Evaluation of Condyle–Fossa Relationships in Adults with Various Skeletal Patterns Using Cone-Beam Computed Tomography

Abstract

This study assessed the condyle–fossa relationships in adults with different skeletal patterns using cone-beam computed tomography (CBCT). A total of 135 adult participants were included in the analysis of the CBCT images. Participants were categorized based on gender, age, race, and skeletal patterns. The measurements of the temporomandibular joint spaces were taken, which include the anterior (AS), superior (SS), posterior (PS), medial (MS), central (CS), and lateral (LS) spaces. Additionally, the dimensions of the condyle were assessed, including mediolateral thickness (MLT), anteroposterior thickness (APT), articular slope (ArS), and the vertical height of the fossa (VHF). These measurements were then compared. The average ratios of AS:SS:PS and MS:CS:LS were 1.00:1.61:1.18 and 1.00:1.15:0.79, respectively. The average values of most measurements were significantly higher in males than in females. The average value of APT was significantly higher in the late age group than in others, but there was no statistical difference according to race. The average values of PS, CS, and LS were significantly higher on the left side than on the right, while the average value of AS was significantly higher on the right side than on the left. The average values of SS, CS, and MLT were significantly higher in hypodivergent than in hyperdivergent skeletal patterns, while the average values did not show any statistical differences based on horizontal skeletal patterns. The average values of SS and CS in the Class II horizontal skeletal group were significantly lower in hyperdivergent individuals compared to other vertical skeletal patterns. In adults, statistical differences in condyle–fossa relationships were observed based on gender, age, sides, and skeletal patterns, but no differences were identified according to race.

1. Introduction

The temporomandibular joint (TMJ) is an essential element of the craniofacial structure, facilitating the proper movement of the mandible in relation to the cranium. The TMJ plays an essential role in mandibular movement, masticatory function, speech, and other functional tasks [1,2,3]. Previous researchers suggested that the morphology of the TMJ, for example, the condyle and the fossa, varies across different skeletal patterns and occlusal relationships. Various factors such as gender, age, skeletal growth patterns, dental occlusion, and both functional and pathological changes may influence condylar positions and TMJ morphology [1,2,3,4].

Comprehending the relationships between the condyle and the glenoid fossa is important in orthodontics since improper condylar positioning may contribute to TMDs, malocclusions, and other functional impairments [5]. Previous research on adolescents has highlighted the influence of skeletal patterns on the condyle–fossa relationships [4]. During adulthood, the mandibular condyles undergo a remodeling process due to functional adaptation and pathological changes, which could affect condylar morphology, such as resorption, erosion, flattening, sclerosis, and bony spur formation [2]. This emphasizes the importance of expanding the previous research to the adult population.

Cone-beam computed tomography (CBCT) has emerged as an important instrument in the examination of TMJ morphology since it generates highly detailed three-dimensional images with reduced radiation exposure compared to conventional computed tomography (CT), which enables the precise evaluation of the relationships between the condyle and the fossa [1,2,4,6,7,8,9,10]. Using CBCT, researchers have investigated variations in mandibular condyle and glenoid fossa morphology in relation to sagittal and vertical skeletal patterns. Other studies have demonstrated associations between skeletal patterns and TMJ morphology [1,6]. For example, Class III patients exhibited greater condylar width, height, and fossa height than Class II patients. Hypodivergent patients showed wider condyles in contrast to the hyperdivergent group, while hyperdivergent patients had significantly reduced condylar volume and superior joint space but larger fossa length and height than both hypodivergent and normovergent groups [6].

Additionally, Class II hyperdivergent women had morphological bony changes in the condyle without regard to the condylar osseous forms, which indicated a potential association between condylar volume and dentoskeletal characteristics [9]. This association underlines the potential impact of craniofacial development and growth on TMJ morphology [7]. Moreover, age and gender have been discussed as factors influencing TMJ morphology among the Korean population. Men showed larger mediolateral condyle width and greater mandibular body size than women. The joint space and fossa depth significantly differed among age groups [2].

Investigating these variations in the mandibular condyle and glenoid fossa morphology in relation to sagittal and vertical skeletal patterns in adults is important for proper diagnosis and treatment planning in orthodontics. Therefore, this research expands upon previous studies conducted on adolescents [4]. The aim of this study is to investigate the condyle–fossa relationships and TMJ morphology in adults with various skeletal patterns using CBCT. The hypothesis (H1) is that skeletal patterns significantly affect TMJ morphology and variations in joint spaces and condylar dimensions, whereases the null hypothesis (H0) states that there are no statistically significant differences in TMJ morphology based on skeletal patterns.

2. Materials and Methods

2.1. Participants, Eligibility Criteria, and CBCT

This study focused on adult participants 20 years or older who had received an orthodontic screening examination and had their initial CBCT images taken during their orthodontic screening appointments at the Arizona School of Dentistry & Oral Health Postgraduate Orthodontic Program since 2017. Images were taken using the head support, head strap, and chin cup to align the patients’ heads in an upright sitting position to obtain the Frankfort horizontal (FH) plane parallel to the floor and with the patients instructed to bite in maximum intercuspation [11].

Participants aged 20 years or older of either gender were included. In addition, only those participants who had CBCT taken with a large field of view (FOV) at their initial orthodontic screening visit at the clinic were considered for this research. The following exclusion criteria were applied: (1) a history of TMDs or active TMD symptoms as evaluated through a questionnaire based on the Axis I clinical diagnostic criteria [12], (2) prior TMJ surgery or trauma, (3) previous orthodontic treatment, (4) craniofacial anomalies such as cleft lip and palate, (5) extracted permanent teeth other than third molars, (6) severe skeletal asymmetry, (7) head and neck neoplasms, (8) systemic disease that could cause structural or physiological changes to TMJ or surrounding structures [13,14,15]. After applying these criteria, a total of 135 participants were selected for the study.

Table 1 shows the sample distribution consisting of 135 participants, 64 males and 71 females. Race was grouped as Caucasian and non-Caucasian. For purposes of analysis, the participants were divided into three age groups: early (20 ≤ y < 30), middle (30 ≤ y < 40), and late (40 ≤ y). They were divided into three vertical skeletal groups based on the angle between sella-nasion and mandibular plane (SN-MP): hypodivergent (SN-MP < 29°), normovergent (29° ≤ SN-MP ≤ 36°), and hyperdivergent (SN-MP > 36°) [16]. Additionally, they were divided into three horizontal skeletal groups based on the ANB angle: Class I (1° ≤ ANB ≤ 4°), Class II (ANB < 1°), and Class III (ANB > 4°) [10].

All CBCT imaging was conducted using the i-Cat FLX (Dental Imaging Technologies Corp, Hatfield, PA, USA). The scanning parameters were standardized to ensure consistency across all scans. The FOV was set at 23D × 17H cm with a voxel size of 0.3 mm. The CBCT machine was operated at 120 kVp and 5 mA. Scans were performed using standardized “ortho” settings, allowing for uniform image acquisition [3,10].

The constructed CBCT images were orientated with the Frankfort horizontal (FH) plane. The FH plane was constructed from the right porion and two orbitales on both sides (Figure 1A). The TMJ slices were constructed using Dolphin imaging version 12.0 (Dolphin Imaging and Management Solutions, Chatsworth, CA, USA) by orienting the center point in the middle of the condylar head and by aligning the axis perpendicular to the condylar head. The slices had a thickness of 1.0 mm, a width ranging from 35 to 45 mm based on condylar head size, and a total of 18 cuts. The slices were oriented in both sagittal and coronal planes (Figure 1B) [4,5].

Institutional review board approval to conduct the study was granted by A.T. Still University Arizona Institutional Review Board (exempt protocol code #2023-189).

2.2. Study Design

This retrospective study assessed the relationships between the condyle and fossa in adult participants with different skeletal patterns. One investigator (A.C.) evaluated all condyle–fossa relationships using CBCT images. To avoid bias, the investigator was blinded to the participants’ skeletal classifications.

The condyle–fossa relationships were evaluated using several specific parameters. The TMJ spaces were measured as the shortest distance between two points. Anterior space (AS) involves the anterior fossa (AF) and anterior condyle (AC). Superior space (SS) includes the superior fossa (SF) and superior condyle (SC). The posterior space (PS) consists of the posterior fossa (PF) and posterior condyle (PC). Central space (CS) comprises the central fossa (CF) and central condyle (CC). Medial space (MS) relates to the medial fossa (MF) and medial condyle (MC). Lateral space (LS) pertains to the lateral fossa (LF) and lateral condyle (LC). This is illustrated in Figure 2 [4,13].

The condyle’s width and depth were measured, including the mediolateral thickness (MLT) and anteroposterior thickness (APT). MLT represents the distance between the medial head (MH) and lateral head (LH) measured perpendicularly to the Frankfort horizontal (FH) plane. APT measures the distance between the anterior head (AH) and posterior head (PH), also perpendicular to the FH plane [4,13]. Additionally, the articular slope (ArS) was calculated as the angle between the FH plane and a line that is tangent to the anterior slope of the fossa. The vertical height of the fossa (VHF) is defined as the perpendicular distance from the FH plane to the articular eminence (AE) (Figure 2) [4].

2.3. Statistical Analysis

Intra-examiner reliability was completed to check whether the first investigator’s measurements were reproducible. After a two-week interval, the same investigator measured a randomly chosen 10 CBCT images twice. Single-measurement, two-way mixed intraclass correlation coefficient (ICC) analyses for consistency were calculated to evaluate the reliability of the measurements [4].

A power analysis using PASS software v. 23.0.2 (NCSS, LLC, Kaysville, UT, USA) was performed to estimate the sample size required for this study. To identify a difference in group means using analysis of variance (ANOVA); an effect size of f = 0.45 indicated that 108 participants would be needed to achieve a power greater than 0.90, with an alpha = 0.05.

Data were analyzed using several statistical tests. For between-group comparisons, independent samples t-tests, ANOVA, Mann–Whitney, and Kruskal–Wallis tests were used. Assumption tests (Shapiro–Wilk) were conducted preliminarily. If the normality assumption failed, p-values for Welch’s test for unequal sample sizes and failure to meet homogeneity of variances assumption are reported parenthetically, as well as results from the Mann–Whitney (two groups) or Kruskal–Wallis (more than two groups) tests. For independent variables with more than two categories in which the main effect was statistically significant, Tukey’s HSD tests were conducted to identify homogeneous subsets.

For within-group comparisons, repeated measures of ANOVA and Friedman tests were used. The Greenhouse–Geisser adjustment for lack of sphericity is reported if the assumption of sphericity was unmet. The p-value for the Friedman test is also reported when at least one of the dependent variables failed to meet normality assumptions. Bonferroni corrections were applied to the multiple pairwise comparisons to identify homogeneous subsets.

The effect size for each test was calculated using either eta-squared or Kendall’s W. Eta-squared, calculated for between-groups comparisons, was interpreted as 0.01 = small, 0.06 = medium, 0.14 = large. Kendall’s W, used for within-subject comparisons, was interpreted as 0.1–0.3 = small, 0.3–0.5 = medium, ≥0.5 = large.

Power was not explicitly calculated for each cell of the dataset. A sample of n = 30 would have been sufficient to detect a small-to-medium effect size with 80% power, alpha = 0.05, two-tailed. However, we were not able to obtain 30 subjects within each cell.

Statistical analyses were performed using SPSS ver. 28 software (IBM Corp., Armonk, NY, USA). For all analyses, an alpha of 0.05 (two-tailed) was used as the criterion for statistical significance. If the parametric and nonparametric test significance results differed, the more conservative nonparametric results were interpreted.

3. Results

Based on a single measurement, two-way mixed intraclass correlations of consistency (ICC) for all measurements except one (right anterior space = 0.91) were greater than 0.95, indicating excellent reliability.

The average AS, SS, and PS values in the sagittal view showed significant differences. Most measurements in the sagittal view indicated that SS was notably greater than AS and PS. The average ratio of AS:SS:PS was 1.00:1.61:1.18, respectively. Similarly, the average values of MS, CS, and LS in the coronal view were also significantly different, except on the left side. Most measurements in the coronal view revealed that the TMJ spaces were significantly different, with the order being CS > MS > LS. The average MS:CS:LS ratio was 1.00:1.15:0.79, respectively (Table 2 and Table 3).

Most measurements, except for ArS and APT, showed significantly higher average values in males compared to females. The average value of APT was significantly higher in the late age group than in others. The average values exhibited no statistical differences according to race. Additionally, the average values of PS, CS, and LS were higher on the left side than on the right, while the average value of AS was higher on the right side than on the left. Furthermore, the average SS, CS, and MLT values were significantly higher in individuals with hypodivergent vertical skeletal patterns compared to those with hyperdivergent patterns. In contrast, average values according to horizontal skeletal patterns showed no significant differences (see Table 2 and Table 3).

The mean values of most measurements showed no significant difference according to vertical skeletal patterns in each group of horizontal skeletal patterns, but the mean value of MLT was significantly smaller in hyperdivergent than other vertical skeletal patterns in Class I and II horizontal skeletal groups. The mean values of SS and CS were significantly smaller in hyperdivergent than other vertical skeletal patterns in the Class II horizontal skeletal group (Table 4).

4. Discussion

This study presents a comprehensive analysis of the condyle–fossa relationship in adult patients with various skeletal patterns using CBCT. These findings expand upon previous research with adolescents. Adults undergo various changes due to age, gender, and skeletal morphology. The results from this study show variations in condylar morphology, TMJ spaces, and condylar asymmetry. These findings are consistent with previous research studying anatomical differences across different sagittal and vertical skeletal classifications [1,4,5].

The hypodivergent group displayed the largest SS, CS, and MLT, which aligns with previous studies [6,9]. Noh et al. [6] reported that hyperdivergent individuals are prone to show reduced condylar volumes and greater joint spaces, especially in the superior aspect of the joint. These morphological changes in TMJ most likely resulted from altered functional loading patterns among hyperdivergent individuals, which may result in compensatory changes in the condyle and fossa. This was further supported by Xie et al. [9]. They suggested that hyperdivergent Class II adults had significantly reduced condylar volumes and altered condylar positioning compared to hypodivergent and normovergent individuals. This may suggest greater susceptibility to TMJ pathologies resulting from mechanical stress and functional alterations in the condylar structure [6.9]. Further research is necessary to investigate whether these morphological characteristics are likely to increase the risk of TMDs.

Males had larger joint spaces in the multiple areas studied (AS, SS, PS, MS, CS, LS, VHF, and MLT) compared to females. Within subject differences, LS showed a significant difference between males and females. Other research reported that males tend to have larger MLT and condylar fossa dimensions than females [2]. Larger condylar dimensions and joint spaces in males may enhance functional adaptations and decrease the risks of TMDs. Conversely, females exhibit a higher susceptibility to TMDs, potentially due to hormonal effects during menstruation or menopause on joint remodeling and muscle functions [2,16].

Our findings suggest that the TMJ remodeling process or degeneration may be age-dependent. The late age group showed a significant increase in APT compared to younger groups, possibly due to osseous changes in TMJ space, such as condylar flattening and osteophyte formation of the condyle [17]. In addition, participants aged 40 years and older displayed trends of a flatter articular slope, a lower vertical height, and a narrower lateral space, although these differences did not reach statistical significance. Earlier studies noted that TMJ morphology continues to change with age, which results in TMJ alterations such as flattening or erosion of the condyles [2,18]. The age-related findings emphasize age consideration when assessing TMJ morphology in clinical settings, as TMJ alterations may compromise TMJ function and elevate TMD risks [19].

The right and the left side of the condylar spaces presented asymmetries. Research conducted by Dalili et al. [20] documented slight yet significant differences in joint space and condylar position between the right and left. These asymmetries may result from habitual functional movement, for example, mastication [21]. Although gender and age were significant factors in TMJ morphology, race and horizontal skeletal classification were not found to have a significant impact in this study. The lack of significant differences in race may be due to the broad division of the group into Caucasian and non-Caucasian since the samples of each race were limited.

Additionally, the non-significant results across different horizontal skeletal classifications (Class I, II, and III) contrast with other earlier studies [1,3,5]. Kariminasab et al. [1] stated that Class III skeletal patterns due to mandibular prognathism are associated with larger condylar widths and larger fossa depth compared to Class II individuals due to mandibular retrognathism. Their findings suggest that Class III patients experience an adaptive remodeling of the condyle and glenoid fossa to accommodate more anterior mandible positioning [1]. This aligns with the findings from Ma et al. [3] that Class III individuals tend to exhibit greater condylar height and fossa height than Class II individuals, potentially due to the structural changes to support anterior mandible positioning [3]. Conversely, Class II individuals often show more anteriorly positioned condyles within the glenoid fossa. This phenomenon could be explained by compensatory mechanisms of mandibular retrognathism [5].

Comparing condylar space ratios in adults with those reported in adolescents by Chae et al. [4] provides additional insights into the change in TMJ morphology. Adults show a significantly larger SS ratio (1.61, p-value < 0.001 ***, η² = 0.03) compared to adolescents (1.27) [4]. An increase in SS in adults might reflect adaptations to long-term functional pressures, allowing the joint to remodel to withstand vertical compression forces [21,22]. PS remains relatively stable across both groups, with ratios of 1.18 with a p-value of 0.044 *, η² = 0.008 in adults and 1.19 in adolescents. In contrast, the ratio of LS was smaller in adults (0.79, p-value < 0.001 **, η² = 0.01) compared to adolescents (1.05). This pattern suggests a narrowing in LS with aging, possibly due to the condyle settling into a more centered position in the condylar fossa as individuals mature and TMJ remodeling takes place [22]. CS for adults is slightly larger (1.15, p-value < 0.001 ***, η² = 0.03), though there are no corresponding data for adolescents, limiting a direct comparison [4].

Our study has several clinical implications for orthodontics and TMJ management. Specifically, this study’s findings on SS ratios larger in adults than adolescents suggest that the condyle undergoes adaptive remodeling with age [22]. This increased joint space may represent a compensatory mechanism to manage vertical loading, which is critical for orthodontic interventions in adults to minimize the risk of TMD [1,5]. In addition, the larger SS and CS values observed in the hypodivergent group align with findings that the hypodivergent group has a lower risk of developing TMD, in contrast to hyperdivergent individuals who are more susceptible due to reduced SS and smaller condylar volume [6]. The use of CBCT provided a comprehensive three-dimensional TMJ evaluation and allowed precise measurement of condylar and fossa morphology. Kapila [8] emphasized the importance of utilizing CBCT in orthodontics, especially for complex craniofacial structure evaluation such as TMJ [10].

The limitations of this study include its cross-sectional design, which limits the ability to theorize causal relationships between skeletal patterns and TMJ changes. CBCT’s strength lies in its ability to capture high-resolution images of bone with less radiation exposure than traditional CT scans, but it falls short in visualizing joint disc morphology, a factor that could provide a more complete picture in TMJ evaluations. Future research should consider a longitudinal approach to clarify how aging, growth patterns, and skeletal variations affect TMJ structure and contribute to TMD development over time [18]. MRI alongside CBCT could offer deeper insights by providing a comprehensive view of soft and hard tissue changes that impact TMJ function [6,8,21].

The small sample sizes in certain subgroups, such as Class III hyperdivergent, have reduced statistical power in tests of differences. However, the data provide estimates of the potential characteristics of these patients in a population. The p-values derived from such samples may not reflect true differences found in larger, more balanced samples. Expanding the demographic diversity of study samples and increasing the number of participants would also be essential for making the findings more applicable across various populations. Despite excluding participants with TMDs, prior TMJ surgery or trauma, and previous orthodontic treatment [23], factors such as occlusal habits [24] may still indirectly influence TMJ morphology. Habits, for example, bruxism, could change TMJ remodeling and potentially affect the results [25]. Additionally, analyzing occlusal factors, such as discrepancies between maximum intercuspation and centric relation, might clarify how variations in TMJ morphology affect its function in different contexts [4].

5. Conclusions

This study evaluated the temporomandibular joint spaces and condylar dimensions in adults with various skeletal patterns using CBCT. The findings are summarized as follows:

• The average values of sagittal TMJ spaces (AS, SS, and PS) and coronal TMJ spaces (MS, CS, and LS) differed significantly, respectively.

• The AS:SS:PS ratio was 1.00:1.61:1.18.

• The MS:CS:LS ratio was 1.00:1.15:0.79.

• Most measurements were significantly higher in males compared to females.

• The average value of APT was significantly higher in the late age group than in others.

• There was no statistical difference according to race.

• PS, CS, and LS values were higher on the left side compared to the right, while AS value was higher on the right side than on the left.

• In hypodivergent skeletal patterns, SS, CS, and MLT values were significantly higher than in hyperdivergent patterns.

• There were no significant statistical differences based on horizontal skeletal patterns.

• In the Class II horizontal skeletal group, SS, CS, and MLT values were significantly lower in hyperdivergent patterns compared to hypodivergent patterns.

In summary, our study indicated statistical differences in condyle–fossa relationships based on gender, age, side, and skeletal patterns, while differences according to race were negligible.

Author Contributions

Conceptualization, A.C. and J.-M.C.; methodology, A.C. and J.-M.C.; software, C.B.; validation, A.C., J.-M.C. and J.H.P.; formal analysis, C.B.; investigation, A.C.; resources, A.C.; data curation, A.C.; writing—original draft preparation, A.C.; writing—review and editing, J.-M.C., J.H.P. and C.B.; visualization, A.C.; supervision, J.-M.C. and J.H.P.; project administration, A.C., J.-M.C. and J.H.P. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of A.T. Still University, Arizona (protocol code #2023-189, approved on 17 April 2024). The IRB determined that this project was exempt under 45 CFR §46.104(d)(4) due to the use of de-identified human data.

Informed Consent Statement

Informed consent was waived as this study used preexisting CBCT data obtained from routine orthodontic screenings, and no identifiable personal information was used.

Data Availability Statement

Data is contained within the article.

Acknowledgments

We express our gratitude to Diane Jeong for her valuable contributions in identifying eligible participants and creating Figure 2. We also appreciate the support from the staff at the Arizona School of Dentistry & Oral Health Postgraduate Orthodontic Program for their assistance with the CBCT imaging. This paper was supported by The Korean Orthodontic Research Institute Inc. This paper was supported by Wonkwang University in 2025.

Conflicts of Interest

The authors declare no conflicts of interest.

Footnotes

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Figures and Tables

Figure 1. Cone-beam computed tomography (CBCT) orientation. (A) Frankfort horizontal (FH) plane constructed from the right porion and two orbitales on both sides. (B) Construction of temporomandibular joint (TMJ) slices using Dolphin software. The axis lines are perpendicular to the center of the condyles.

Figure 2. Landmarks and measurements in cone-beam computed tomography (CBCT) images. (A) Sagittal CBCT image at the greatest anteroposterior condylar head. (B) Coronal CBCT image at the greatest mediolateral condylar head. The abbreviations are as follows: AC, anterior condyle; AE, articular eminence; AF, anterior fossa; AH, anterior head; APT, anteroposterior thickness; ArS, articular slope; AS, anterior space; CF, central fossa; CS, central space; LC, lateral condyle; LF, lateral fossa; LH, lateral head; LS, lateral space; MC, medial condyle; MF, medial fossa; MH, medial head; MLT, mediolateral thickness; MS, medial space; PC, posterior condyle; PF, posterior fossa; PH, posterior head; PS, posterior space; SC, superior condyle; SF, superior fossa; SS, superior space; VHF, vertical height of fossa. AS, PS, MS, and LS were drawn at an angle of 90° from the tangent lines extending from SF and CF, respectively [4,13].

Table 1

Sample distribution (Number).

Variables			Gender		Age			Race
		Total	M	F	Early	Middle	Late	Caucasian	Non-Caucasian
					20 ≤ y < 30	30 ≤ y < 40	40 ≤ y
Gender	Male	135	64		29	15	20	27	37
	Female			71	22	25	24	26	45
Age	Early	51	29	22				18	33
	Middle	40	15	25				15	25
	Late	44	20	24				20	24
Race	Caucasian	53	27	26	33	25	24
	Non-Caucasian	82	37	45	18	15	20
SN-MP	Hypodivergent	35	25	10	15	7	13	17	18
	Normovergent	67	30	37	25	22	20	28	39
	Hyperdivergent	33	9	24	11	11	11	8	25
ANB	Class III	33	22	11	16	8	11	12	21
	Class I	53	24	29	24	17	12	25	28
	Class II	49	18	31	13	15	21	16	33
Total (each)			135		51	40	44	53	82
Variables			SN-MP				ANB
		Total	Hypodivergent		Normovergent	Hyperdivergent	Class III	Class I	Class II
			SN-MP < 29°		29° ≤ SN-MP ≤ 36°	SN-MP > 36°	ANB < 1°	1° ≤ ANB ≤ 4°	ANB > 4°
Gender	Male	135	25		30	9	22	24	18
	Female		10		37	24	11	29	31
Age	Early	51	15		25	11	14	24	13
	Middle	40	7		22	11	8	17	15
	Late	44	13		20	11	11	12	21
Race	Caucasian	53	17		28	8	12	25	16
	Non-Caucasian	82	18		39	25	21	28	33
SN-MP	Hypodivergent	35					13	18	4
	Normovergent	67					16	29	22
	Hyperdivergent	33					4	6	23
ANB	Class III	33	13		16	4
	Class I	53	18		29	6
	Class II	49	4		22	23
Total (each)			35		67	33	33	53	49

SN-MP: Angle between sella-nasion and mandibular plane. ANB: Angle between nasion-point A and nasion-point B.

Table 2

Average values of temporomandibular joint spaces and condylar dimensions categorized by gender, age, race, and the side of the condyle.

		Means (Standard Deviations) and p-Values
		Total (n = 135)		Ratio	SD	Male (n = 64)		SD	Female (n = 71)	SD	p-Value/Effect Size
Sagittal view	AS (mm)	2.21 A		1.00	0.62	2.40 A		0.67	2.05 A	0.51	<0.001 (0.002) **/η2 = 0.02
	SS (mm)	3.38 B		1.61	0.88	3.69 B		0.90	3.10 B	0.77	<0.001 ***/η2 = 0.03
	PS (mm)	2.46 A		1.18	0.71	2.59 A		0.72	2.34 A	0.69	0.044 (0.035) */η2 = 0.008
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.61		<0.001 (<0.001) ***/KW = 0.48			<0.001 (<0.001) ***/KW = 0.44
	ArS (°)	50.04		17.42	8.54	51.54		8.22	48.69	8.65	0.053/η2 = 0.008
	VHF (mm)	7.30		2.55	1.27	7.73		1.26	6.91	1.16	<0.001 ***/η2 = 0.02
	APT (mm)	8.65		3.05	1.07	8.68		1.17	8.63	0.97	0.784/η2 = 0.0004
Coronal view	MS (mm)	3.05 A		1.00	0.85	3.24 A		0.84	2.88 A	0.83	0.014 (<0.001) ***/η2 = 0.03
	CS (mm)	3.39 B		1.15	0.88	3.71 B		0.92	3.11 B	0.74	<0.001 (<0.001) ***/η2 = 0.03
	LS (mm)	2.30 C		0.79	0.71	2.51 C		0.84	2.12 C	0.52	<0.001 (0.009) **/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.78		<0.001 (<0.001) ***/KW = 0.44			<0.001 (<0.001) ***/KW = 0.48
	MLT (mm)	19.27			2.32	20.56		2.11	18.10	1.85	<0.001 ***/η2 = 0.07
		Means (standard deviations) and p-values
		Total (n = 135)		Early 20 ≤ y < 30 (n = 51)	SD	Middle 30 ≤ y < 40 (n = 40)		SD	Late 40 ≤ y (n = 44)	SD	p-value/Effect Size
Sagittal view	AS (mm)	2.21 A		2.22 A	0.57	2.22 A		0.64	2.20 A	0.66	0.99/η2 = 0.01
	SS (mm)	3.38 B		3.22 B	0.77	3.44 B		0.94	3.51 B	0.93	0.23/η2 = 0.01
	PS (mm)	2.46 A		2.38 A	0.63	2.55 A		0.92	2.46 A	0.57	0.568/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.38		<0.001 (<0.001) ***/KW = 0.47			<0.001 (<0.001) ***/KW = 0.55
	ArS (°)	50.04		49.54	8.85	49.72		6.77	50.90	9.66	0.75/η2 = 0.01
	VHF (mm)	7.30		7.61	1.28	7.14		1.28	7.08	1.21	0.089/η2 = 0.03
	APT (mm)	8.65		8.46 a	0.96	8.44 a		1.07	9.06 b	1.09	0.01 */η2 = 0.05
Coronal view	MS (mm)	3.05 A		3.02 A	0.64	3.04 A		1.08	3.09 A	0.85	0.874/η2 = 0.01
	CS (mm)	3.39 B		3.22 A	0.72	3.46 A		0.96	3.53 B	0.95	0.161/η2 = 0.001
	LS (mm)	2.30 C		2.28 B	0.66	2.20 B		0.61	2.43 C	0.84	0.354/η2 = 0.004
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.44		<0.001 (<0.001) ***/KW = 0.55			<0.001 (<0.001) ***/KW = 0.43
	MLT (mm)	19.27		19.51	2.51	18.76		2.19	19.44	2.20	0.247/η2 = 0.01
		Means (standard deviations) and p-values
		Caucasian (n = 53)	SD	Non-Caucasian (n = 82)	SD	p-value/Effect Size	Right (n = 135)	SD	Left (n = 135)	SD	p-value/Effect Size
Sagittal view	AS (mm)	2.19 A	0.55	2.23 A	0.65	0.723 (0.905)	2.30 A	0.70	2.13 A	0.79	0.018 (<0.001) ***/η2 = 0.09
	SS (mm)	3.48 B	0.89	3.31 B	0.88	0.285	3.36 B	0.97	3.40 B	0.93	0.456 (0.480)/η2 = 0.004
	PS (mm)	2.35 A	0.55	2.53 A	0.79	0.151 (0.268)	2.35 A	0.78	2.52 C	0.79	0.006 **/η2 = 0.05
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.55		<0.001 (<0.001) ***/KW = 0.41			<0.001 (<0.001) ***/KW = 0.41		<0.001 (<0.001) ***/KW = 0.46
	ArS (°)	52.56	8.69	48.41	8.07	0.005	49.52	8.47	50.56	10.39	0.143/η2 = 0.01
	VHF (mm)	7.50	1.19	7.17	1.31	0.146	7.35	1.35	7.25	1.38	0.278/η2 = 0.01
	APT (mm)	8.49	0.93	8.75	1.14	0.168	8.71	1.23	8.60	1.09	0.221 (0.233)/η2 = 0.01
Coronal view	MS (mm)	2.97 A	0.70	3.10 A	0.94	0.42 (0.538)	3.04 A,B	0.98	3.06	0.93	0.79/η2 = 0.0001
	CS (mm)	3.49 B	0.86	3.33 B	0.89	0.305 (0.233)	3.29 A	0.96	3.50	0.97	0.002 (0.004) **/η2 = 0.06
	LS (mm)	2.34 C	0.79	2.28 C	0.66	0.641 (0.860)	2.17 B	0.74	2.46	0.91	<0.001 (<0.001) ***/η2 = 0.11
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.47		<0.001 (<0.001) ***/KW = 0.66			0.054 (0.019) */KW = 0.42		0.164 (0.479)/KW = 0.33
	MLT (mm)	19.38	2.21	19.19	2.41	0.646	19.28	2.37	19.26	2.51	0.877 (0.770)/η2 = 0.001

SD = standard deviation; AS = anterior space; SS = superior space; PS = posterior space; ArS = articular slope; VHF = vertical height of fossa; APT = anteroposterior thickness; MS = medial space; CS = central space; LS = lateral space; MLT = mediolateral thickness; η² = eta-squared; KW = Kendall’s W. For between-subject comparisons (rows), p-values for Welch’s test for unequal sample sizes and failure to meet the homogeneity of variances assumption are reported. For the measurements in which the main effect of the categorical variables was significant, Tukey’s HSD tests were conducted to identify homogenous subsets. The same lowercase superscript associated with the measurements means that the two groups were not significantly different. Different superscripts (e.g., a and b) indicate a significant difference, p < 0.05. For within-subject comparisons (columns), sagittal (AS, SS, and PS) and coronal (MS, CS, and LS) temporomandibular joint spaces were evaluated. Repeated-measures ANOVAs were used, and the Greenhouse–Geisser adjustment was reported if the assumption of sphericity was violated. The p-value for the Freidman test is also reported parenthetically in each case because dependent variables often fail to meet normality assumptions. A Bonferroni correction was applied to significance tests, and the same uppercase superscript associated with the measurements means that the two groups were not significantly different. Different superscripts (e.g., A, B, C) indicate a significant difference, p < 0.05. * p < 0.05, ** p < 0.01, *** p < 0.001.

Table 3

Average values of temporomandibular joint spaces and condylar dimensions in relation to vertical (SN-MP) and horizontal (ANB) skeletal patterns.

		Means (Standard Deviations) and p-Values
		Total (n = 135)	SD	Hypodivergent	SD	Normovergent	SD	Hyperdivergent	SD	p-Value/Effect Size
				SN-MP < 29° (n = 35)		29° ≤ SN-MP ≤ 36° (n = 67)		SN-MP > 36° (n = 33)
Sagittal view	AS (mm)	2.21 A	0.62	2.25 A	0.59	2.22 A	0.68	2.15 A	0.50	0.723/η2 = 0.01
	SS (mm)	3.38 B	0.88	3.70 a,B	1.03	3.39 a,b,B	0.73	3.02 b,B	0.88	0.018 */η2 = 0.05
	PS (mm)	2.46 A	0.71	2.44 A	0.78	2.49 C	0.64	2.40 A	0.79	0.834/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.65		<0.001 (<0.001) ***/KW = 0.52		<0.001 (<0.001) ***/KW = 0.21
	ArS (°)	50.04	8.54	51.11	7.42	50.53	9.20	47.91	8.10	0.212/η2 = 0.001
	VHF (mm)	7.30	1.27	7.54	1.23	7.28	1.34	7.09	1.15	0.294/η2 = 0.006
	APT (mm)	8.65	1.07	8.79	1.30	8.64	0.99	8.53	0.96	0.642/η2 = 0.006
Coronal view	MS (mm)	3.05 A	0.85	3.31 A	0.80	3.00 A	0.82	2.86 A	0.93	0.076/η2 = 0.03
	CS (mm)	3.39 B	0.88	3.70 a,A	1.03	3.36 a,b,B	0.75	3.12 b,A	0.87	0.048 */η2 = 0.03
	LS (mm)	2.30 C	0.71	2.40 B	0.85	2.30 C	0.73	2.20 B	0.48	0.469/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.56		<0.001 (<0.001) ***/KW = 0.45		<0.001 (<0.001) ***/KW = 0.39
	MLT (mm)	19.27	2.32	20.66 a	2.27	19.11 b	2.10	18.09 b	2.11	<0.001 ***/η2 = 0.14
		Means (standard deviations) and p-values
		Total (n = 135)		Class III	SD	Class I	SD	Class II	SD	p-value/Effect Size
				ANB < 1° (n = 33)		1° ≤ ANB ≤ 4° (n = 53)		ANB > 4° (n = 49)
Sagittal view	AS (mm)	2.21 A		2.23 A	0.60	2.18 A	0.50	2.25 A	0.73	0.833/η2 = 0.01
	SS (mm)	3.38 B		3.36 B	1.15	3.38 B	0.72	3.39 B	0.86	0.991/η2 = 0.01
	PS (mm)	2.46 A		2.43 A	0.84	2.38 A	0.66	2.56 A	0.67	0.396/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.35		<0.001 (<0.001) ***/KW = 0.63		<0.001 (<0.001) ***/KW = 0.37
	ArS (°)	50.04		47.71	9.99	50.27	7.67	51.35	8.22	0.231/η2 = 0.001
	VHF (mm)	7.30		7.17	1.37	7.44	1.22	7.23	1.26	0.582/η2 = 0.01
	APT (mm)	8.65		8.47	1.07	8.65	1.07	8.78	1.07	0.453/η2 = 0.008
Coronal view	MS (mm)	3.05 A		2.87 A	0.92	3.15 A	0.82	3.05 A	0.84	0.366/η2 = 0.005
	CS (mm)	3.39 B		3.37 B	1.13	3.37 A	0.71	3.43 B	0.88	0.916/η2 = 0.01
	LS (mm)	2.30 C		2.19 C	0.72	2.25 B	0.69	2.43 C	0.72	0.287/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.46		<0.001 (<0.001) ***/KW = 0.40		<0.001 (<0.001) ***/KW = 0.59		<0.001 (<0.001) ***/KW = 0.40	<0.001 (<0.001) ***/KW = 0.40
	MLT (mm)	19.27		19.79	2.58	19.33	2.17	18.85	2.27	0.228/η2 = 0.01

SD = standard deviation; AS = anterior space; SS = superior space; PS = posterior space; ArS = articular slope; VHF = vertical height of fossa; APT = anteroposterior thickness; MS = medial space; CS = central space; LS = lateral space; MLT = mediolateral thickness; η² = eta-squared; KW = Kendall’s W. For between-subject comparisons (rows), p-values for Welch’s test for unequal sample sizes and failure to meet the homogeneity of variances assumption are reported. For the measurements in which the main effect of the categorical variables was significant, Tukey’s HSD tests were conducted to identify homogenous subsets. The same lowercase superscript associated with the measurements means that the two groups were not significantly different. Different superscripts (e.g., a and b) indicate a significant difference, p < 0.05. For within-subject comparisons (columns), sagittal (AS, SS, and PS) and coronal (MS, CS, and LS) temporomandibular joint spaces were evaluated. Repeated-measures ANOVAs were used, and the Greenhous–Geisser adjustment was reported if the assumption of sphericity was violated. The p-value for the Freidman test is also reported parenthetically in each case because dependent variables often fail to meet normality assumptions. A Bonferroni correction was applied to significance tests, and the same uppercase superscript associated with the measurements means that the two groups were not significantly different. Different superscripts (e.g., A, B, C) indicate a significant difference, p < 0.05. * p < 0.05, *** p < 0.001.

Table 4

Average values of temporomandibular joint spaces and condylar dimensions based on vertical skeletal patterns (SN-MP) within each group of horizontal skeletal patterns (ANB).

		Means (Standard Deviations) and p-Values
		Class III ANB < 1° (n = 33)
		Hypodivergent	SD	Normodivergent	SD	Hyperdivergent	SD	p-Value/Effect Size
		SN-MP < 29°		29° ≤ SN-MP ≤ 36°		SN-MP > 36°
		(n = 13)		(n = 16)		(n = 4)
Sagittal view	AS (mm)	2.16 A	0.61	2.23 A	0.63	2.41	0.57	0.779/η2 = 0.01
	SS (mm)	3.77 B	1.41	3.25 B	0.84	2.48	0.83	0.153/η2 = 0.01
	PS (mm)	2.43 A	1.07	2.47 A,B	0.68	2.28	0.72	0.748/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.55		<0.001 (0.002) **/KW = 0.38		0.732 (0.165)/KW = 0.06
	ArS (°)	49.00	8.36	48.45	11.02	40.55	9.98	0.277/η2 = 0.004
	VHF (mm)	7.24	1.20	7.25	1.56	6.63	1.22	0.592/η2 = 0.01
	APT (mm)	8.88	1.05	8.27	0.97	7.96	1.35	0.141/η2 = 0.01
Coronal view	MS (mm)	3.31 A,B	1.01	2.63 A	0.80	2.44	0.48	0.083/η2 = 0.02
	CS (mm)	3.90 A	1.35	3.13 B	0.76	2.59	1.02	0.084/η2 = 0.02
	LS (mm)	2.40 B	1.02	2.04 A	0.43	2.11	0.42	0.848/η2 = 0.01
	p-value/Effect Size	<0.001 (0.004) **/KW = 0.43		<0.001 (<0.001) ***/KW = 0.57		0.544 (0.779)/KW = 0.06
	MLT (mm)	20.59	3.29	19.28	1.81	19.23	2.63	0.371/η2 = 0.004
		Means (standard deviations) and p-values
		Class I 1° ≤ ANB ≤ 4° (n = 53)
		Hypodivergent	SD	Normovergent	SD	Hyperdivergent	SD	p-value/Effect Size
		SN-MP < 29°		29° ≤ SN-MP ≤ 36°		SN-MP > 36°
		(n = 18)		(n = 29)		(n = 6)
Sagittal view	AS (mm)	2.31 A	0.60	2.04 A	0.44	2.41	0.25	0.109/η2 = 0.02
	SS (mm)	3.53 B	0.69	3.34 B	0.69	3.14	0.95	0.745/η2 = 0.01
	PS (mm)	2.33 A	0.55	2.42 A	0.55	2.33	1.34	0.329/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.68		<0.001 (<0.001) ***/KW = 0.68		0.213 (0.069)/KW = 0.44
	ArS (°)	51.24	6.82	49.87	8.46	49.33	6.88	0.892/η2 = 0.01
	VHF (mm)	7.61	1.33	7.20	1.09	8.09	1.40	0.278/η2 = 0.004
	APT (mm)	8.41	1.23	8.89	0.96	8.17	0.90	0.139/η2 = 0.01
Coronal view	MS (mm)	3.23 A	0.65	3.08 A	0.64	3.28 A,B	1.79	0.631/η2 = 0.01
	CS (mm)	3.37 A	0.56	3.39 A	0.72	3.24 A	1.08	0.834/η2 = 0.01
	LS (mm)	2.20 B	0.45	2.31 B	0.83	2.15 B	0.61	0.935/η2 = 0.01
	p-value/Effect Size	<0.001 (<0.001) ***/KW = 0.68		<0.001 (<0.001) ***/KW = 0.55		0.168 (0.030) */KW = 0.58
	MLT (mm)	20.63 a	1.54	18.99 a	2.17	17.07 b	1.16	<0.001 ***/η2 = 0.09
		Means (standard deviations) and p-values
		Class II ANB > 4° (n = 49)
		Hypodivergent	SD	Normodivergent	SD	Hyperdivergent	SD	p-value/Effect Size
		SN-MP < 29°		29° ≤ SN-MP ≤ 36°		SN-MP > 36°
		(n = 4)		(n = 22)		(n = 23)
Sagittal view	AS (mm)	2.25	0.54	2.46 A	0.90	2.04 A	0.51	0.225/η2 = 0.01
	SS (mm)	4.25 a	0.86	3.55 a,b,B	0.70	3.09 b,B	0.88	0.020 */η2 = 0.04
	PS (mm)	3.01	0.35	2.60 A	0.72	2.44 A,B	0.64	0.097/η2 = 0.02
	p-value/Effect Size	0.008 (0.097)/KW = 1.0		<0.001 (<0.001) ***/KW = 0.45		<0.001 (0.002) **/KW = 0.28
	ArS (°)	57.35	2.98	52.91	8.61	48.82	7.74	0.095/η2 = 0.02
	VHF (mm)	8.23	0.63	7.40	1.51	6.90	0.96	0.082/η2 = 0.02
	APT (mm)	10.20	1.65	8.58	0.99	8.72	0.88	0.085/η2 = 0.02
Coronal view	MS (mm)	3.73 A,B	0.71	3.18 A,B	0.97	2.82 A	0.64	0.107/η2 = 0.02
	CS (mm)	4.55 a,A	1.05	3.50 a,b,A	0.79	3.18 b,A	0.80	0.036 */η2 = 0.04
	LS (mm)	3.25 B	1.29	2.49 B	0.74	2.23 B	0.47	0.179/η2 = 0.01
	p-value/Effect Size	0.084 (0.039) */KW = 0.81		<0.001 (0.001) **/KW = 0.30		<0.001 (<0.001) ***/KW = 0.45
	MLT (mm)	21.05 a	1.26	19.15 a,b	2.27	18.17 b	2.17	0.042 */η2 = 0.03

SD = standard deviation; AS = anterior space; SS = superior space; PS = posterior space; ArS = articular slope; VHF = vertical height of fossa; APT = anteroposterior thickness; MS = medial space; CS = central space; LS = lateral space; MLT = mediolateral thickness; η² = eta-squared; KW = Kendall’s W. For between-subject comparisons (rows), p-values for Welch’s test for unequal sample sizes and failure to meet the homogeneity of variances assumption are reported. For the measurements in which the main effect of the categorical variables was significant, Tukey’s HSD tests were conducted to identify homogenous subsets. The same lowercase superscript associated with the measurements means that the two groups were not significantly different. Different superscripts (e.g., a and b) indicate a significant difference, p < 0.05. For within-subject comparisons (columns), sagittal (AS, SS, and PS) and coronal (MS, CS, and LS) temporomandibular joint spaces were evaluated. Repeated-measures ANOVAs were used, and the Greenhouse–Geisser adjustment was reported if the assumption of sphericity was violated. The p-value for the Freidman test is also reported parenthetically in each case because dependent variables often fail to meet normality assumptions. A Bonferroni correction was applied to significance tests, and the same uppercase superscript associated with the measurements means that the two groups were not significantly different. Different superscripts (e.g., A, B) indicate a significant difference, p < 0.05. * p < 0.05, ** p < 0.01, *** p < 0.001.

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