Computerized tomography (CT) and magnetic resonance (MR) imaging of the temporomandibular joint are often not a routine part of a dental patient's pain and clinical evaluation. As a result, the most poorly understood region within the masticatory system is the temporomandibular joint foundation. Unfortunately, patient care and occlusal management are often compromised because of a lack of insight into the relationship between the anatomy of the temporomandibular joints and the occlusion. This chapter's four distinct sections review the key concepts about the temporomandibular joint foundation anatomical structures, detail structurally intact and structurally altered temporomandibular joint anatomy, clarify how structurally altered temporomandibular joints influence occlusal function, and classify the stages of temporomandibular joint structural degeneration. The concept of joint-based malocclusion is explored with numerous temporomandibular joint foundation anomalous software renderings, and sample CT and MR images, which together illustrate in detail how soft tissue and bony abnormalities in a structurally altered temporomandibular joint can create distortions in the occlusion. Lastly, the chapter addresses the specific requirements a clinician must technically master to perform a comprehensive CT or MR examination.