeda K, Kawamura A. Assessment of optimal condylar position with limited cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2009, 135(4): 495-501.
[19]	Kamelchuk LS, Grace MG, Major PW. Post-imaging temporomandibular joint space analysis[J]. Cranio, 1996, 14(1): 23-29.
[20]	陈鹏, 张晓娟, 魏博, 等. 关节穿刺术应用于老年颞下颌关节不可复性盘前移位的临床研究[J]. 中华老年口腔医学杂志, 2022, 20(3): 162-166.
	Chen P, Zhang XJ, Wei B, et al. Clinical study of the application of arthrocentesis in the elderly temporomandi-bular joint with irreversible anterior[J]. Chin J Geriatr Dent, 2022, 20(3): 162-166.
[21]	姜婷, 李健, 许桐楷, 等. 咬合板的临床应用特点[J]. 口腔颌面修复学杂志, 2022, 23(1): 1-10.
	Jiang T, Li J, Xu TK, et al. Clinical application of occlusal splints[J]. Chin J Prosthodont, 2022, 23(1): 1-10.
[22]	胡敏. 颞下颌关节骨关节炎: 认识与挑战[J]. 中华口腔医学杂志, 2022, 57(7): 665-673.
	Hu M. Temporomandibular joint osteoarthritis: understanding and challenges[J]. Chin J Stomatol, 2022, 57(7): 665-673.
[23]	Song H, Lee JY, Huh KH, et al. Long-term changes of temporomandibular joint osteoarthritis on computed tomography[J]. Sci Rep, 2020, 10(1): 6731.
[24]	李晓星, 马博文, 徐鑫宇, 等. 伴偏侧咀嚼颞下颌关节骨关节炎患者1年随访的CBCT研究[J]. 口腔颌面修复学杂志, 2025, 26(1): 42-49.
	Li XX, Ma BW, Xu XY, et al. CBCT study of patients with temporomandibular joint osteoarthritis accompanied by lateral chewing for 1 year follow-up[J]. Chin J Prosthodont, 2025, 26(1): 42-49.
[25]	Zhang Y, Zhang H, Liu R, et al. The efficacy of treatments for temporomandibular disorders with occlusal splints versus other conservative therapies: a meta-analysis of randomized controlled trials[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2025, 139(5): 509-520.
[26]	Shu J, Xiong X, Chong DY, et al. The relations between the stress in temporomandibular joints and the deviated distances for mandibular asymmetric patients[J]. Proc Inst Mech Eng H, 2021, 235(1): 109-116.
[27]	Silva MAG, Pantoja LLQ, Dutra-Horstmann KL, et al. Prevalence of degenerative disease in temporomandibular disorder patients with disc displacement: a systema-tic review and meta-analysis[J]. J Craniomaxillofac Surg, 2020, 48(10): 942-955.
[28]	Derwich M, Mitus-Kenig M, Pawlowska E. Temporomandibular joints’ morphology and osteoarthritic chan-ges in cone-beam computed tomography images in patients with and without reciprocal clicking—A case control study[J]. Int J Environ Res Public Health, 2020, 17(10): 3428.
[29]	Poluha RL, Cunha CO, Bonjardim LR, et al. Temporomandibular joint morphology does not influence the presence of arthralgia in patients with disk displacement with reduction: a magnetic resonance imaging-based stu-dy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2020, 129(2): 149-157.
[30]	Pinto GNS, Grossmann E, Iwaki Filho L, et al. Correlation between joint effusion and morphology of the articular disc within the temporomandibular joint as viewed in the sagittal plane in patients with chronic disc displacement with reduction: a retrospective analytical study from magnetic resonance imaging[J]. Cranio, 2021, 39(2): 119-124.
[31]	Gaggl A, Enzinger S, Bürger H, et al. The condylar capping for microvascular temporomandibular joint reconstruction: a preliminary study[J]. Microsurgery, 2023, 43(4): 331-338.
[32]	Liu YS, Yap AU, Lei J, et al. Association between hypoplastic condyles and temporomandibular joint disc displacements: a cone beam computed tomography and magnetic resonance imaging metrical analysis[J]. Int J Oral Maxillofac Surg, 2020, 49(7): 932-939.
[33]	Abdelrehem A, Hu YK, Yang C, et al. Arthroscopic versus open disc repositioning and suturing techniques for the treatment of temporomandibular joint anterior disc displacement: 3-year follow-up study[J]. Int J Oral Maxillofac Surg, 2021, 50(10): 1351-1360.
[34]	Ok SM, Jeong SH, Ahn YW, et al. Effect of stabilization splint therapy on glenoid fossa remodeling in temporomandibular joint osteoarthritis[J]. J Prosthodont Res, 2016, 60(4): 301-307.
[35]	Bedran LM, Dos Santos AASMD. Changes in temporomandibular joint anatomy, changes in condylar translation, and their relationship with disc displacement: magnetic resonance imaging study[J]. Radiol Bras, 2019, 52(2): 85-91.

指标	右侧				左侧
指标	初诊	复诊	t值	P值	初诊	复诊	t值	P值
髁突内外径/mm	17.64±3.01	18.84±3.08	-1.463	0.154	18.39±1.87	18.09±2.04	0.761	0.453
髁突前后径/mm	8.13±1.96	8.37±2.42	-0.414	0.682	8.15±2.60	7.89±1.27	0.498	0.622
半径值/mm	54.56±8.35	54.33±5.37	0.121	0.905	53.98±8.33	54.19±3.20	-0.131	0.897
髁突水平角/°	29.49±14.63	28.52±11.84	0.295	0.770	29.71±14.66	25.83±9.34	1.384	0.176
关节内间隙/mm	2.68±1.26	2.78±1.18	-0.347	0.731	3.17±1.54	2.75±0.93	1.354	0.186
关节外间隙/mm	3.92±2.10	3.25±1.24	1.473	0.151	3.55±2.10	3.14±1.02	0.952	0.349
髁突垂直角/°	18.33±9.10	19.59±9.09	-0.490	0.628	18.41±9.11	19.66±9.26	-0.476	0.637
髁突受力角/°	49.26±14.51	53.43±12.49	-1.450	0.157	52.11±14.43	56.3±7.01	-1.431	0.163
关节窝宽度/mm	22.85±4.91	23.07±4.38	-0.178	0.860	23.09±2.78	23.16±2.58	-0.105	0.917
关节窝深度/mm	9.12±3.18	7.63±3.10	1.847	0.075	8.15±3.09	8.38±3.19	-0.286	0.777
关节结节斜度/°	54.95±13.94	55.33±15.08	-0.104	0.918	54.96±13.97	51.29±15.06	1.028	0.312
关节前间隙/mm	3.32±1.24	2.86±1.43	1.233	0.227	3.32±0.92	3.26±0.83	0.278	0.783
关节上间隙/mm	3.34±0.75	5.15±1.64	-5.515	0.000**	4.01±2.09	5.06±1.65	-2.584	0.015*
关节后间隙/mm	2.29±1.44	3.36±2.03	-2.361	0.025*	2.42±1.47	3.33±1.62	-2.176	0.038*
髁突高度/mm	17.86±4.28	18.17±4.10	-1.003	0.324	16.8±4.70	16.8±4.70	-1.000	0.325

指标		初诊			复诊
指标		均值	t值	P值	均值	t值	P值
髁突内外径/mm	左侧	18.39±1.87	1.175	0.245	18.09±2.04	-1.121	0.267
	右侧	17.64±3.01			18.84±3.08
髁突前后径/mm	左侧	8.15±2.60	0.031	0.975	7.89±1.27	-0.983	0.329
	右侧	8.13±1.96			8.37±2.42
半径值/mm	左侧	53.98±8.33	-0.272	0.787	54.19±3.20	-0.123	0.903
	右侧	54.56±8.35			54.33±5.37
髁突水平角/°	左侧	29.71±14.66	0.060	0.953	25.83±9.34	-0.992	0.325
	右侧	29.49±14.63			28.52±11.84
关节内间隙/mm	左侧	3.17±1.54	1.378	0.173	2.75±0.93	-0.105	0.917
	右侧	2.68±1.26			2.78±1.18
关节外间隙/mm	左侧	3.55±2.10	-0.686	0.496	3.14±1.02	-0.369	0.714
	右侧	3.92±2.10			3.25±1.24
髁突垂直角/°	左侧	18.41±9.11	0.037	0.970	19.66±9.26	0.028	0.977
	右侧	18.33±9.10			19.59±9.09
髁突受力角/°	左侧	52.11±14.43	0.775	0.441	56.3±7.01	1.115	0.269
	右侧	49.26±14.51			53.43±12.49
关节窝宽度/mm	左侧	23.09±2.78	0.243	0.809	23.16±2.58	0.101	0.919
	右侧	22.85±4.91			23.07±4.38
关节窝深度/mm	左侧	8.15±3.09	-1.227	0.225	8.38±3.19	0.932	0.355
	右侧	9.12±3.18			7.63±3.10
关节结节斜度/°	左侧	54.96±13.97	0.003	0.998	51.29±15.06	-1.053	0.297
	右侧	54.95±13.94			55.33±15.08
关节前间隙/mm	左侧	3.32±0.92	0.027	0.979	3.26±0.83	1.360	0.179
	右侧	3.32±1.24			2.86±1.43
关节上间隙/mm	左侧	4.01±2.09	1.690	0.096	5.06±1.65	-0.204	0.839
	右侧	3.34±0.75			5.15±1.64
关节后间隙/mm	左侧	2.42±1.47	0.351	0.727	3.33±1.62	-0.064	0.949
	右侧	2.29±1.44		0.727	3.36±2.03
髁突高度/mm	左侧	17.05±4.56	-0.982	0.330	17.05±4.56	-0.983	0.329
	右侧	18.13±4.06			18.13±4.07

指标	习惯侧				非习惯侧
指标	初诊	复诊	t值	P值	初诊	复诊	t值	P值
髁突内外径/mm	18.41±2.38	19.29±2.39	-2.311	0.026*	18.53±2.43	19.12±2.35	-2.357	0.023*
髁突前后径/mm	7.94±1.47	8.32±1.38	-2.057	0.046*	7.69±1.48	7.94±1.09	-2.092	0.043*
半径值/mm	52.34±4.47	53.05±3.09	-0.938	0.353	52.89±3.86	53.11±4.18	-0.303	0.763
髁突水平角/°	25.59±8.14	23.13±1.55	1.983	0.054	25.09±8.04	23.23±5.79	1.435	0.159
关节内间隙/mm	2.82±0.47	3.16±0.85	-2.300	0.026*	2.53±0.95	2.79±1.03	-2.032	0.049*
关节外间隙/mm	2.79±0.49	2.71±0.84	0.590	0.558	2.98±1.00	2.63±1.06	1.679	0.101
髁突垂直角/°	10.37±3.41	11.66±4.98	-1.509	0.139	11.63±2.97	11.19±3.16	0.706	0.484
髁突受力角/°	54.09±7.74	53.34±7.17	0.445	0.659	56.64±11.81	55.42±6.02	0.577	0.567
关节窝宽度/mm	22.76±2.89	23.09±3.73	-0.451	0.654	22.41±2.66	21.97±2.15	0.932	0.357
关节窝深度/mm	10.56±2.82	10.38±1.31	0.423	0.675	10.49±1.24	10.31±1.13	0.723	0.473
关节结节斜度/°	45.52±6.92	46.03±6.69	-2.567	0.014*	44.86±5.69	44.87±6.53	-0.010	0.992
关节前间隙/mm	2.33±0.59	2.52±0.94	-1.060	0.295	2.46±1.25	2.42±0.81	0.174	0.863
关节上间隙/mm	3.60±0.67	4.14±1.45	-2.289	0.027*	3.15±1.47	3.83±1.12	-2.226	0.031*
关节后间隙/mm	2.95±1.15	3.83±1.78	-2.480	0.017*	2.83±0.92	3.06±0.83	-2.126	0.039*
髁突高度/mm	18.56±4.92	18.58±4.91	-2.223	0.032*	18.46±2.45	18.56±2.46	0.510	0.613

指标	位置	均值	t值	P值
髁突内外径/mm	非习惯侧	19.64±2.29	0.008	0.994
	习惯侧	19.63±2.08	0.008	0.994
髁突前后径/mm	非习惯侧	8.13±1.34	-1.565	0.121
	习惯侧	8.6±1.44	-1.565	0.121
半径值/mm	非习惯侧	53.11±4.18	0.076	0.939
	习惯侧	53.05±3.09	0.076	0.939
髁突水平角/°	非习惯侧	23.23±5.79	0.107	0.915
	习惯侧	23.13±1.55	0.107	0.915
关节内间隙/mm	非习惯侧	2.79±1.03	-2.195	0.031*
	习惯侧	3.23±0.81	-2.195	0.031*
关节外间隙/mm	非习惯侧	2.63±1.06	-0.391	0.697
	习惯侧	2.71±0.84	-0.391	0.697
髁突垂直角/°	非习惯侧	11.19±3.16	-0.521	0.603
	习惯侧	11.66±4.98	-0.521	0.603
髁突受力角/°	非习惯侧	55.42±6.02	1.453	0.150
	习惯侧	53.34±7.17	1.453	0.150
关节窝宽度/mm	非习惯侧	21.97±2.15	-1.713	0.090
	习惯侧	23.09±3.73	-1.713	0.090
关节窝深度/mm	非习惯侧	10.31±1.13	-0.247	0.805
	习惯侧	10.38±1.31	-0.247	0.805
关节结节斜度/°	非习惯侧	44.87±6.53	-0.948	0.346
	习惯侧	46.24±6.86	-0.948	0.346
关节前间隙/mm	非习惯侧	2.42±0.81	-0.514	0.609
	习惯侧	2.52±0.94	-0.514	0.609
关节上间隙/mm	非习惯侧	4.37±1.17	0.632	0.529
	习惯侧	4.19±1.47	0.632	0.529
关节后间隙/mm	非习惯侧	3.06±0.83	-2.596	0.011*
	习惯侧	3.83±1.78	-2.596	0.011*
髁突高度/mm	非习惯侧	16.88±2.45	-2.029	0.047*
	习惯侧	18.58±4.91	-2.029	0.047*