{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T23:36:33Z","timestamp":1775172993434,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Objectives: To evaluate any changes in condylar and mandibular ramus height and dental malocclusion in adult patients with temporomandibular disorders (TMDs) diagnosed with DC\/TMD criteria after treatment with an upper occlusal splint. Methods: This retrospective observational study included 48 adult patients with TMDs treated with an occlusal splint in the upper arch for about 12 months. For each patient, panoramic dental X-rays were analyzed using the Habets method to calculate the asymmetry index between the condyles and mandibular branches before and after treatment. The digital dental models were also studied at T0 and T1 to define the occlusal sagittal molar relationship and the posterior dental crossbite. The statistical analysis was performed using the Shapiro\u2013Wilk normality tests, Student t-tests, or Wilcoxon tests using the R studio software (released version 4.3.3). Results: Condylar height showed a statistically significant difference (p = 0.022) and reduced condylar asymmetry between T0 and T1. The measurement of the condylar branch showed a statistical significance (p = 0.037), revealing an improvement of the mandibular symmetry in the vertical direction after treatment. Moreover, at T0, posterior dental crossbite was found in 37.5% of patients, specifically, bilateral in 12.5%, while unilateral crossbite in 22.9% on the right and 2.1% on the left side, and Class I malocclusion was found in the main part of the sample (72.9%). Conclusions: Patients with TMDs diagnosed according to DC\/TMD and treated with an upper stabilization occlusal splint in the case of symptoms of masticatory muscle dysfunction showed a symmetrization in the mandibular ramus and condyle pre- and post-treatment (T0-T1). At the same time, no clinical differences were found in the occlusal characteristics.<\/jats:p>","DOI":"10.3390\/dj13040176","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T20:15:06Z","timestamp":1745180106000},"page":"176","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mandibular Asymmetry Index and Dental Occlusion in Patients with Temporomandibular Disorders Treated with Occlusal Splint"],"prefix":"10.3390","volume":"13","author":[{"given":"Sergio","family":"Paduano","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaella","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Cagliari, Via Universit\u00e0 40, 09124 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludovica","family":"Nucci","sequence":"additional","affiliation":[{"name":"Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0790-892X","authenticated-orcid":false,"given":"Mario","family":"Fordellone","sequence":"additional","affiliation":[{"name":"Medical Statistics Unit, University of Campania Luigi Vanvitelli, Via Luciano Armanni 5, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1444-2788","authenticated-orcid":false,"given":"Rossana P.","family":"Rotolo","sequence":"additional","affiliation":[{"name":"Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi De Crecchio 6, 80138 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6671-2380","authenticated-orcid":false,"given":"Vincenzo","family":"Grassia","sequence":"additional","affiliation":[{"name":"Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi De Crecchio 6, 80138 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0291-9339","authenticated-orcid":false,"given":"Fabrizia","family":"d\u2019Apuzzo","sequence":"additional","affiliation":[{"name":"Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi De Crecchio 6, 80138 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1080\/08869634.2018.1444537","article-title":"Temporomandibular disorders and mandibular vertical asymmetry","volume":"37","author":"Vidal","year":"2019","journal-title":"Cranio\u00ae"},{"key":"ref_2","unstructured":"National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Care Services, Board on Health Sciences Policy, Committee on Temporomandibular Disorders (TMDs): From Research Discoveries to Clinical Treatment, Yost, O., Liverman, C.T., English, R., Mackey, S., and Bond, E.C. (2020). Temporomandibular Disorders: Priorities for Research and Care, National Academies Press (US)."},{"key":"ref_3","unstructured":"Okeson, J.P. (2019). Management of Temporomandibular Disorders and Occlusion, Mosby Elsevier. [8th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/joor.13687","article-title":"Evaluation of tinnitus in patients with Temporomandibular Disorders through Axis II of the Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD) and the Tinnitus Handicap Inventory (THI)","volume":"51","author":"Minervini","year":"2024","journal-title":"J. Oral Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1111\/joor.13470","article-title":"Protective masks during the SARS-CoV-2 pandemic: Any relationship with temporomandibular disorders and orofacial pain?","volume":"50","author":"Rotolo","year":"2023","journal-title":"J. Oral Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"116","DOI":"10.4103\/0975-5950.94463","article-title":"Etiological factors of temporomandibular joint disorders","volume":"2","author":"Sharma","year":"2011","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1046\/j.1365-2842.1998.00303.x","article-title":"The effect of parafunction on condylar asymmetry in patients with temporomandibular disorders","volume":"25","author":"Miller","year":"1998","journal-title":"J. Oral Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., Paj\u0105k-Zieli\u0144ska, B., and Ginszt, M. (2024). A Meta-Analysis of the Global Prevalence of Temporomandibular Disorders. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051365"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2522\/ptj.20140548","article-title":"Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis","volume":"96","author":"Pitance","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11607\/jop.1151","article-title":"Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD) for Clinical and Research Applications: Recommendations of the International RDC\/TMD Consortium Network and Orofacial Pain Special Interest Group","volume":"28","author":"Schiffman","year":"2014","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"847","DOI":"10.14219\/jada.archive.2012.0289","article-title":"The effectiveness of splint therapy in patients with temporomandibular disorders: A systematic review and meta-analysis","volume":"143","author":"Ebrahim","year":"2012","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_12","first-page":"378","article-title":"Diagnosis and treatment of temporomandibular disorders","volume":"91","author":"Gauer","year":"2015","journal-title":"Am. Fam. Physic."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/08869634.2017.1389506","article-title":"Management of pain in TMD patients: Bio-oxidative ozone therapy versus occlusal splints","volume":"37","author":"Celakil","year":"2019","journal-title":"Cranio\u00ae"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.sdentj.2022.12.013","article-title":"Occlusal splints-types and effectiveness in temporomandibular disorder management","volume":"35","author":"Albagieh","year":"2023","journal-title":"Saudi Dent. J."},{"key":"ref_15","unstructured":"deLeeuw, R., and Klasser, G.D. (2018). Differential Diagnosis and Management of TMDs. Orofacial Pain: Guidelines, Assessment, Diagnosis, and Management, Quintessence Publishing. [6th ed.]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.bjoms.2020.08.068","article-title":"Outcomes of physical therapy in patients with temporomandibular disorder: A retrospective review","volume":"59","author":"Fisch","year":"2021","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_17","first-page":"CD012850","article-title":"Occlusal interventions for managing temporomandibular disorders","volume":"9","author":"Singh","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/07345410.1983.11677832","article-title":"Evaluation of occlusal splint therapy","volume":"1","author":"Okeson","year":"1983","journal-title":"J. Craniomandib. Pr."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Gibreel, M., Perea-Lowery, L., Vallittu, P.K., and Lassila, L. (2021). Characterization of occlusal splint materials: CAD-CAM versus conventional resins. J. Mech. Behav. Biomed. Mater., 124.","DOI":"10.1016\/j.jmbbm.2021.104813"},{"key":"ref_20","first-page":"536","article-title":"The efficacy of bilateral balanced and canine guidance occlusal splints in the treatment of temporomandibular joint disorder","volume":"13","author":"Alammari","year":"2014","journal-title":"Oral Health Dent. Manag."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/j.1365-2842.2012.02327.x","article-title":"Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: A short-term evaluation","volume":"39","author":"Conti","year":"2012","journal-title":"J. Oral Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6122","DOI":"10.21037\/apm-21-451","article-title":"Effectiveness of exercise therapy versus occlusal splint therapy for the treatment of painful temporomandibular disorders: A systematic review and meta-analysis","volume":"10","author":"Zhang","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5005\/jcdp-5-3-59","article-title":"Condylar Asymmetry Measurements in Patients with Temporomandibular Disorders","volume":"5","year":"2004","journal-title":"J. Contemp. Dent. Pr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/ejo\/cji073","article-title":"Temporomandibular joint internal derangement in mandibular asymmetry. What is the relationship?","volume":"28","author":"Buranastidporn","year":"2006","journal-title":"Eur. J. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/j.1365-2842.1987.tb00742.x","article-title":"The orthopantomogram, an aid in diagnosis of temporomandibular joint problems. I. The factor of vertical magnification","volume":"14","author":"Habets","year":"1987","journal-title":"J. Oral Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/j.1365-2842.1988.tb00182.x","article-title":"The Orthopantomogram, an aid in diagnosis of temporomandibular joint problems II. The vertical symmetry","volume":"15","author":"Habets","year":"1988","journal-title":"J. Oral Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/j.1365-2842.1989.tb01340.x","article-title":"The Recognition of Craniomandibular Disorders; Condylar Symmetry in Relation to Myogenous and Arthrogenous Origin of Pain","volume":"16","author":"Bezuur","year":"1989","journal-title":"J. Oral Rehabil."},{"key":"ref_28","unstructured":"Proffit, W.R., Fields, H., Larson, B., and Sarver, D.M. (2018). Contemporary Orthodontics, Elsevier. [6th ed.]."},{"key":"ref_29","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Routledge. [2nd ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jcms.2018.12.012","article-title":"Investigating possible correlation between condylar asymmetry and clinical dysfunction indices in patients with temporomandibular dysfunction using Cone-beam computed tomographic","volume":"47","author":"Khojastepour","year":"2018","journal-title":"J. Cranio-Maxillofacial Surg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tortarolo, A., Rotolo, R., Nucci, L., Tepedino, M., Crincoli, V., and Piancino, M.G. (2022). Condylar Asymmetry in Children with Unilateral Posterior Crossbite Malocclusion: A Comparative Cross-Sectional Study. Children, 9.","DOI":"10.3390\/children9111772"},{"key":"ref_32","first-page":"e852","article-title":"Association between condylar asymmetry and temporo- mandibular disorders using 3D-CT","volume":"17","year":"2012","journal-title":"Med. Oral Patol. Oral Y Cirugia Bucal"},{"key":"ref_33","first-page":"E141","article-title":"The temporomandibular opening index and condylar asymmetry in myogenous TMD and non-TMD patients: Report of a pilot study","volume":"44","author":"Karic","year":"2013","journal-title":"Quintessence Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1179\/crn.2013.31.4.005","article-title":"Temporomandibular Dysfunction: Internal Derangement Associated with Facial and\/or Mandibular Asymmetry","volume":"31","author":"Maglione","year":"2013","journal-title":"Cranio\u00ae"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1046\/j.1365-2842.2003.01089.x","article-title":"The condylar asymmetry measurements in different skeletal patterns","volume":"30","year":"2003","journal-title":"J. Oral Rehabil."},{"key":"ref_36","first-page":"813","article-title":"Clinical Practice Guideline: Condylar Hyperplasia of the Mandible\u2014Diagnosis and Treatment","volume":"121","author":"Riechmann","year":"2024","journal-title":"Dtsch Arztebl Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/cre2.53","article-title":"Occlusal features and need for orthodontic treatment in persons with osteogenesis imperfecta","volume":"3","author":"Nguyen","year":"2017","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Piancino, M.G., Rotolo, R., Cannavale, R., Cuomo, G., Masini, F., Dalmasso, P., D\u2019apuzzo, F., Perillo, L., and Nucci, L. (2023). Cranial structure and condylar asymmetry of adult patients with rheumatoid arthritis. BMC Oral Health, 23.","DOI":"10.1186\/s12903-023-03001-2"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1111\/joor.13529","article-title":"Comparison between ultrasound and magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: A systematic review","volume":"50","author":"Rotolo","year":"2023","journal-title":"J. Oral Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G., and Gawda, P. (2024). Analysis of the Use of Sample Size and Effect Size Calculations in a Temporomandibular Disorders Randomised Controlled Trial\u2014Short Narrative Review. J. Pers. Med., 14.","DOI":"10.3390\/jpm14060655"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e076227","DOI":"10.1136\/bmj-2023-076227","article-title":"Management of chronic pain associated with temporomandibular disorders: A clinical practice guideline","volume":"383","author":"Busse","year":"2023","journal-title":"BMJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1002\/ejp.755","article-title":"Temporomandibular pain and jaw dysfunction at different ages covering the lifespan\u2014A population based study","volume":"20","author":"Visscher","year":"2016","journal-title":"Eur. J. Pain"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jab.2016.10.002","article-title":"Examining the temporo-mandibular joint from a biotensegrity perspective: A change in thinking","volume":"15","author":"Scarr","year":"2017","journal-title":"J. Appl. Biomed."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/4\/176\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:18:09Z","timestamp":1760030289000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/4\/176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,20]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["dj13040176"],"URL":"https:\/\/doi.org\/10.3390\/dj13040176","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,20]]}}}