Assessment of the Position and Height of the Mandibular Condyle in Different Skeletal Patterns Using CBCT

Objectives: This retrospective cone-beam computed tomography (CBCT)-based study investigated whether sagittal and vertical skeletal patterns are associated with differences in condylar morphology, spatial position, and ramus-condyle dimensions and explored the potential clinical implications of these variations in orthodontic assessment. Methods: CBCT images of 132 individuals meeting predefined inclusion criteria were selected from the departmental archive. Cephalograms were reconstructed and cephalometric analyses were performed. Individuals were categorized into three sagittal skeletal pattern groups and three vertical skeletal pattern groups. Condylar morphology was evaluated using the Yale classification, and condylar position was assessed according to Pullinger's method. Condylar and ramus heights were measured using the Habets method. Statistical analyses included Chi-square tests, one-way ANOVA, ANCOVA, and the Habets asymmetry index. Intra-observer reliability was assessed using Cohen's kappa and intraclass correlation coefficients. Results: Condylar height differed significantly across vertical skeletal patterns, with the highest values in hypodivergent and the lowest in hyperdivergent individuals (right p = 0.004, left p = 0.011). A significant association was found between condyle position and vertical skeletal pattern on the right side (p = 0.041), but not on the left side (p = 0.554). Individuals with a Class III sagittal skeletal pattern showed significantly greater condylar height asymmetry (Habets index) than Class I and Class II individuals; an unadjusted difference in right ramus height (p = 0.001) and left condyle height (p = 0.046) between Class III and Class II individuals did not remain significant after adjusting for the unequal sex distribution between these groups. Males showed significantly greater condylar and ramus height than females (all p < 0.001). No significant relationships were identified between condylar morphology or position and sagittal skeletal patterns. Conclusions: A possible association was observed between vertical skeletal pattern and condylar position on the right side, which requires confirmation given the number of comparisons performed and the absence of a corresponding left-side finding. The observed differences in ramus and condylar height among skeletal groups, including significantly greater condylar height asymmetry in Class III individuals and greater ramus height asymmetry in hyperdivergent individuals, suggest that mandibular structural characteristics may vary according to underlying skeletal configuration.