ORIGINAL RESEARCH
Conventional radiographic
analysis of facet joint and condylar erosion in patients at the UCSG. Prevalence study
Análisis
radiográfico convencional de fasetamientos y
erosiones condilares en pacientes de la UCSG. Estudio de prevalencia
Christian Steven Ávila Aguirre1.
Dennisse Fernanda Diaz Rojas2. Nicole Fabiana Diaz Rojas3
1 Dentist.
Universidad Católica de Santiago de Guayaquil. https://orcid.org/0009-0006-5910-1836
2 Specialist in Dental
Radiology and Imaging. Master’s Degree in Health Services Management. Professor, Universidad Católica de
Santiago de Guayaquil. https://orcid.org/0000-0002-1474-0232
3 Dentist.
Universidad Católica de Santiago de Guayaquil. https://orcid.org/0009-0009-3273-5590
Correspondence to: dennisse.diaz@cu.ucsg.edu.ec
Received: 12/12/2025 Accepted: 02/10/2026
ABSTRACT
Introduction: The degenerative alterations commonly found in the TMJ
include condylar flattening and erosion of its articular surface, changes that
can be observed in imaging studies. Objective: To determine the prevalence of
condylar facets and erosions observed in panoramic radiographs of patients
treated at the dental clinic of the Catholic University of Santiago de
Guayaquil during the B – 2024 term (January-December). Materials and Methods: A cross-sectional descriptive and
analytical study with a qualitative-quantitative approach was conducted. The
final sample size consisted of 274 digital panoramic radiographs obtained from
the UCSG Radiology Laboratory, after obtaining prior permission. Results: The findings revealed that
only 16.8% (n = 15) of the evaluated samples presented condylar erosions. When
evaluating facets, it was observed that 41.6% exhibited bilateral condylar
facets. Women presented higher percentages of both erosions and facets compared
to men (p > 0.05). The group with condylar facets had a mean age of 34.45
years, while the group with condylar erosions had a mean age of 38.48 years. Conclusion: This study found that
condylar facets, whether unilateral or bilateral, were significantly more
frequent in the study population than condylar erosions. The results
demonstrated a complete absence of coexistence between both evaluated
conditions, suggesting a statistically significant inverse relationship.
Keywords:
Faceting. Erosion. Degenerative alterations. Temporomandibular Disorders,
mandibular condyle
RESUMEN
Introducción: Las alteraciones degenerativas que se encuentran
comúnmente en la ATM comprenden el aplanamiento del cóndilo y la erosión de su
cara articular, cambios que pueden observarse en las imágenes. Objetivo: Determinar la prevalencia de
facetamientos y erosiones condilares observadas en
radiografías panorámicas de pacientes atendidos en la clínica odontológica de
la Universidad Católica de Santiago de Guayaquil durante el periodo B – 2024 (Enero-Diciembre). Materiales
y métodos: Se realizó un estudio transversal, de diseño descriptivo y
analítico, de enfoque cuali-cuantitativos. El tamaño
de la muestra final fue de 274 radiografías panorámicas digitales obtenidas del
Laboratorio Radiológico de la UCSG, previo permiso. Resultados: Los
resultados obtenidos reportan que solo el 16,8% (n = 15) de las muestras
evaluadas presentaron erosiones condilares. Al evaluar los facetamientos,
se observó que el 41,6% presentaron facetamientos en
ambos cóndilos mandibulares (bilaterales). Las mujeres presentaron porcentajes
mayores de erosiones y facetamientos en comparación
con los hombres (p > 0,05). El grupo de pacientes con presencia de facetamientos condilares presentaron una media de edad de
34,45 años, el grupo de facetamientos condilares
presentaron una media de 38,48 años. Conclusión:
En el presente estudio se encontró que los facetamientos
condilares, ya sea unilateral o bilateral, fue significativamente más frecuente
en la población de estudio que las erosiones condilares. Los resultados
evidenciaron una ausencia total de convivencia entre ambas condiciones
evaluadas, sugiriendo una relación inversa estadísticamente significativa.
Palabras
Clave: Facetamiento, Erosión, Alteraciones degenerativas,
Trastornos temporomandibulares, cóndilo mandibular.
INTRODUCTION
The temporomandibular joint
(TMJ) is one of the most complex joints in the human body and is essential for
performing masticatory, swallowing, and speech functions. It connects the
mandibular condyle with the fossa of the temporal bone, and an articular disc
facilitates its movement. It allows both rotation and translation, making it
susceptible to various structural and functional changes due to the loads it supports.
¹ ²
Temporomandibular disorders (TMD)
include morphoanatomical and myofunctional alterations of the masticatory
muscles, which are more
prevalent in women. They are associated
with symptoms such as pain, clicking, and limited or deviated mandibular
movement, significantly affecting patients’ quality of life. ¹ ³ ⁴ Common
degenerative alterations in the TMJ include condylar flattening (facet
formation) and erosion, associated with visible wear signs on imaging. These
are frequent in temporomandibular osteoarthritis (OA), an inflammatory disease
that causes degenerative changes on joint surfaces without bone regeneration,
impairing function and causing pain. ⁴ ²
Condylar erosion affects
cartilage, cortical bone, and subcortical bone, manifesting with pain and
functional limitation. These alterations, associated with the condition of the
articular disc, aggravate symptoms and complicate the clinical picture in young
patients, affecting their growth and dentofacial morphology, in addition to
reducing mandibular functional capacity. ¹ ⁵ Condylar flattening, in turn, is
characterized by the loss of its natural convexity. It may be anatomical,
without significant changes in bone structure, or abnormal, accompanied by
modifications in the cortical bone. ⁶ ⁷ The study of
degenerative changes in the TMJ can be carried out using radiographic
techniques such as computed tomography and panoramic radiography. Panoramic
radiography is recommended for identifying bony alterations of the condyle and
is especially useful in patients with trismus, trauma, or financial limitations
preventing access to tomography or magnetic resonance imaging. ¹ ⁵ ⁶
Erosive alterations of the
TMJ, such as condylar erosion and flattening, present significant challenges
for dental diagnosis and management, as they may generate symptoms such as
pain, mandibular deviation, and joint sounds, among others, highlighting the
need for proper evaluation and treatment.⁵ ⁷ Based on the reviewed background,
the objective of this study was to determine the prevalence of condylar
flattening and erosions observed in panoramic radiographs of patients treated
at the dental clinic of the Universidad Católica de Santiago de Guayaquil
during Period B – 2024.
MATERIALS AND METHODS
A cross-sectional study was
conducted with a descriptive and analytical design, and a
qualitative-quantitative approach. Sample size calculation was performed using EpiInfo (Population size: 967 panoramic radiographs;
Confidence level: 95%; Frequency: 50%; Margin of error: 5%). The sample
consisted of radiographs from patients aged between 18 and 69 years. The final
sample size was 274 digital panoramic radiographs obtained from the Radiology UCSG
Laboratory, collected from January to December 2024.
Data Collection: Before data collection,
permission was requested to access radiographic records. All radiographs
showing projection of the ascending ramus of the mandible and the entire
condylar contour without image superimposition were included. Radiographs with
blurred, distorted, or low-quality images were excluded, as well as radiographs
of patients with a history of reconstructive surgery. A visual analysis was
performed on each radiograph, and findings were recorded on a data collection
form. The presence or absence of condylar flattening and erosions was recorded,
in addition to age and sex. Statistical
Analysis: Variables were coded in Microsoft Excel for tabulation. Descriptive
statistics were used for general data interpretation. The following tests were applied:
Chi-square, Fisher–Freeman–Halton exact test, Shapiro–Wilk, and Mann–Whitney U
test.
RESULTS
The sample consisted of
radiographs from patients aged between 18 and 69 years, with a mean age of
33.79 (SD: 11.659). Regarding sex, women predominated in the sample,
representing 72.6% of the evaluated radiographs (Table 1).
Table 1. Demographic Characterization of the Study
Population
|
N |
% |
Mean |
Min |
Max |
SD |
|
|
Age |
274 |
100 |
33.79 |
18 |
69 |
11.659 |
|
Sex |
N |
% |
|
Female |
199 |
72.60% |
|
Male |
75 |
27.40% |
The results show that only
16.8% (n = 15) of the evaluated samples presented condylar erosions (Figure 1).
When assessing flattening, it was observed that 41.6% presented flattening in
both mandibular condyles (bilateral). Although in lower proportion, panoramic
radiographs were also observed in patients presenting condylar flattening only
on the right side and others only on the left side (Figure 1). No case with
flattening presented condylar erosions and vice versa. The obtained results
suggest a statistically significant inverse relationship (p < 0.001).
Figure 1. Prevalence of
condylar flattening and erosions in the study population.
Regarding
percentage distribution by sex, it was observed that within the group
presenting condylar erosions, the highest percentage corresponded to women, at
11.3% (p = 0.383). Within the group presenting flattening, women also
predominated, with 29.9% bilateral (p = 0.827), 6.6% left side (p = 0.527), and
4% right side (p = 1.000) (Figure 2).
Figure
2. Condylar erosions and flattening according to sex
It
was observed that the group presenting condylar flattening—whether on the left
side, right side, or bilaterally—had a mean age of 34.45 years, with a minimum
of 18 and a maximum of 69 (SD: 12.141) (Figure 3). Regarding condylar erosions,
the group presenting erosions had a mean age of 38.48 years, suggesting a
slightly older age in this group, with a minimum of 18 and a maximum of 68 (SD:
12.053) (Figure 3).
Figure
3. Condylar erosions and flattening according to age
The
Shapiro–Wilk normality test was used. The results showed a significance value
less than 0.05 (p < 0.001), indicating that the evaluated data do not follow
a normal distribution. Due to the non-normal distribution of the data, the
Mann–Whitney U test was applied (Table 2). No statistically significant
differences were found between patients with and without flattening and age (p
= 0.431). Regarding condylar erosions, a p-value of 0.001 was obtained,
indicating significant age differences between patients with and without
condylar erosions (Table 2).
Table 2. Shapiro–Wilk Normality Test – Mann–Whitney U
Test for Independent Samples
|
Shapiro-Wilk |
|||
|
|
Statistic |
gl |
Sig. |
|
Erosions |
0,925 |
274 |
<
0,001 |
|
Flattening |
0,451 |
274 |
<
0,001 |
|
Independent Samples Mann–Whitney U |
|||
|
Age |
Condylar Erosions |
N |
274 |
|
U M W |
3656,5 |
||
|
Test Statistic |
-3,241 |
||
|
Sig. |
0,001 |
||
|
Flattening |
N |
274 |
|
|
U M W |
8759,5 |
||
|
Test Statistic |
-0,787 |
||
|
Sig. |
0,431 |
||
DISCUSSION
In a study conducted by Emshoff
R et al.5 (2021), a high percentage of condylar erosions was found, accounting
for 40.3% of their study sample. In contrast, in the present study, the absence
of condylar erosions predominated, while condylar erosions were observed less
frequently, comprising 16.9% of the sample.
Oliveira D et al.8 (2024), on the other hand,
evaluated morphological changes of the condyle in patients with Angle Class II
malocclusion. These authors reported that 59% of the sample presented
flattening, followed by 31% with condylar erosions. These results contrast with
those observed in this study, where minimal percentages of patients showed the
presence of condylar erosions and flattening in the studied sample.
In another study, Arayasantiparb
R et al.9 (2020), evaluated the radiographic characteristics of patients who
had undergone Cone Beam Computed Tomography scans at a dental clinic in
Thailand, where they observed that condylar flattening predominated at 89.4%.
Other authors, such as Jeon K et al.10 (2021), reported low percentages of
these anomalies, with 7% flattening and 7.3% condylar erosions in their study
population.
Regarding flattening, Kilic
S et al.11 (2015), reported that 41% of the evaluated patients presented
bilateral condylar flattening and 35% unilateral flattening. These findings
partially coincide with those reported in this study, where 41.6% of cases
presented bilateral condylar flattening. Meanwhile, Rodríguez Y, et al.12
(2020) reported higher percentages; through panoramic radiographs, they
observed that 78.4% of their sample presented flattening in the right condyle
and 79.3% in the left condyle. In contrast, in this study, only 8.4% presented
flattening on the left side and only 5.5% on the right side.
Bae et al.13 (2017) found that the presence of both
condylar erosions and flattening was the most frequently observed combination
in their sample (12.7%). Jung et al.14 (2022) also reported a slightly lower
percentage of patients presenting this combination (condylar erosions and
flattening), accounting for only 9.58% of the sample. Unlike these findings, in
the present study, none of the evaluated cases presented a combination of these
anomalies. Differences in craniofacial size, bite force, and masticatory muscle
strength may influence the structural and functional characteristics of the
temporomandibular joint. Several studies have reported a higher prevalence of
temporomandibular disorders in female patients, as well as in patients with
skeletal Class II.15
Gharge NR et al.1 (2020) evaluated the temporomandibular
joints and observed minority percentages in both sexes. Only 14% of the
evaluated women presented condylar erosions, followed by 11% of men who also
presented this pathology. In the present study, a similar percentage
distribution was observed, where 11.30% of women presented condylar erosions.
Regarding men, a slightly lower percentage than that reported by the authors
was observed (5.5%).
Pearson’s Chi-square test revealed that there are no
significant differences in the prevalence of condylar erosions between sexes (p
= 0.383). This contrasts with what was reported by Vasegh
Z et al.16 (2023), who evaluated TMJ changes and found statistically
significant differences between sex and the presence of condylar erosions (p =
0.001).
Other authors, such as Barrera P, et al.17 (2017),
observed that in their study, 24% of men presented right-side flattening, while
women accounted for 48.2% (p = 0.002). On the left side, the authors reported
that only 20% of men presented flattening, with women predominating at 42.1% (p
= 0.004). These results differ from the percentage distribution observed in
this study, where women, although representing minority percentages, showed
slightly higher proportions than men. Only 1.5% of men presented right-side
condylar flattening and 1.8% left-side flattening.
Regarding age, Emshoff R et
al.5 (2021) reported a mean age of 40.1 years in the group of patients without
condylar erosion and 32.8 years in the group with condylar erosion (p = 0.003).
These results partially agree with those observed in this study, where patients
with condylar erosions had a similar mean age (38.48). The mean age observed in
this study within the group of patients without condylar erosions was lower
compared to that reported by the authors.
In another study, Rudiger E,
et al.7 (2021) reported a mean age of 36.6 years in patients without erosion
and 39 years in patients with erosion. These authors indicated a lack of
statistical significance between these variables (p = 0.174), contrasting with
what was observed in this study, where a highly significant p-value was
obtained (p = 0.001).
Jeon K et al.10 (2021), on the other hand, reported
that patients with condylar flattening had a mean age of 26.33 years. These
results differ from those observed in this study, where a higher mean age
(34.45 years) was obtained among patients with condylar flattening (left side,
right side, or bilateral). In another study, Koc N,
et al.18 (2020), reported a mean age of 38.95 years in patients with condylar
flattening. The authors indicated that there was no significant difference
between these variables (p = 0.212), similar to what was observed in the
present study.
CONCLUSION
The results showed a higher frequency of bilateral
flattening compared to unilateral flattening and condylar erosions, which were
observed in a lower proportion within the studied sample. Additionally, a total
absence of coexistence between both conditions was observed; that is, no cases
were found in which flattening and erosions were present in the same patient.
Finally, significant differences were observed between age and the prevalence
of condylar erosions. These results highlight the importance of considering age
as a determining factor in the increase of condylar erosions, reinforcing the
need to comprehensively evaluate TMJ conditions, especially in older
populations.
RECOMMENDATIONS
It is recommended to conduct a study to evaluate other
factors that may be related to the presence of condylar flattening and
erosions, such as malocclusions and parafunctional habits, in addition to
variables such as stress and anxiety levels. It is also recommended to conduct
research incorporating more advanced imaging techniques for evaluation, such as
Cone Beam Computed Tomography (CBCT), to improve diagnostic accuracy.
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AUTHOR
CONTRIBUTION STATEMENT
“Conceptualization and design: Ávila Aguirre Christian, Diaz Rojas Dennisse; Literature review: Diaz Rojas Nicole; Methodology
and validation: Ávila Aguirre Christian, Diaz Rojas Dennisse;
Formal analysis: Diaz Rojas Nicole; Investigation and data collection: Ávila
Aguirre Christian, Diaz Rojas Dennisse, Diaz Rojas
Nicole; Resources: Not applicable; Data analysis and interpretation: Ávila
Aguirre Christian, Diaz Rojas Dennisse; Writing –
original draft preparation: Ávila Aguirre Christian; Writing – review and
editing: Ávila Aguirre Christian, Diaz Rojas Dennisse;
Supervision: Diaz Rojas Dennisse; Project administration:
Diaz Rojas Dennisse; Funding acquisition: Not
applicable.”
CONFLICTS OF INTEREST
The authors declare that there were no conflicts of
interest during the conduct of this research. In addition, the manuscript was
submitted exclusively to the Revista Científica “Especialidades Odontológicas UG” for review and publication.
FUNDING
The authors report that personal funds were used to
carry out this research.
HOW TO CITE:
Avila Aguirre CS, Diaz Rojas DF, Diaz Rojas NF. Conventional
radiographic analysis of facet joint and condylar erosion in patients at the
UCSG. Prevalence study. Revista Científica
Especialidades Odontológicas UG. 2026;9(1):22-8.