Morphometric Analysis of the Mandibular Condyle and Ramus on Panoramic Radiographs: A Cross-Sectional Study in Hail, Saudi Arabia

Introduction: The mandibular condyle and ramus exhibit considerable anatomical variation, with morphology influenced by growth, function, occlusion, and age-related remodeling. While cone-beam computed tomography (CBCT) provides high diagnostic accuracy, panoramic radiography remains widely used due to its accessibility and low radiation burden. This study aimed to assess radiographic condylar morphology, measure condylar and ramus dimensions, and examine associations with age, sex, and posterior dentition in adults in Hail, Saudi Arabia. Methodology: A retrospective cross-sectional study analyzed 366 digital panoramic radiographs obtained between 2023 and 2024 at the University of Hail dental polyclinics. Condylar shape, condylar height and width, ramus height, total mandibular height, intercondylar distance, and posterior molar presence were recorded bilaterally. Measurements were performed in Sirona Dental Imaging Software (SIDEXIS XG) using standardized landmarks. Associations with sex and age were assessed using chi-square tests, with P < 0.05 considered significant. Results: The round condylar morphology was the most common bilaterally - right side: 241 (75.8%) and left side: 262 (71.6%). Ramus height showed significant sexual dimorphism, with higher values in males (n = 93, 57.4%) compared with females (n = 91, 44.6%) in the 45-55 mm category. Age was significantly associated with condylar width, condylar height, ramus height, and total mandibular height across all groups. Posterior molar presence demonstrated a marked age-related decline. For example, the upper right first molar was present in 47 individuals (95.9%) aged 18-20 years but in only 11 individuals (50.0%) aged ≥60 years. Intercondylar distance showed no significant differences by sex or age. Conclusions: Panoramic radiography reliably demonstrated condylar morphology and vertical mandibular dimensions in this population. Round condyles were the predominant morphology, and ramus height was the only parameter consistently exhibiting sexual dimorphism. Age strongly influenced mandibular vertical dimensions and molar presence. Panoramic radiographs remain valuable for population-level screening, though CBCT is necessary when detailed morphometric evaluation is required.