Qualitative Alterations of Mandibular Kinematics in Patients with Myogenous Temporomandibular Disorders: An Axiographic Study Using the Cadiax Diagnostic System

<b>Background</b>: Myogenous temporomandibular disorders (TMDs) typically present with pain but without obvious restriction of mandibular motion, making subtle dysfunctions difficult to detect clinically. In this study, we evaluated mandibular kinematics in myogenous TMDs using an electronic axiography system (Cadiax Diagnostic). The specific objective of this study was to evaluate whether patients with myogenous temporomandibular disorders exhibit qualitative abnormalities in mandibular movements that are not detectable using conventional clinical examination. <b>Methods</b>: Twenty-six patients with myogenous TMD (muscle pain without intra-articular disorders, diagnosed per DC/TMD) and 26 matched controls were examined. Clinical assessment (DC/TMD Axis I) measured mandibular range of motion and deviations. Instrumental recordings of maximal opening, protrusion, and laterotrusion were obtained with Cadiax 4. Quantitative (excursion ranges) and qualitative (movement symmetry and sagittal deviations) parameters were analyzed. Condylar position changes between the reference position and maximum intercuspation were evaluated (Condyle Position Measurement, CPM). Exact χ² or Fisher tests were applied with effect sizes (φ) and 95% confidence intervals (CI). <b>Results</b>: Maximal opening, lateral excursions, and protrusion ranges were statistically similar between groups (mean opening: 47.96 ± 6.5 mm in TMDs vs. 49.46 ± 5.4 mm in controls, <i>p</i> = 0.40; 95% CI of difference -1.8 to 4.8 mm). However, qualitative deviations were more frequent in TMD. Of note, 12/26 (46.2%) patients vs. 6/26 (23.1%) controls showed a ΔY deflection during protrusion (χ² = 3.06, <i>p</i> = 0.08; φ ≈ 0.24; difference = 23.1%, 95% CI -2.0-48.2%). Identical proportions (46.2% vs. 23.1%) showed a ΔY deflection upon opening (χ² = 3.06, <i>p</i> = 0.08). Inferior condylar shifts (distractions) on closing into intercuspation occurred only in the mTMD group: 5/26 (19.2%) left condyles vs. 0% (<i>p</i> ≈ 0.05; 95% CI diff 4.1-34.4%) and 2/26 (7.7%) right vs. 0% (<i>p</i> ≈ 0.49; 95% CI -2.5-17.9%). Condylar compressions (superior shifts) were similar between groups. In summary, roughly half of TMD patients exhibited lateral jaw deflections (ΔY) and exclusive condylar "distraction" on closure; upon comparison, these conditions were rare in controls. <b>Conclusions</b>: Despite normal mandibular range of motion, patients with myogenous TMDs exhibited qualitative abnormalities in jaw kinematics, including movement deflections, condylar asymmetries, and centric-intercuspal discrepancies. Axiographic analysis with Cadiax enabled detection of subtle functional changes not identifiable in routine examinations, underscoring its diagnostic value in early dysfunction and potential therapeutic planning. The detection of kinematic abnormalities could influence early diagnosis or treatment planning for myogenous TMDs.