Three-dimensional spatiotemporal analysis of condylar remodeling after conservative treatment of pediatric mandibular condylar sagittal fractures.

OBJECTIVE

This study investigated condylar remodeling and the role of the temporomandibular joint (TMJ) disc in growing patients with sagittal fractures of the mandibular condyle (SFMC) treated conservatively.

MATERIALS AND

METHODS

A retrospective analysis was performed on 28 children with 43 SFMC joints, using three-dimensional models reconstructed from computed tomography (CT) and magnetic resonance imaging (MRI) obtained before treatment and at 3, 6, and 12 months after treatment. All included patients underwent closed treatment consisting of full-arch soft occlusal splints and adjunctive mouth-opening exercises. To evaluate condylar remodeling and its relationship with the articular disc, multimodal image registration was applied to fuse CT and MRI datasets.

RESULTS

The results demonstrated a significant decrease in condylar volume from pre-treatment to 3 months post-treatment (Phase P1, P = 0.009). No significant change was observed between 3 and 6 months (Phase P2, P = 0.977), followed by a significant increase from 6 months to 1 year (Phase P3, P = 0.009). Bone formation predominantly occurred in regions covered by the articular disc, with significant differences in root mean square (RMS) values between disc-covered and non-disc-covered areas (P = 0.024).

CONCLUSIONS

These findings indicate that condylar remodeling is highly active, characterized by early resorption followed by delayed bone formation following conservative treatment of pediatric SFMC and that the TMJ disc plays a critical role in this process.

CLINICAL RELEVANCE: Highlighting the critical role of the TMJ disc in guiding favorable bone formation, this study suggests that conservative strategies aimed at functional rehabilitation and disc preservation are vital for optimizing long-term condylar remodeling in pediatric patients.