Temporomandibular disorder clinical practice teaching through case-based learning with the symptom “limited mouth opening”: a pilot study

Abstract

Objective

The aim of this study is to evaluate efficacy of case-based learning (CBL) focusing on the limited mouth opening temporomandibular disorder (TMD) symptom.

Methods

Thirty dental resident trainees from the First Affiliated Hospital of the University of Science and Technology of China (USTC) were enrolled in the study. The control group (n = 15; 2021–2022) received conventional CBL sessions focusing on TMD while completing standard clinical rotations. The experimental group (n = 15, 2023–2024) experienced CBL that focused exclusively on Limited Mouth Opening integrated with clinical training. Post-intervention assessments at 2 months included: (1) theoretical exams, (2) clinical competency evaluations (history-taking, imaging interpretation), and (3) validated satisfaction surveys. Analyses utilized SPSS 26.0 with χ²/Mann-Whitney U tests (α = 0.05).

Results

Both groups exhibited comparable theoretical knowledge (P = 0.35). The experimental group demonstrated superior clinical performance in history synthesis and temporomandibular joint imaging analysis. Post-training satisfaction surveys administered to both groups revealed that the experimental cohort demonstrated significantly higher mean scores (all p < 0.05) than controls across four core competencies: clinical reasoning, literature utilization, clinical documentation quality, and interdisciplinary collaboration.

Conclusion

Integrating “Limited Mouth Opening” CBL with clinical training in the practical teaching of temporomandibular disorder (TMD) can enhance residents’ diagnostic acumen, cultivate multidisciplinary competencies in TMD management, and optimise evidence-based pedagogical outcomes through structured clinical reasoning development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-07429-8.

Introduction

The temporomandibular joint (TMJ) is the sole movable hinge joint in the maxillofacial region, characterized by its complex structure and multifaceted physiological functions, which are essential for activities such as chewing, swallowing, and speech. The joint facilitates various movements, including mouth opening and closing, protrusion, and lateral shifts [1].

Temporomandibular disorder (TMD) is recognized as one of the “four major diseases” in dentistry, alongside caries, periodontal disease, malocclusion, with an incidence rate of approximately 31% in adults and 11% in children and adolescents [2]. Temporomandibular disorder encompasses a diverse array of pathological conditions that can affect the TMJ and/or its muscles. These disorders are typically characterized by a classic triad of clinical manifestations: pain in the muscles and/or the TMJ, TMJ sounds, and alterations in the mouth opening path, such as restriction, deviation, or deflection [3]. The majority of patients seek medical attention due to symptoms such as clicking sounds during mouth opening or limited mouth opening [4]. Residents rotating in our department tend to broadly classify such conditions under the term “TMD”. The first evidence-based diagnostic method for TMD is the Research Diagnostic Criteria for TMD (RDC/TMD), which was introduced in 1992. The RDC/TMD is a dual-axis system comprising physical diagnoses (Axis I) and psychosocial profiles (Axis II). It classifies TMD into three diagnostic groups: Group I–Muscle Disorders, Group II–Disc Displacements, and Group III–Arthralgia, Osteoarthropathy, and Osteoarthritis [5]. Over the past 25 years, TMD diagnosis has evolved from a structural-abnormality focus to the evidence-based DC/TMD system, integrating a biopsychosocial dual-axis framework, improved diagnostic validity, psychosocial protocols, and ongoing etiological research to refine taxonomy for complex disease contexts [6]. In clinical practice, residents frequently attribute unclear joint diseases to psychological factors, often assuming they are untreatable. This diagnostic ambiguity surrounding TMD represents a significant barrier to effective treatment, resulting in frequent delays in patient care. Therefore, providing dental residents with effective learning experiences that enhance comprehension and ability to clinically apply foundational knowledge related to TMD is a significant clinical teaching challenge [7, 8].

Temporomandibular disorder is clinically classified into nine major categories: disc disorders, dislocations, ankylosis, degenerative joint disease, fractures, developmental deformities, neoplastic conditions, masticatory muscle disorders, and coronoid hyperplasia [9, 10]. Notably, all categories except dislocations may manifest as limited mouth opening. The etiology, clinical manifestations, and treatment of these diseases remain conceptually complex and challenging to comprehend, rendering conventional didactic approaches often inadequate for operational knowledge integration. Therefore, cultivating residents’ clinical reasoning skills and proactive learning capabilities in the management of TMD with restricted mouth opening are subjects worthy of ongoing exploration.

The teaching of TMD can draw on experiences from conventional medical education, which is undergoing continuous pedagogical innovation. Current medical teaching innovations encompass teaching methods, content, and evaluation. Emerging pedagogical frameworks such as online teaching, outcome-based education - bridge-in, learning objective, pretest, participatory learning, posttest and summary (OBE-BOPPPS), diversified teaching model, Case-Based Learning (CBL), Problem-Based Learning (PBL), shadow curriculum approach, and virtual reality have yielded positive teaching outcomes [11–15]. Among these, CBL is widely implemented in medical education. Notably, CBL has gained substantial traction in medical education as a student-centered approach. This methodology employs structured small-group discussion formats centered on authentic clinical scenarios, facilitating problem-driven exploration and analytical reasoning under faculty supervision. Its primary objective is to connect theoretical knowledge with clinical application competencies [16]. Numerous educational studies demonstrate that CBL, PBL, or hybrid CBL-PBL implementations yield marked improvements in academic performance and learner satisfaction compared to traditional methods [11–17]. Temporomandibular disorder presents educational challenges due to unclear etiology, complex subtype classification, and variable treatment protocols [2, 6]. Traditional teacher-centered passive instruction fails to effectively engage students or translate theoretical knowledge into clinical competence. Case-Based Learning addresses this gap by bridging theoretical knowledge and clinical practice through structured case analysis. Prior studies in orthodontics and endodontics demonstrate CBL’s efficacy in enhancing diagnostic and treatment planning skills [14, 18, 19]. This study therefore employs CBL to evaluate students’ clinical decision-making capacity in TMD management. However, for complex diseases like TMD, classic case teaching of these disorders is insufficient in fostering residents’ clinical reasoning competencies and systemic diagnostic perspectives.

The “Limited Mouth Opening” symptom-focused case series systematizes clinical data from patients presenting with this primary complaint, initially diagnosed with TMD. Drawing on the anatomical and physiological understanding of the joint, the structures involved in mouth opening and closing movements encompass hard tissues, articular discs, joint capsules, and associated muscles [1]. Organized according to this subspecialty, the cases are classified into eight categories: joint ankylosis, coronoid process elongation, joint disorders, medial pterygoid muscle spasm, osteomyelitis, impacted maxillary teeth, joint infections, and joint tumors [9, 10]. Traditional instruction, including case-based learning (CBL), in TMD predominantly emphasizes routine internal derangements [7, 8].

In contrast, this study focused on evaluating the efficacy of CBL that concentrated on the symptom of Limited Mouth Opening. This approach was used to instruct residents in the diagnosis and management of TMD. This study hypothesized that implementing CBL featuring limited mouth opening as the main complaint would enhance dental resident trainees’ competencies in four domains: (1) superior theoretical knowledge of TMD, (2) better patient history collection and analysis skills, (3) better clinical practice including TMD examination and MRI interpretation, and (4) higher trainee self-assessment ratings of the symptom-focused CBL model and other capacities often associated with CBL.

Subjects and methods

Research subjects

The study subjects were residents rotating through the TMJ specialty at the First Affiliated Hospital of the University of Science and Technology of China from September 2021 to April 2024.( Clinical trial number: not applicable.) All participants in this study hold bachelor’s degrees. All are undergraduate graduates of Stomatology (dentistry) who had no specialized clinical orientation upon graduation. Their standardized residency training encompasses multiple specialty tracks, such as Oral Medicine, General Dentistry, Oral and Maxillofacial Surgery, Orthodontics and Prosthodontics.

Inclusion criteria

Residents rotating through the TMJ specialty at the First Affiliated Hospital of the University of Science and Technology of China from September 2021 to April 2024.

Exclusion criteria

Those with a rotation period of less than two months.

Research methods

The study design is presented in Fig. 1, which shows a CONSORT flow diagram detailing the study’s design.

Fig. 1.

Consolidated Standards of Reporting Trials (CONSORT) diagram

A total of 30 residents were included in the study. Fifteen residents rotating from September 2021 to December 2022 were assigned to the control group, which received conventional CBL curriculum on TMD combined with clinical chair-side teaching. The experimental group consisted of fifteen residents rotating from January 2023 to April 2024, who were exposed to an innovative CBL program focused on “limited mouth opening” pathophysiology alongside equivalent clinical training components.

In accordance with the DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) examination guidelines for Axis I (physiological diagnostic axis) [20], the following conditions in the two groups were classified into:

Experimental group

Group I disorders (temporomandibular joint disorders): Anterior disc displacement without reduction, infection of the TMJ, synovial chondromatosis of the TMJ, and TMJ ankylosis.

Group II disorders (masticatory muscle disorders): Medial pterygoid muscle spasm, and symptoms associated with impacted maxillary teeth and osteomyelitis.

Group IV disorders (associated structures): Coronoid process hyperplasia.

Control group

Group I disorders (temporomandibular joint disorders): Anterior disc displacement with reduction, anterior disc displacement without reduction, osteoarthritis, joint dislocation, and ankylosis.

Group II disorders (masticatory muscle disorders): Muscle dysfunction.

Teaching implementation

Both cohorts received standardized instruction under the supervision of the same lecturer, a senior attending physician with a health education qualification certificate. The core curriculum focused on TMJ pathologies and associated conditions. All participants completed an identical foundational curriculum encompassing: essential TMJ anatomy and biomechanics, DC/TMD diagnostic criteria for TMD, common TMJ pathologies including: disc displacement disorders, TMJ subluxation, muscular dysfunction, degenerative joint diseases, TMJ ankylosis, TMJ dislocation, TMJ infectious diseases and TMJ neoplasms, and standardized clinical examination protocols.

Control group

The control group received a structured curriculum employing case-based learning (CBL) methodology integrated with clinical chair-side training.

Phase 1: foundation Building (Week 1)

Didactic instruction: Multimedia lectures covering TMJ anatomy, biomechanics, imaging examinations and pathophysiological mechanisms.

Core content: Current diagnostic system—the Diagnostic Criteria for TMD (DC/TMD) [20].

Phase 2: clinical immersion (Weeks 2–8)

Apprenticeship training

Direct observation of specialist-patient interactions.

Hands-on practice with: Clinical history collection, TMJ clinical examinations, and interpretation of Cone Beam Computed Tomography (CBCT) for joint structural diseases such as osteoarthritis, dislocation and ankylosis and Magnetic Resonance Imaging (MRI) scans for disc displacement and synovial diseases.

Case-based learning implementation

Structured weekly case-based learning (CBL) sessions were implemented using standardized clinical case portfolios systematically aligned with the six pathological domains outlined in Table 1.

Table 1.

Six pathological domains of TMD

Disorder Type	Case Features	Imaging Modality
Disc displacement with reduction	clicking	MRI
Disc displacement without reduction	closed lock	MRI
Myofascial dysfunction	Trigger point
Osteoarthritis	Condylar erosion patterns	Cone-beam CT
Dislocation	Acute vs. chronic presentation	Panoramic radiography
Ankylosis	Fibrous vs. bony fusion differentiation	CT 3D reconstruction

Phase 3: active learning cycle

Residents discussed two cases each week. Faculty provided student groups (3–4 members) with anonymized patient portfolios containing comprehensive medical/dental histories, enabling the application of evidence-based decision matrices to develop structured presentations encompassing medical history collection, differential diagnosis flowcharts, therapeutic planning, and relevant literature review.

Phase 4: expert feedback

The instructor conducted structured debriefing sessions utilizing assessment rubrics to address identified gaps in history-taking protocols, diagnostic reasoning, and evidence-based treatment strategies, thereby enhancing residents’ clinical decision-making competencies in TMJ pathology management. This educational intervention was conducted once a week for two months, for a total of 8 sessions.

Experimental group

The experimental cohort underwent curriculum integrating “Limited Mouth Opening” case-based learning with clinical chair-side training. Following standardized theoretical instruction paralleling control group protocols, residents engaged in scaffolded clinical immersion through: (1) direct observation of comprehensive patient evaluations (history-taking, clinical examinations, diagnostic imaging interpretation), (2) weekly structured learning modules analyzing prospectively collected cases of restricted mandibular movement. The study encompassed eight types of diseases associated with “limited mouth opening,” including joint ankylosis, coronoid process elongation, disc displacement without reduction, medial pterygoid muscle spasm, osteomyelitis, impacted maxillary teeth, joint infections, and joint tumors. Both cohorts-maintained parity in case discussion protocols, frequency and summative evaluation processes.

Evaluation of teaching effectiveness

The assessment framework was implemented for both cohorts, incorporating four dimensions: theoretical examination, clinical medical history collection and analysis, specialty practice, and a questionnaire survey. All assessment instruments were specifically developed by our research team and implemented for the first time. The assessment tools for history-taking and clinical examination practices utilized in this study were developed through systematization and simplification of the work proposed by Okeson JP [21], comprising three methodologically stratified components: (1) Screening History and Examination, (2) History Taking for Temporomandibular Disorders, and (3) Clinical Examination.

Theoretical knowledge assessment

This component covered the anatomy and function of the TMJ, etiology, classification, clinical manifestations, and treatment, with a total score of 120 points. The theoretical assessment forms administered anonymously via “WJX.cn” for data collection. (The complete assessment is shown in supplemental Form 1)

Clinical medical history collection and analysis

The medical history collection form was assessed by the same TMJ specialist instructor for evaluation.

Clinical reasoning was assessed via case-based evaluations (40-point scale) examining medical history analysis, diagnostic workup planning, differential diagnosis with supporting rationale, and therapeutic strategy development. (The complete assessment is shown in supplemental Form 2)

Specialty practice

The specialty practice form was assessed by the same TMJ specialist instructor for evaluation.

Assessment encompassed standardized TMJ examination protocols (assessing comprehensive evaluation competencies) and diagnostic imaging analysis (interpreting MRI findings for anterior disc displacement with reduction (ADDwR), anterior disc displacement without reduction (ADDwoR), disc degeneration, synovial pathology, and arthritic changes) with a 20-point scoring system. (The complete assessment is shown in supplemental Form 3)

Student self-assessment

An online trainee satisfaction questionnaire was conducted to determine residents’ perceptions of the effectiveness of learning experiences in the experimental and control groups, considering aspects such as teaching model evaluation, literature search capability, clinical reasoning ability, teamwork, and medical record writing. Administered anonymously via web-based platform (WJX.cn). (The complete assessment is shown in supplemental Form 4)

Participant satisfaction was quantified using a 4-point Likert-type scale: 4 (“Very Satisfied/Very Helpful”), 3 (“Generally Satisfied/Helpful”), 2 (“Neutral”), and 1 (“Dissatisfied/Unhelpful”).

Statistical analysis

Statistical analyses were performed using SPSS (v26.0). Categorical variables are presented as counts (%) and analyzed with χ² or Mann-Whitney U tests. Normally distributed continuous data are expressed as mean ± SD (Student’s t-test), while non-normal data as median (IQR) (Mann-Whitney U). Statistical significance was set at p < 0.05 (two-tailed).

Results

Comparison of general information between the two groups

The survey results indicated that the experimental group consisted of 15 residents, aged 25–29, with an average age of (27 ± 1.07), including 7 females. The control group also consisted of 15 residents, aged 26–30, with an average age of (28.2 ± 1.1), including 8 females. The differences in age (t=-3.154, P = 0.911) and gender (χ2 = 0.1333, P = 0.715) between the two groups were not statistically significant, indicating comparability.

Comparison of theoretical knowledge scores between the experimental and control groups

There was no significant difference in theoretical knowledge scores between the two groups of residents (P = 0.35). (The comprehensive performance metrics are shown in supplemental table 1.)

Comparison of clinical medical history collection and analysis between the experimental and control groups

The experimental group demonstrated significantly superior case-based clinical reasoning scores compared to controls ( p = 0.005), with comprehensive performance metrics detailed in Table 2.

Table 2.

Comparison of TMJ clinical practice scores between the two groups [Score, M(IQR)]

Group	Medical History Collection	Specialty Practice
Experimental Group	35 (4)	17 (2)
Control Group	31 (4)	15 (1)
Z-value	-2.814	-3.399
P-value	0.005	0.001

Comparison of specialty practice between the experimental and control groups

The experimental cohort demonstrated significantly higher clinical procedural competency scores versus controls (p = 0.001), exhibiting comprehensive MRI interpretation patterns encompassing myofascial architecture, synovial compartments, disc-condyle dynamics, and osseous morphology - contrasting with controls’ predominant focus on disc-condyle relationships. The experimental cohort demonstrated enhanced diagnostic rigor through systematic evaluation of dental arch, mucosal pathosis characterization, and myofascial kinetics profiling during clinical assessments. (Detailed metrics in Table 2)

Comparison of questionnaire survey results between the two groups

The validated survey achieved 100% response rate (30/30), revealing significantly higher participant-reported satisfaction with the experimental CBL curriculum. Superiority reached statistical significance (p < 0.05) in five core competencies: teaching methods satisfaction, evidence synthesis efficiency, improvement of clinical reasoning, interprofessional collaboration, and clinical documentation quality. Please refer to Table 3 to view the results of the comparison from the two groups. The higher teaching method satisfaction and interprofessional collaboration were observed in experimental group (median: 4, IQR: 4–4) compared to those from the control group (median: 4, IQR: 3–4; P < 0.05). Notably, residents in experimental group showed superior capacities in evidence synthesis efficiency, clinical reasoning and medical record writing (median: 3, IQR: 3–3) compared to their counterparts (median: 3, IQR: 2–3; P < 0.05). (The additional data is shown in supplemental Fig. 1.)

Table 3.

Teaching evaluation of the two groups of residents [Satisfaction Score, M(IQR)]

Group	Teaching Method  Satisfaction	Evidence synthesis efficiency	Enhancement of Clinical Reasoning	Strengthening Teamwork	Improvement in Medical Record Writing
Experimental Group	4(4–4)	3(3–3)	3(3–3)	4(4–4)	3(3–3)
Control Group	4(3–4)	3(2–3)	3(2–3)	4(3–4)	3(2–3)
Z-value	-2.693	-2.112	-2.693	-2.399	-2.693
P-value	0.007	0.035	0.007	0.016	0.007

Discussion

In this study, we evaluated the effect of CBL with the symptom “Limited Mouth Opening” in clinical practice teaching of TMD. The study indicates that the CBL teaching group utilizing “limited mouth opening” as the chief complaint entry point exhibited significantly.

higher self-assessment satisfaction and enhanced clinical reasoning competencies compared to the classic CBL teaching group.

Unlike traditional lecture-based learning (LBL), CBL is a pedagogical approach that utilizes clinical case demonstrations as active learning tools, emphasizing heuristic pedagogy. Widely implemented in clinical medical education, CBL can be employed either as a standalone methodology or synergistically integrated with role-playing simulations to enhance instructional efficacy [22, 23]. The study demonstrated that CBL exhibits significantly higher instructional efficacy in orthodontic education compared to LBL [18]. The integration of PBL with CBL significantly enhances students’ engagement in theoretical studies and strengthens their clinical competencies in case diagnosis and management of oral mucosal diseases [19]. However, the instructional efficacy of CBL in the field of TMD has rarely been reported.

Temporomandibular disorder is included in dental curricula across many countries. However, there are significant differences in the curriculum among schools, or the lack of a specialized department responsible for TMD education. Studies have shown that dental students lack systematic competency in TMD diagnosis and clinical management [7, 24, 25]. A survey of American Association of Orthodontists revealed 62% received inadequate TMD training during residency, while 50.2% lacked confidence in managing TMD cases [26]. This underscores the persistent instructional challenges in TMD education. Temporomandibular disorder involves joint/muscle pain, clicking/crepitus, and mandibular dysfunction, with multifactorial etiology. Evolving diagnostic taxonomy enhances precise assessment and management [9, 10]. A persistent challenge in clinical education lies in equipping residents with the ability to systematically address six critical questions when managing TMJ cases: 1)Is the pathology truly TMJ-related? 2)Does it qualify as TMD? 3)What specific TMD subtype is present? 4)What constitutes the diagnostic criteria and key differentials? 5)Which diagnostic modalities are indicated? 6)How should treatment strategies be prioritized?

The studies reveal that despite receiving theoretical training in TMD, students, faculty, and clinicians demonstrate insufficient understanding of evidence-based diagnostic and therapeutic protocols for TMD management [7, 26, 27]. Clinical observations reveal a concerning disparity: residents excel in theoretical knowledge yet face challenges in practical application. This theory-practice gap manifests through three predominant limitations: (1) Compartmentalized Knowledge-Failure to synthesize interdisciplinary concepts and recognize disease interrelationships; (2) Anatomico-Clinical Disconnect-Inability to correlate TMJ structural/functional characteristics with symptomatic presentations; (3) Diagnostic Fragmentation-Deficient capacity for holistic case analysis integrating multiple diagnostic dimensions. This study has achieved significant teaching outcomes in clinical education by deeply integrating knowledge of the TMJ.

Students are satisfied with the effectiveness of the hybrid teaching approach combining CBL and Team-Based Learning (TBL) [28]. Therefore, we implemented CBL in the instruction of TMD management.

The control group employed case-based teaching on classic TMD, targeting key diagnostic challenges from curricular materials. Guided by TMJ specialty instructor, residents conducted systematic analysis spanning etiology, diagnostic criteria, and evidence-based treatment protocols, incorporating medical history evaluation and literature synthesis. Case discussions focused on developing differential diagnoses, imaging strategies, and staged treatment plans. Current research indicates that active learning (PBL/CBL) and virtual reality -enhanced simulations improve engagement, knowledge retention, and clinical competence in dental education [17, 19].

In this study, no statistically significant difference was observed in the theoretical knowledge of TMD between the experimental and control groups of trainees. This finding diverged from the initial research hypothesis, as both teaching models incorporated consistent theoretical content, including TMJ anatomy, physiology, clinical manifestations, and management of common joint disorders. However, in line with the research hypothesis, participants in the experimental group exhibited significant improvements in patient history collection and case analysis capabilities compared to the control group. Notably, specialized joint examination practices and MRI image interpretation skills were markedly enhanced among trainees in the experimental group. Furthermore, the experimental group reported higher self-assessment ratings with the training program.

Despite the lack of significant differences in theoretical knowledge of TMD between the two groups, the experimental group achieved more favorable outcomes in clinical practice and self-assessment. These results suggest that the innovative teaching model employed in the experimental group may have effectively bridged the gap between theoretical knowledge and practical application, thereby fostering greater clinical competence and self-confidence among trainees.

This study developed a CBL module centered on limited mouth opening, integrating cases across diagnostic complexity with shared chief complaints. Diagnostic accuracy necessitates multidimensional assessment spanning clinical history, specialized examinations, and diagnostic imaging. Evidence-guided therapeutic planning further mandates literature synthesis and guideline application.

This case-based learning module centered on " limited mouth opening” systematically guided residents through: (1) Systematic exploration of trismus etiologies stimulates differential diagnosis review spanning TMD, odontogenic impactions, oral submucous fibrosis, tetanus-induced lockjaw, and ankylotic pathologies [29], (2) anatomical-physiological correlations of TMJ biomechanics [1], (3) Mechanistic categorization of trismus severity enables differentiation between myogenic, arthrogenic, and structural etiologies through biomechanical analysis [29], (4) Syndrome-pathology mapping of trismus subtypes cultivates clinical reasoning through biomechanical correlations between rotational/translational dysfunction and specific etiopathological entities, (5) evidence-based diagnostic reasoning through history-taking and literature synthesis, (6) exclusion criteria development via critical appraisal, (7) multimodal examination planning (imaging/biomechanical analysis), and (8) precision treatment strategies employing mind-mapping techniques [30].

The current study focuses on “limited mouth opening” due to its prevalence among TMD patients, characterized by diverse disease types and varied MRI findings, leading to frequent clinical misdiagnosis [31–33]. Implementation of structured case-based learning with clinical chair-side teaching significantly enhanced trainees’ interdisciplinary competencies, demonstrating measurable improvements in diagnostic reasoning, procedural accuracy, and temporomandibular complex biomechanical analysis capabilities.

Conclusion

This study integrates “limited mouth opening” cases with TMJ outpatient teaching to offer personalized TMJ disease training for residents. The design philosophy of CBL emphasizes starting from the chief complaint, then analyzing and mastering the disease. By leveraging thematic cases, this model enhanced trainees’ history-taking proficiency, clinical practice including TMD examination and MRI interpretation, as well as their self-evaluated performance in the symptom-focused CBL framework. This approach bridges TMJ theory and clinical practice. The future research studies should examine topics like “joint pain,” “joint clicking,” and “mandibular deviation” to further improve clinical competence.

Limitations

There were some limitations to this study. In this study, the number of participants in both groups was relatively small, with 15 individuals in each group. The research was conducted at only one hospital, and the participants came from universities with varying levels. Therefore, the results may not represent the overall competency of standardized training residents. The medical history collection and theoretical exams in the study did not cover all aspects of TMJ knowledge, potentially affecting the accuracy of the findings.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

ADDwR

Anterior disc displacement with reduction

ADDwoR

Anterior disc displacement without reduction

CBCT

Cone beam computed tomography

CBL

Case-based learning

DC/TMD

Diagnostic criteria for temporomandibular disorders

LBL

Lecture-based learning

MRI

Magnetic resonance imaging

OBE-BOPPPS

Outcome-based education - bridge-in, learning objective, pretest, participatory learning, posttest and summary

PBL

Problem-based learning

RDC/TMD

Research diagnostic criteria for temporomandibular disorders

TBL

Team-based learning

TMD

Temporomandibular disorder

TMJ

Temporomandibular joint

Author contributions

Haixiang Chen implemented the experiments and wrote the paper; Jing Li collected and analyzed the data; Hangtian Zhou drew the schematic diagram in the paper; Pan Jiang designed the experiments, revised the paper and supervised this work. All authors participated in the design of the questionnaires, read and approved the final manuscript.

Funding

This research was supported by the funding of The program for educational Reform of USTC, Grant Number 2023xjyxm087.

Data availability

All data generated or analysed during this study are included in this published article.

Declarations

Ethics approval and consent to participate

All methods were performed in accordance with the Declaration of Helsinki. Informed consent was obtained orally from all subjects, the survey was anonymous and voluntary, which was approved by the ethics committee of the First Affiliated Hospital, University of Science and Technology of China.

The need for ethics approval was waived by the ethics committee of the First Affiliated Hospital, University of Science and Technology of China (No.2025-ky062).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial number

Not applicable.