{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:52:05Z","timestamp":1792158725929,"version":"4.4.0"},"reference-count":33,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,8,26]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The review involves the assessment of morphological variations in the temporomandibular joint (TMJ) and its associated structures in patients with temporomandibular disorder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Temporomandibular disorders (TMD) are debilitating conditions that affect the TMJ complex, surrounding musculature and osseous components. Studies have reported that TMD result from morphological alterations in TMJ. These alterations can be efficiently studied using three-dimensional imaging. This review will summarise the morphological changes in TMJ and associated structures based on studies with three-dimensional imaging in patients with TMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Inclusion criteria<\/jats:title>\n                    <jats:p>The systematic review will include studies with adult subjects with any one symptom of TMD and those studies that assessed TMJ morphology using three-dimensional imaging like CT, cone beam CT, MRI or arthrography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic searches for relevant studies will be carried out in multiple databases. Sources will include MEDLINE, Scopus, Dentistry and Oral Sciences Source, Cochrane CENTRAL, CINAHL, Web of Science, ProQuest Dissertation and Thesis and Google Scholar. The databases will be searched from inception to November 2023. Analytical observational studies comprising retrospective and prospective cohort studies, case\u2013control studies and analytical cross-sectional studies will be selected and critical appraisal will be performed. No restrictions will be imposed on the date and country of publication. Joanna Briggs Institute (JBI) guidelines for systematic effectiveness reviews will be followed for data appraisal, extraction and synthesis. The strength of evidence will be graded using the Grading of Recommendations, Assessment, Development and Evaluation method and the summary of findings will be created using GRADEpro software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not applicable for this study since this involves analysis of secondary data. Results will be disseminated through peer-reviewed publications and cnference presentations. A comprehensive summary of morphological alterations in TMJ is essential for assessing risk factors, accurate diagnosis, treatment planning and will collectively contribute to enhanced clinical care and overall patient well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>The protocol is registered in PROSPERO: CRD42023448882.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082396","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T01:27:44Z","timestamp":1726450064000},"page":"e082396","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Morphological changes in temporomandibular joint architecture in patients with temporomandibular disorders: systematic review protocol"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4171-8129","authenticated-orcid":false,"given":"Sarika","family":"Kadekuzhi","sequence":"first","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5358-4391","authenticated-orcid":false,"given":"Vineetha","family":"Karuveettil","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"},{"name":"Amrita Centre for Evidence Based Oral Health: A JBI Centre of Excellence, Kochi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul D","family":"Prabha","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajith","family":"Vallikat Velath","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sapna Varma","family":"N K","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvathy","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangeeth","family":"Suresh","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"2025121510271847000_14.9.e082396.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sult.2007.02.002"},{"key":"2025121510271847000_14.9.e082396.2","unstructured":"JP O . Management of temporomandibular disorders and occlusion. 8th edn. Elsevier Health Sciences, 2019."},{"key":"2025121510271847000_14.9.e082396.3","unstructured":"Gray\u2019s Anatomy,38th edition, Churchill Livingstone. 2000;578\u201382."},{"key":"2025121510271847000_14.9.e082396.4","doi-asserted-by":"publisher","DOI":"10.1177\/0022034516653743"},{"key":"2025121510271847000_14.9.e082396.5","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.11607\/ofph.1917","article-title":"Prevalence of Temporomandibular Disorders in Rheumatoid Arthritis and Associated Risk Factors: a Nationwide Study in Taiwan","volume":"31","author":"Lin","year":"2017","journal-title":"J Oral Facial Pain Headache"},{"key":"2025121510271847000_14.9.e082396.6","doi-asserted-by":"publisher","DOI":"10.1177\/0022034513488140"},{"key":"2025121510271847000_14.9.e082396.7","first-page":"E292","article-title":"Review of temporomandibular joint pathology. Part I: classification, epidemiology and risk factors","volume":"12","author":"Poveda Roda","year":"2007","journal-title":"Med Oral Patol Oral Cir Bucal"},{"key":"2025121510271847000_14.9.e082396.8","doi-asserted-by":"publisher","DOI":"10.11607\/jop.1151"},{"key":"2025121510271847000_14.9.e082396.9","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1111\/joor.13446","article-title":"Prevalence of temporomandibular disorders in children and adolescents evaluated with Diagnostic Criteria for Temporomandibular Disorders: a systematic review with meta\u2010analysis","volume":"50","author":"Minervini","year":"2023","journal-title":"J Oral Rehab"},{"key":"2025121510271847000_14.9.e082396.10","first-page":"143","article-title":"Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based Study of Health in Pomerania","volume":"35","author":"Gesch","year":"2004","journal-title":"Quint Int"},{"key":"2025121510271847000_14.9.e082396.11","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1111\/j.1365-2842.2003.01187.x","article-title":"Symptoms and signs of temporomandibular disorders and oral parafunctions among Saudi children","volume":"30","author":"Farsi","year":"2003","journal-title":"J Oral Rehabil"},{"key":"2025121510271847000_14.9.e082396.12","doi-asserted-by":"publisher","DOI":"10.1259\/dmfr\/17815139"},{"key":"2025121510271847000_14.9.e082396.13","doi-asserted-by":"crossref","first-page":"338","DOI":"10.4103\/1735-3327.294334","article-title":"Association of temporomandibular joint morphology in patients with and without temporomandibular joint dysfunction: a cone-beam computed tomography based study","volume":"17","author":"Choudhary","year":"2020","journal-title":"Dent Res J (Isfahan)"},{"key":"2025121510271847000_14.9.e082396.14","doi-asserted-by":"crossref","DOI":"10.1259\/dmfr\/90929410","article-title":"Relationship between the thickness of the roof of glenoid fossa, condyle morphology and remaining teeth in asymptomatic European patients based on cone beam CT data sets","volume":"42","author":"Ejima","year":"2013","journal-title":"Dentomaxillofac Radiol"},{"key":"2025121510271847000_14.9.e082396.15","unstructured":"Oliveira-Santos C , Bernardo RT , Capelozza A . Mandibular condyle morphology on panoramic radiographs of asymptomatic temporomandibular joints. Int J Dent 2009. Available: https:\/\/www.semanticscholar.org\/paper\/Mandibular-condyle-morphology-on-panoramic-of-Oliveira-Santos-Bernardo\/dccd13f489ac15297b64bcb5de099c61389fe1fa"},{"key":"2025121510271847000_14.9.e082396.16","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(66)90238-6"},{"key":"2025121510271847000_14.9.e082396.17","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1590\/S1806-83242010000400016","article-title":"Assessment of simulated mandibular condyle bone lesions by cone beam computed tomography","volume":"24","author":"Marques","year":"2010","journal-title":"Braz Oral Res"},{"key":"2025121510271847000_14.9.e082396.18","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4067\/S0718-381X2015000100010","article-title":"Shape and Symmetry of Human Condyle and Mandibular Fossa","volume":"9","author":"Ribeiro","year":"2015","journal-title":"Int J Odontostomat"},{"key":"2025121510271847000_14.9.e082396.19","doi-asserted-by":"publisher","DOI":"10.1590\/S1806-83242007000300013"},{"key":"2025121510271847000_14.9.e082396.20","doi-asserted-by":"publisher","DOI":"10.1053\/joms.2001.25015"},{"key":"2025121510271847000_14.9.e082396.21","first-page":"280","article-title":"Imaging modalities for temporomandibular joint disorders: an update","volume":"91","author":"Talmaceanu","year":"2018","journal-title":"Cluj Med"},{"key":"2025121510271847000_14.9.e082396.22","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.14219\/jada.archive.2007.0351","article-title":"Condylar and disk position and signs and symptoms of temporomandibular disorders in stress-free subjects","volume":"138","author":"Vasconcelos Filho","year":"2007","journal-title":"J Am Dent Assoc"},{"key":"2025121510271847000_14.9.e082396.23","doi-asserted-by":"publisher","DOI":"10.1067\/mod.2002.120641"},{"key":"2025121510271847000_14.9.e082396.24","doi-asserted-by":"crossref","DOI":"10.1259\/dmfr.20140235","article-title":"Temporomandibular joint diagnostics using CBCT","volume":"44","author":"Larheim","year":"2015","journal-title":"Dentomaxillofac Radiol"},{"key":"2025121510271847000_14.9.e082396.25","unstructured":"Lisa Hopp CT . JBI Manual for Evidence Synthesis - JBI Global Wiki, 2024. Available: https:\/\/jbi-global-wiki.refined.site\/space\/MANUAL\/4688621\/Chapter+3%3A+Systematic+reviews+of+effectiveness"},{"key":"2025121510271847000_14.9.e082396.26","unstructured":"The BMJ . PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. 2023. Available: https:\/\/www.bmj.com\/content\/372\/bmj.n160"},{"key":"2025121510271847000_14.9.e082396.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"2025121510271847000_14.9.e082396.28","first-page":"634","article-title":"System for the Unified Management, Assessment, and Review of Information (SUMARI)","volume":"107","author":"Piper","year":"2019","journal-title":"j m l a"},{"key":"2025121510271847000_14.9.e082396.29","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000064"},{"key":"2025121510271847000_14.9.e082396.30","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000065"},{"key":"2025121510271847000_14.9.e082396.31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"2025121510271847000_14.9.e082396.32","doi-asserted-by":"crossref","first-page":"127","DOI":"10.17219\/dmp\/147514","article-title":"Degenerative changes of the mandibular condyle in relation to the temporomandibular joint space, gender and age: a multicenter CBCT study","volume":"60","author":"G\u00f6r\u00fcrg\u00f6z","year":"2023","journal-title":"Dent Med Probl"},{"key":"2025121510271847000_14.9.e082396.33","doi-asserted-by":"crossref","first-page":"67","DOI":"10.17219\/dmp\/112392","article-title":"Evaluation of osteoarthritic changes in the temporomandibular joint and their correlations with age: A retrospective CBCT study","volume":"57","author":"Ko\u00e7","year":"2020","journal-title":"Dent Med Probl"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-082396","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:27:27Z","timestamp":1765823247000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-082396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,13]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/bmjopen-2023-082396"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-082396","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}