the relationship between orthodontic treatment and TMD

“The relationship between Orthodontic Treatment and TMD”

Acontinuous debate among the dental community regarding the whether orthodontic treatment causes or increases (worsen) the signs and symptoms of temporomandibular joint disorders TMDs.

Another question is whether to intervene orthodontically to treat patients with TMD symptoms, a belief that has also been opposed widely by the opinion that orthodontic treatment alone will not alleviate those symptoms.

The main question will be :Is the severity and prevalence of TMD influenced or even caused by orthodontic treatment ?

A 20-Year Follow-up of Signs and Symptoms ofTemporomandibular Disorders and Malocclusions in SubjectsWith and Without Orthodontic Treatment in Childhood

Inger Egermark, LDS, Odont Dr/PhDa; Tomas Magnusson, LDS, Odont Dr/PhDb;Gunnar E. Carlsson, LDS, Odont Dr/PhD, Dr Odont hc, FDSRCSc

This investigation analyzes the influence of orthodontic treatment on signs and symptoms of temporomandibular disorders (TMDs) and different malocclusions during a 20-year period.

RESULT :

Studies on the consequences of orthodontic treatment on TMD have shown that such treatment neither increases nor decreases the risk of developing TMD later in life.

Conclusion:

• Subjects who previously have received orthodontic treatment are in general very pleased with the treatment result,especially in a long-term perspective.

• Subjects who have received orthodontic treatment in childhood do not run an increased risk of developing signs or symptoms of TMD later in life.• Correlations between signs and symptoms of TMD and

different kinds of malocclusion are in general nonexistent or weak.

TMD in Relation to Malocclusion and Orthodontic TreatmentA Systematic ReviewBengt Mohlina; Susanna Axelssonb; Gunnar Paulinc; Terttu Pietila ̈d; Lars Bondemarke;Viveca Brattstro¨mf; Ken Hanseng; Anna-Karin Holmh

• Objective: • The aim of this systematic literature review was to evaluate

associations between different malocclusions, orthodontic treatment, and signs and symptoms of temporomandibular disorders (TMD).

• Results:• Associations between certain malocclusions and TMD were

found in some studies, whereas the majority of the reviewed articles failed to identify significant and clinically important associations. TMD could not be correlated to any specific type of malocclusion, and there was no support for the belief that orthodontic treatment may cause TMD.

• Conclusion:• Associations between specific types of

malocclusions and development of significant signs and symptoms of TMD could not be verified. There is still a need for longitudinal studies.

Condyle fossa relationship associated with functional posterior crossbite,before and after rapid maxillary expansionRosalia Leonardia; Mario Caltabianoa; Costanza Cavallinib; Edoardo Sicurezzab; Ersilia Barbatoc;Concetto Spampinatod; Daniela Giordanoe

• Objective:• To investigate condylar symmetry and condyle fossa

relationships in subjects with functional posterior crossbite comparing findings before and after rapid maxillary expansion (RME) treatment through low-dose computed tomography (CT).

• Conclusion: • There were no statistically significant differences in condyle position

within the glenoid fossa between the FPXB and non-crossbite side before treatment. Increases in joint spaces were observed after treatment with RME on both sides. These changes were, however, of small amounts.

TMJ function and the effects on the masticatorysystem on 14-16-year-old Danish children inrelation to orthodontic treatment

Lisbeth Nielsen, Birte Melsen, and Svend TerpRoyal Dental College, Aarhus, Denmark, University of Aarhus, Aarhus, Denmark

• The effect of orthodontic treatment on the functional status of the masticatory system was analysed in 706 children from three Danish communities.

• Children who had their treatments performed by either orthodontist or paedodontist alone demonstrated more muscular problems than children who had been treated by a team of orthodontists and pedodontists.

• Conclusion:

• selection criteria for orthodontic treatment rather than increased prevalence of orthodontic treatment is of importance for the functional status in a young population.

• When comparing children with completed and discontinued orthodontic treatment no difference in the functional status was found.

• orthodontic treatments including extraction therapy (with or without appliances) can successfully be performed with no increased risk of joint clicking.

Effect of chin-cup treatment on the temporomandibular jointa systematic review

Monika A. Zurfluh , Dimitrios Kloukos , Raphael Patcas , Theodore EliadesDOI: http://dx.doi.org/10.1093/ejo/cju048 First published online: 1 September 2014

• Objective:the influence of chin-cup therapy on the temporomandibular joint regarding morphological adaptations and appearance of temporomandibular disorders (TMD).

RESULT: chin-cup therapy for Class III orthodontic anomaly seems to

induce craniofacial adaptations. Nevertheless, there are insufficient or low-quality data in the orthodontic literature to allow the formulation of clear statements regarding the influence of chin-cup treatment on the temporomandibular joint.

Effects of orthodontic treatment with fixed functionalorthopaedic appliances on the disc-condyle relationship in the temporomandibular joint: a magnetic resonance imaging study (Part II)

GSM Kinzinger*,1, A Roth1, N Gu¨lden1, A Bu¨cker2 and PR Diedrich11Department of Orthodontics, RWTH Aachen University, Germany; 2Department of Diagnostic Radiology, RWTH

Aachen University,Germany

• Objective: This study aimed to verify the effects that corrective treatment for

skeletal Class II malocclusions with fixed functional orthopaedic appliances has on the relative positions of the articular disc and the mandibular condyle

• Conclusion:• The comparison of pre-treatment and post-treatment findings

revealed in none of the joints that the disc-condyle relationship had been adversely affected as a consequence of the treatment.

Relationship between temporomandibular disorders and orthodontic treatment.

a literature review  Ronaldo Antônio LeiteI; Joacir Ferreira RodriguesII; Maurício Tatsuei SakimaIII; Tatsuko SakimaIV

• Objective:• Review the most recent studies from the last 15 years, in search of

clinical studies that report the relationship between TMD and orthodontic treatment and/or malocclusion. Our intention was to determine whether orthodontic treatment would increase the incidence of signs and symptoms of TMD, and whether orthodontic treatment would be recommended for treating or preventing signs and symptoms of TMD.

• CONCLUSION:• All studies cited in this literature review reported that orthodontic

treatment did not provide risk to the development of signs and symptoms of TMD,

Longitudinal study of signs of temporomandibular disorders (TMD) in orthodontically treated and nontreated groups.Ronald H. Hirataa, Marc W. Heftb, Belen Hernandezc, Gregory J. Kingd,

• Objective:

This study measured the prevalence and incidence of signs of temporomandibular (TM) disorders in both a group undergoing orthodontic treatment. • RESULT:

• The incidence of TM signs for the treatment group and control

group were not significantly different. Preliminary results are in agreement with the contention that orthodontically treated patients are not more likely to develop TM signs while undergoing treatment.

Temporomandibular disorders in the active phase of orthodontic treatment.

E G E R M A R K & A. R O N N E R M A N Departments of Orthodontics and Stomatognathic Physiology, Faculty of Odontology, Goteborg University, Goteborg, Sweden

• Objective:

symptoms and clinical signs of temporomandibular disorders (TMD) as well as presence of headache, bruxism and occlusal interferences were examined in 50 patients (mean age 12-9 years) before, during and immediately after orthodontic treatment.

• Result:

This study has shown that there was a high prevalence of signs and symptoms of TMD in patients before orthodontic treatment, however, very rarely severe.• During the active phase of the orthodontic treatment there was a

reduction of signs and symptoms of TMD.

Signs and symptoms of temporomandibular disorders in 19-year-old individuals who have undergone orthodontic treatment

Lagerström L, Egermark I, Carlsson GE,Department of Public and Child Dental Health, Dublin Dental Hospital, Ireland.Swedish Dental Journal [1998, 22(5-6):177-186

Objective:There are two groups, one has been treated by Specialists and the other has been treated by General practitioners The aims were to study the prevalence of signs and symptoms of temporomandibular disorders (TMD) in the two groups a long-term basis, to identify any possible difference between the groups.

RESULT: Severe signs and symptoms of TMD were rare, the prevalence did not differ significantly between the two orthodontic groups.

Conclusion:it was concluded that the vast majority of the 19-year old individuals who had undergone orthodontic treatment had well-functioning masticatory systems, and severe signs and symptoms of TMD were rare.

 Occlusion, Orthodontic treatment, and temporomandibular disorders. McNamara JA Jr,Seligman DA, Okeson JP. J Orofac Pain. 1995 Winter;9(1):73-90.

• According to the existing literature, the relationship of TMD to occlusion and orthodontic treatment is minor.

• Signs and symptoms of TMD occur in healthy individuals and increase with age, particularly during adolescence; thus, TM disorders that originate during various types of dental treatment may not be related to the treatment but may be a naturally occurring phenomenon.

Orthodontics and temporomandibular disorder.A meta-analysisKim et al. Am J Orthod Dentofacial Orthop 2002;121:438–46

• The data in this metaanalysis do not indicate that traditional orthodontic treatment increases the prevalence of TMD.

Orthodontic treatment and temporomandibular disorders: is there a relationship? Part 1: Clinical studies.McNamara JA Jr,Türp JC. J Orofac Orthop. 1997;58(2):74-89

• Based on these studies, the following statements can be made:

• 1. Orthodontic treatment performed during adolescence does

not increase or decrease the chances of developing TMD later in life.

• 2. The extraction of teeth as part of an orthodontic treatment plan does not increase the risk of TMD.

• 3. Thus far, there is no compelling evidence that orthodontic

treatment prevents TMD.

A Prospective Long-Term Study of Signs and Symptoms of Temporomandibular Disorders in Patients Who Received Orthodontic Treatment in ChildhoodInger Egermark et al,  The Angle Orthodontist , July 2005 

• RESULT:• The prevalence of signs and symptoms of TMD was low both

before and after the active phase of orthodontic treatment, as well as at the long-term follow-up after 15 to 18 years.

Symptoms and signs of temporomandibular disorders before, during and after orthodontic treatment.Henrikson T, Nilner M, Kurol J. Eur J Orthod (2000) 22 (3): 271-281

• Both symptoms and signs of TMD showed considerable fluctuations over the three-year period within the individuals.

• The prevalence of pain on mandibular movement and tenderness to palpation of the masticatory muscles was significantly less common during and after orthodontic treatment than before.

• Clinically registered TMJ clicking increased slightly over the three year period.

• We concluded that the orthodontic treatment either with or without tooth extractions did not increase the risk for TMD or worsen pre-treatment signs of TMD.

• CONCLUSION:

• After reading through most of the inclusive articles, it could be easily concluded that

latest evidence of current literature inarguably states that: orthodontic treatment neither causes nor cures TMDs.

• One can also find out the amount of obstacles facing the researchers in this field of study. Most of these obstacles are the variations and lack of standardized methods of recording information about TMD signs and symptoms, in addition to lack of bulk of evidence, especially RCT due to many reasons, in this area of research.

• • Orthodontic treatment only to cure TMDs is not recommended by most authors and

experts. Also, patients with at least one sign of TMDs seeking orthodontic treatment should be treated with caution, and put under periodical supervision.

•

• Bengt Mohlin, Susanna Axelsson, Gunnar Paulin, Terttu Pietilä, Lars Bondemark, Viveca Brattström, Ken Hansen, and Anna-Karin Holm (2007) TMD in Relation to Malocclusion and Orthodontic Treatment. The Angle Orthodontist: May 2007, Vol. 77, No. 3, pp. 542-548.

• Monika A. Zurfluh , Dimitrios Kloukos , Raphael Patcas , Theodore Eliades DOI: http://dx.doi.org/10.1093/ejo/cju048 First published online: 1 September 2014

• Inger Egermark, Gunnar E. Carlsson and Tomas Magnusson. (2009) A Prospective Long-Term Study of Signs and Symptoms of Temporomandibular Disorders in Patients Who Received Orthodontic Treatment in Childhood. The Angle Orthodontist 75:4, 645-650.

• Rosalia Leonardi, Mario Caltabiano, Costanza Cavallini, Edoardo Sicurezza, Ersilia Barbato, Concetto Spampinato and Daniela Giordano. (2012) Condyle fossa relationship associated with functional posterior crossbite, before and after rapid maxillary expansion. The Angle Orthodontist 82:6, 1040-1046.

• TMJ function and the effects on the masticatory system on 14–16-year-old Danish children in relation to orthodontic treatment • Lisbeth Nielsen , Birte Melsen , Svend Terp• DOI: http://dx.doi.org/10.1093/ejo/12.3.254 254-262 First published online: 1 August 1990

• GSM Kinzinger*,1, A Roth1, N Gu¨lden1, A Bu¨cker2 and PR Diedrich1• Ronaldo Antônio LeiteI; Joacir Ferreira RodriguesII; Maurício Tatsuei SakimaIII;

Tatsuko SakimaIV

• Ronald H. Hirataa, Marc W. Heftb, Belen Hernandezc, Gregory J. Kingd,

• I . E G E R M A R K & A. R O N N E R M A N Departments of Orthodontics and Stomatognathic Physiology, Faculty of Odontology, Goteborg University, Goteborg, Sweden

• Lagerström L, Egermark I, Carlsson GE Department of Public and Child Dental Health, Dublin Dental Hospital, Ireland. Swedish Dental Journal [1998, 22(5-6):177-186]

•

• McNamara JA Jr,Seligman DA, Okeson JP. J Orofac Pain. 1995 Winter;9(1):73-90.• Kim et al. Am J Orthod Dentofacial Orthop 2002;121:438–46• McNamara JA Jr,Türp JC. J Orofac Orthop. 1997;58(2):74-89• Inger Egermark et al, The Angle Orthodontist , July 2005 • Henrikson T, Nilner M, Kurol J. Eur J Orthod (2000) 22 (3): 271-281

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