The Influence of Pediatric Dental Trauma on Temporomandibular Joint Disorders: A Retrospective Clinical and Radiological Analysis

Plain-language summary

This retrospective study received ethical approval from the Ethics Committee of Dicle University Faculty of Medicine, Diyarbakır, Turkey (Decision No:03.05.2012-567). A priori power analysis (Cohen's d = 0.5, α = 0.05, 80% power) indicated that a minimum of 33 participants was required to achieve statistical reliability. Group 1 (Study Group) included 42 pediatric patients (17 females, 25 males; mean age: 12.54 ± 1.74 years) who experienced complicated crown-root fractures due to dental trauma between 2008 and 2023. All presented within one month of trauma, ensuring diagnostic uniformity. Group 2 (Control Group) included 25 orthodontic patients (9 females, 16 males; mean age: 12.60 ± 1.04 years) with Class I malocclusion and no TMJ (Temporomandibular Joint)-related symptoms. Controls were selected from orthodontic records based on skeletal harmony and availability of pre-treatment CBCT (Cone Beam Computerized Tomography) scans. In the study group, CBCT was utilized for diagnostic purposes to evaluate post-traumatic TMJ changes, as conventional imaging may not reveal subtle or asymptomatic alterations, particularly in growing children. CBCT scans in the control group were retrospectively analyzed from orthodontic records. These scans had been acquired prior to orthodontic treatment planning in accordance with standard clinical indications. In both groups, no additional radiation exposure was introduced for research purposes. Imaging followed the ALADA ( As Low As Diagnostically Acceptable) principle to balance diagnostic efficacy and radiation safety. Parental informed consent was obtained at the time of initial treatment. Data were extracted from standardized clinical and radiological records. All patients in Group 1 were evaluated and treated by a single clinician; likewise, control group patients were examined by a single orthodontist to maintain procedural consistency. All subjects underwent comprehensive clinical and CBCT-based assessments. TMJ pain was evaluated through palpation and mandibular movement (opening and closing). A four-point ordinal scale was used: No Pain, Mild, Moderate, Severe. Pain location was classified as: No Pain, Right TMJ, Left TMJ, or Bilateral. This classification supported both qualitative and quantitative assessment of TMJ symptom distribution. All CBCT scans were performed using an ICAT 3D system (Model 17-19, Imaging Sciences International, Hatfield, PA) with a 360° rotation, 120 kV, 5.0 mA, 9.6 s scan duration, and a voxel resolution of 0.3 mm. Images were analyzed using I-CAT software. The Ikeda and Kawamura (2009) method was used to measure anterior, superior, and posterior joint spaces between the condyle and glenoid fossa. The True Horizontal Line (THL) served as a reproducible reference plane. Measurements were performed with the mandible in a closed rest position. Non-parametric Mann-Whitney U tests were used for intergroup comparisons of joint space dimensions. Chi-square tests were used for categorical pain scores. A significance threshold of p ≤ 0.05 was set. Statistical analyses were performed using SPSS v21.0 (IBM Corp., Armonk, NY, USA).

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