Risk factors for CBCT-defined condylar cortical blurring and regional osseous changes in temporomandibular disorders

Temporomandibular disorders (TMD) are commonly accompanied by adaptive or degenerative osseous alterations of the mandibular condyle, and parafunctional oral behaviors may contribute to abnormal joint loading. This retrospective cross-sectional study investigated the association between self-reported parafunctional activities and cone-beam computed tomography (CBCT)-defined condylar remodeling patterns in adults with TMD. Consecutive patients diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) between June 2023 and June 2024 were reviewed, and 102 individuals with complete clinical and imaging data were included. Parafunctional behaviors were assessed using a structured questionnaire adapted from the Oral Behaviors Checklist, focusing on unilateral chewing, tooth clenching, bruxism, and preference for hard foods. Bilateral CBCT images were reconstructed in multiplanar views, and osseous changes (including cortical blurring/vanishing, defects, flattening, sclerosis, osteophytes, and cystic degeneration) were recorded and localized by quadrant. Multivariable logistic regression was used to identify behavioral factors independently associated with specific radiographic phenotypes. Hard-food preference was independently associated with cortical blurring/vanishing and with changes involving the anterolateral and posterolateral condyle as well as the articular tubercle. Habitual unilateral chewing showed an inverse association with anteromedial condylar changes. Bruxism and clenching did not remain significant after adjustment. These findings suggest that specific parafunctional behaviors, particularly hard-food preference, are associated with distinct CBCT-detected condylar remodeling patterns in TMD and support behavioral assessment and counseling during clinical evaluation.