OBJECTIVE: This study aims to evaluate the application and effectiveness of fractal analysis (FA) in assessing temporomandibular joint disorders (TMDs) with dental imaging. METHODS: This systematic review, conducted in adherence to PRISMA-P and Cochrane Handbook guidelines, involved a comprehensive search of five electronic indexed databases up to September 15, 2024. The thorough search aimed to ensure the inclusion of all relevant studies on dental imaging with fractal dimension (FD) analysis for TMDs. The risk of bias was performed using the revised QUADAS 2 tool. RESULTS: Out of 342 studies retrieved, 15 met the inclusion criteria and were included in the systematic review. These studies comprised 7 retrospective and 8 prospective nonrandomized clinical studies. Various imaging modalities were used including panoramic, CT, CBCT, and MRI. Most studies reported significantly lower FD values in TMD patients than in controls suggesting FD analysis' potential for detecting early TMJ degenerative changes. However, a few studies did not find significant differences or lacked control groups, highlighting the variability in findings across the research. The overall risk of bias was high regarding the applicability of all included studies. CONCLUSION: The fractal dimension (FD) analysis of dental images shows potential as a valuable tool for detecting early degenerative changes in temporomandibular disorders (TMDs). It could enhance diagnostic efficiency by providing additional insights from routine radiographs. However, the variability in findings and methodologies underscores the need for further research to validate and standardize these techniques.