Modifications in Class I and Class II Div. 1 malocclusion during orthodontic treatment and their association with TMD problems

Adolescent Patient's Perceptions During Treatment With Class II Elastics

The article presents a case of a 13-year-old adolescent male patient who started orthodontic treatment at the age of 12. Before treatment, he was diagnosed with narrow maxilla, proclination of upper incisors, deep overbite, distal occlusion bilaterally with significant sagittal overjet in frontal area, skeletal Class II, and hypodivergent growth pattern. During treatment, the patient is in his pubertal growth spurt. About 2 months after intermaxillary Class II elastics (1/4 heavy, 6.5 Oz) were applied, he complained of pain during mastication, wide opening of the mouth, and sometimes during protrusive and lateral movements in the right TMJ. The TMJ X-ray examination did not reveal abnormal morphological changes. Occlusion was evaluated by an electromyographic device, Teethan. The result was typical for Class II malocclusion. During the bilateral palpation of the zones of TMJ and opening of the mouth and chewing, the patient reported pain on the right side. There was no clicking in the joint. The elastic wear was stopped, and soon afterwards, the pain disappeared. These complaints point to a possible relationship between orthodontic treatment and TMJ pain. However, the disappearance of complaints after the removal of the Class II elastics points that the temporomandibular joint disorder (TMD) symptoms are reversible and resolved.

Impact of clear aligner therapy on masticatory musculature and stomatognathic system: a systematic review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions

BACKGROUND

Clear aligner therapy has gained popularity as a minimally invasive orthodontic treatment option. However, its impact on the masticatory musculature and the stomatognathic system is an area of growing interest, as it involves the adjustment of occlusion and tooth movement. This systematic review aims to comprehensively assess and synthesise existing evidence regarding the influence of clear aligner therapy on the masticatory musculature and the stomatognathic system.

METHODS

An exhaustive search was performed on electronic databases that adhered to PRISMA guidelines. Clinical studies that evaluated the impact of patients receiving aligner orthodontic treatment on the muscles of the mastication and stomatognathic systems were included. A standardised data extraction form was devised for relevant variables. Two reviewers extracted the data variables. ROB-2 was used for bias evaluation in the selected studies.

RESULTS

A total of six studies met the inclusion criteria. The wearing of clear aligners significantly impacted the muscles of mastication. Muscle activity and discomfort showed a significant alteration in the initial days of appliance placement. but this observation was temporary, with no significant changes thereafter in subsequent follow-up. Bite force reduction was also noted. All the studies evaluated showed good methodological quality.

CONCLUSION

The review found that aligned orthodontic treatment may have a variable impact on muscles of mastication, with a potential for initial exacerbation of symptoms followed by possible improvement. However, due to the limited number of studies and their heterogeneous nature, further robust research is recommended to fully understand the relationship between aligned orthodontic treatment and masticatory muscles.

Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: A cross-sectional study

BACKGROUND

The objective of this investigation is to assess the relationship between the utilisation of orthodontic intermaxillary elastics and temporomandibular disorder (TMD) symptoms in clear aligner patients and to examine the correlation between the elastic usage time with the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)-Axis II Evaluation Forms.

METHODS

This study was carried out on a total of 40 clear aligner patients using intermaxillary elastics in the experimental group and 30 clear aligner patients who did not use any intermaxillary elastics in the control group. The data were evaluated using the Mann-Whitney U, chi-square, Fisher's exact chi-square, and Fisher Freeman Halton exact chi-square tests.

RESULTS

The characteristic pain intensity, mastication, mobility, communication, global and PHQ-9 scores of the experimental group were significantly higher than those of the control group (p < .05). The characteristic pain intensity score, interference score and chronic pain grade score of patients using Class III elastics were statistically significantly higher than those of patients using Class II elastics (p < .05). Patients who used elastics for less than 6 months had statistically significantly higher PHQ-9 scores than those who used elastics for more than 6 months (p < .05).

CONCLUSIONS

Orthodontic treatment may affect occlusion, bite force and jaw movement, which may cause or worsen TMD symptoms, and the DC/TMD questionnaires can determine if orthodontic patients acquire TMD by assessing their psychosocial state and pain-related problems.

The Impact of Temporomandibular Disorders on Orthodontic Management: A Systematic Review and Meta-Analysis

The literature on the impact of temporomandibular disorders (TMDs) on orthodontic management or vice versa lacks clarity. This study presents a review that aims to evaluate the influence of TMDs on orthodontic management and explore the association between TMDs and various aspects of orthodontic treatment. A systematic search was conducted across multiple databases to identify relevant articles documenting the correlation between TMD incidence and orthodontic treatment to achieve the objectives. The selection process followed predefined criteria, and the selected studies underwent bias assessment using the AXIS tool and Cochrane risk of bias (RoB) tool. Among the articles identified, nine studies were deemed suitable for inclusion in the review. The findings from the subsequent meta-analysis indicated a significant overall effect, suggesting that orthodontic treatment may increase the risk of developing TMD. Furthermore, the analysis revealed that patients with TMD had higher odds of experiencing orthodontic issues than those without TMD. Subgroup analysis further demonstrated that orthodontic treatment could have a negative impact on the psychological well-being of TMD patients, while its effect on TMD incidence was found to be negligible. The results highlight the need for additional research to gain a better understanding of the underlying mechanisms and develop appropriate interventions aimed at minimizing the risk of TMD in patients undergoing orthodontic treatment. Clinicians should be aware of TMD as a potential complication of orthodontic treatment and implement appropriate monitoring strategies.

Evaluation of occlusion parameters using T-scan III in patients receiving fixed orthodontic treatment

Objectives:

The aim of this study is to examine the relationship between occlusal factors and temporomandibular joint diseases (TMD).

Material and Methods:

In our study, 43 individuals who had fixed orthodontic treatment and 20 individuals who did not need treatment at Istanbul Aydin University Faculty of Dentistry Department of Orthodontics were included in the study. Evaluations were made at the beginning of treatment (T0) and at 6 months (T1). T-Scan® computerized Occlusion Analyzer was used to evaluate the number of contact points, occlusal force parameters during centric occlusion and lateral movements, and occlusion and disclusion times. Differences between groups were evaluated with Mann–Whitney or independent t-test, and within-group differences were evaluated with Wilcoxon sign test or paired t-test, depending on whether the data showed normal distribution or not.

Results:

There was no statistically significant distinction between the gender-based parameters and right and left joint of Joint Vibration Analysis record in all three groups (P > 0.05). At the beginning of orthodontic treatment, there was no statistical difference in the variables within the group and between the groups. As a result of the comparison between the beginning of treatment (T0) and the 6th month (T1), no significant difference was found between the parameters of the anterior/posterior occlusal force distribution of the right-left quadrant and the force distribution of the working and non-working sides in lateral movements, and the occlusion and disclusion time parameters. Maximum intercuspal position left/right (MxlntlTSCANT1) was found to be statistically significant at 6 months in individuals who received fixed orthodontic treatment with extraction compared to the none xtraction treatment group (P < 0.05).

Conclusion:

According to our research, T-scan is one of the best devices for the early detection of TMD, especially for people undergoing orthodontic treatment. T-scan offers fast, non-invasive, and repeatable occlusion recording.

Examination of chewing performance with extraction and non-extraction fixed orthodontic treatment – A prospective clinical 1-year study

Objectives:

It shows that patients receiving orthodontic treatment may have a risk of developing temporomandibular disorder symptoms. The aim of this study is to examine the changes in the chewing system of occlusal contact parameters related to joint vibrations, chewing patterns, and measured excursive movements in fixed and non-extractive orthodontic treatments.

Material and Methods:

A total of 43 individuals with premolar extraction (n = 23) and without extraction (n = 20) who applied to the Department of Orthodontics, Dentistry Faculty of Istanbul Aydin University and needed orthodontic treatment were included in the study. In this study, 43 active fixed orthodontic treatment patients were conducted at the beginning (T0) and 6th month (T1) and 12th month (T2) on the parameter recorded during chewing. For occlusion analysis, T-Scan® computerized occlusion analysis recording and examination of the chewing pattern were used for JVA and JT temporomandibular joint parameters. Depending on whether the data showed normal distribution or not, differences between groups were evaluated using the Mann–Whitney or independent t-test, and intragroup differences were evaluated using the Wilcoxon sign test or paired t-test.

Results:

At the beginning, 6th month and 12th month of orthodontic treatment, it was observed that the opening, closing, and occlusion times and joint vibration frequencies in the chewing pattern in cases with and without tooth extraction, the integral value differences of total integral, and frequencies below 300 Hz and above 300 Hz were statistically significant (P < 0.001). In digital occlusion analysis values, the right-left differences were not found statistically significant in the measurements made in cases with and without extraction (P > 0.05), while there were statistically significant differences in disclusion values at the beginning, 6th and 12th months (P < 0.05).

Conclusion:

At the beginning of the orthodontic treatments with or without extraction, it was observed that the values at the joint level changed significantly in the 6th month. However, the changes in the joints during the treatment, when they return to their ideal values at the end of the 12th month, are more than the change in occlusion.

The relationship between orthodontic treatment and temporomandibular disorders: A dental specialists' perspective

Introduction:

The relationship between temporomandibular disorders (TMDs) and orthodontic treatment/malocclusion has changed from a cause-and-effect association to an idea without sufficient evidence.

Objective:

This survey was designed to assess the beliefs of different disciplines - orthodontists, oral surgeons, and oral medicine specialists - on the relationship between TMDs and orthodontic treatment, with regard to treatment, prevention and etiology of TMDs.

Method:

A survey in the form of questionnaire was designed and distributed to 180 orthodontists, 193 oral surgeons and 125 oral medicine specialists actively involved in treating TMDs. The questionnaire aimed to collect basic information about each participant and their beliefs, and clinical management of patients with TMDs.

Results:

Halve of the responding orthodontists and most of the oral surgeons (69.9%) were male participants, whereas the majority of oral medicine specialists (83.3%) were female respondents. The participants’ age ranged from 29 to 58 years. The majority of orthodontists believes that there is no relationship between orthodontic treatment and TMDs, and that orthodontic treatment does not provoke TMDs or prevent the onset of the disorder. However, oral surgeons and oral medicine specialists have different and conflicting opinions. Most surgeons tended to treat those patients, while most of the other two disciplines tended to seek an interdisciplinary approach. Chi-square test was done to find an association between the referral status and specialists’ experience, and to compare between the different disciplines’ belief.

Conclusions:

Orthodontist’s beliefs were in accordance with the scientific evidence, whereas most oral surgeons and oral medicine specialist believed that orthodontic treatment may provoke TMDs. Therefore, continuing program series development is important to embrace the concept of the multidisciplinary team approach and improve the health care and quality of life for those patients.

Temporomandibular disorders among medical students in China: prevalence, biological and psychological risk factors

BACKGROUND

The purpose of the present study is to evaluate the prevalence of temporomandibular disorders (TMD) and their associated biological and psychological factors in Chinese university students.

METHODS

A total of 754 students were included from Zunyi Medical University, each participant completed questionnaires and clinical examinations according to the Diagnostic Criteria for Temporomandibular Disorders.

RESULTS

The overall prevalence of TMD was 31.7% among medical students. Subjects with TMD had a high prevalence of bruxism, empty chewing, unilateral chewing, chewing gum, anterior teeth overbite, anterior teeth overjet, depression, anxiety, and sleep disturbance. Moreover, sleep bruxism, empty chewing, unilateral chewing, anterior teeth overbite, depression, and anxiety were the strongest risk factors for TMD.

CONCLUSIONS

Individuals with TMD have a high prevalence of psychological distress and oral parafunctional habits. Except for the psychological factors associated with TMD, bruxism, abnormal chewing, and malocclusion also shared similar risks for TMD.