Investigation of the association between orthodontic treatment and temporomandibular joint pain and dysfunction in the South Korean population

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.

The association between orthodontic treatment and temporomandibular disorders diagnosis and disease characteristics

BACKGROUND

The association between orthodontic treatment and temporomandibular disorders (TMD) has been contentious in the literature.

OBJECTIVES

To analyse the associations between orthodontic treatment and TMD diagnosis and diseases characteristics.

METHODS

This case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Differences in orthodontic treatment between TMDs and controls, as well as across different TMD diagnoses within the TMD group were analysed. Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality.

RESULTS

Of the 291 participants, 119 (40.9%) underwent orthodontic treatment and 172 (59.1%) had no orthodontics experience. Orthodontic treatment included: mandibular orthodontic treatment (102 subjects) and maxillary orthodontic treatment (113 subjects) of those 47 used a headgear. Following multivariate analysis among TMDs, orthodontic treatment was associated with a good level of oral hygiene versus poor (Odds ratio [OR]: 5.17 [1.04-25.59]), lower number of tender muscles [OR = 0.84 (0.74-0.96)] and lower (better) Pittsburgh Sleep Quality Index (PSQI) scores (OR = 0.86 [0.76-0.97]). None of the studied parameters maintained a statistically significant association with orthodontic treatment in the multivariate analysis among the entire study population.

CONCLUSIONS

Utilising a holistic approach, this study supports the main hypothesis that orthodontic treatment is not associated with TMD diagnosis and disease characteristics.

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.

Association between orthodontic treatment and the occurrence of temporomandibular disorders: A systematic review and meta-analysis

Background

Temporomandibular disorders (TMD) are related to a series of clinical manifestations that appear in the form of pain. Currently, there is controversy about the appearance of TMDs after orthodontic treatment. Therefore, the objective of the present study was to determine the association between orthodontic treatment and the occurrence of Temporomandibular Disorders (TMD).

Material and Methods

A bibliographic search was carried out until April 2022, in the following electronic databases: Pubmed/Medline, Scopus, Scielo, Google Scholar and Web of Science. We included studies that were case-control and cohort studies, dealing with the association between orthodontic treatment and TMD, in English and Spanish, and with no time limit. The Newcastle-Ottawa scale was used to assess risk in the included studies. In addition, RevMan 5.3 was considered for meta-analysis, using as a measure the ODDS ratio in a random-effects model with a 95% confidence interval.

Results

The preliminary search yielded a total of 686 articles, discarding those that did not meet the selection criteria, leaving only 6 articles. These studies reported that there is a significant association between orthodontic treatment and the occurrence of TMD, equivalent to an ODDS ratio of 1.84 with a confidence interval of 1.19-2.83.

Conclusions

It is concluded that there is an association between orthodontic treatment and the occurrence of TMD, therefore, a person undergoing orthodontic treatment is up to 1.84 times more likely to develop TMD. Key words:Orthodontic treatment, temporomandibular disorders, orthodontics, cases and controls, cohorts, review, Meta-Analysis.

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.

Associations among Orthodontic History, Psychological Status, and Temporomandibular-Related Quality of Life: A Cross-Sectional Study

OBJECTIVES

This cross-sectional study aimed to evaluate the associations among orthodontic history, psychological status, and temporomandibular-related quality of life.

METHODS

A questionnaire was developed and distributed to students in a local college, containing questions about demographic information, the Patient Health Questionnaire-4 (PHQ-4), the Fonseca anamnestic index, and the Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD). The respondents were divided into with orthodontic history (OS) group and without OS group. Binary logistic regression and multiple linear regression were performed for statistical analysis.

RESULTS

A total of 531 valid questionnaires were collected, covering 161 participants with OS and 370 participants without OS. No statistically significant differences were observed in the scores of PHQ-4 between the two groups. There was statistical difference in the prevalence of TMD (with OS group, 54.66%; without OS group, 40.81%) and the mean value ( ± standard deviations) of the scores of OHIP-TMD (with OS group, 9.64 ± 12.36; without OS group, 6.64 ± 10.79) (p < 0.05). After adjusting confounding factors, participants with OS have worse temporomandibular-related quality of life and a higher risk of having TMD than the participants without OS.

CONCLUSIONS

Orthodontic history was related with the higher prevalence of TMD and worse temporomandibular-related quality of life, but not related with psychological distress, and the cause-and-effect relationship needs further exploration.

Posterior Mandibular Displacement-A Systematic Review Based on Animal Studies

Treating extreme mandibular growth is challenging. The mandible is pushed backwards to address itsprotrusion. Nevertheless, conclusions after such displacement in animals have been contradictory. The aim of the present review is to present measurable alterations of the mandible and the condyle following retractionin healthy rats or rabbits. PubMed, Scopus and Web of Science were accessed for relevant studies up to October 2020. Eligibility was determined by the PICOS process, while the risk of bias was estimated with SYRCLE's risk of bias tool. Retraction resulted in a more distal molar occlusion and the condyle rested more posteriorly. Mandibular anteroposterior bilateral growth restriction was achieved, the condylar process measured smaller and its angulation increased. The condylar neck thickened, its posterior surface flattened, the coronoid process was measured longer, and enlarged retromolar density was registered. Differences in the ramus height and the intercondylar distance were insignificant. Changes persisted for the period of study and subsequently the mandible resumed its inherited growth pattern. The timing of mandibular shaping and TMJ outcomes might depend on the properties of the applied force. Stability is of concern and well-structured, long-term studies are expected to resolve the issue and further clarify the results of posterior mandibular displacement.