# 3D Comparative Evaluation of Condylar Morphology Between Chronic Areca Nut Chewers and Nonchewers: Protocol for a Case-Control Study

## TL;DR

This study will use 3D imaging to compare jaw joint shape differences between people who chew areca nut long-term and those who don't.

## Contribution

The study introduces 3D imaging to evaluate condylar morphology in chronic areca nut chewers, addressing limitations of 2D methods.

## Key findings

- Chronic areca nut chewing may cause structural changes like osteophytes and surface flattening in condylar morphology.
- 3D imaging could reveal more accurate and detailed alterations in TMJ structures compared to conventional 2D methods.
- Findings may improve diagnosis and management of TMJ disorders linked to areca nut consumption.

## Abstract

Areca nut (AN) is a commonly consumed psychoactive substance, especially in South and Southeast Asia. Chronic chewing of AN has been linked to multiple health problems, including temporomandibular joint (TMJ) disorders. Excessive strain on TMJ during chronic AN chewing can lead to repetitive injury, resulting in microtrauma and macrotrauma to both the TMJ and the surrounding masticatory structures. Previous studies have reported the long-term impact of AN chewing on TMJ by using conventional 2D imaging.

This study aims to evaluate and compare condylar morphology in chronic AN chewers and nonchewers by using 3D imaging.

This study will include 90 patients who will be divided into 2 groups: chronic AN chewers (n=45, 50%) and nonchewers (n=45, 50%). The study will be undertaken after obtaining institutional ethics committee approval and written informed consent from each patient. A detailed habit history of all the participants will be recorded. Each patient will undergo a clinical examination and radiographic evaluation of condylar morphology. Condylar morphology will be evaluated using cone beam computed tomography scans in both sagittal and coronal planes. All the findings will be recorded and then examined for statistical significance.

On comparison of condylar morphology between chronic AN chewers and nonchewers by using cone beam computed tomography, statistical variations relevant to structural and pathological alterations such as osteophytes, surface flattening, and erosions are likely to occur.

This study aims to overcome the limitations of conventional 2D radiography and provide a more accurate assessment of condylar morphology. The findings should fill an existing gap in the literature by providing useful insights on the effects of chronic AN chewing on condylar structure by using 3D imaging. This research may help to improve the diagnosis, prevention, and management of TMJ disorders.

Clinical Trials Registry-India CTRI/2025/06/088238; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTMzNzQz&Enc=&userName=

PRR1-10.2196/84038