Published: 2021-10-27

Temporomandibular disorders and occlusion effect on orthodontic treatment

Sara Ahmed Hifny, Nada Mohsen Alsaidi, Eman Abdullah Al Khater, Maryam Fuad Alomran, Nawaf Khamis Alnufaie, Dalia Mansour Almotairi, Sama Abdulelah Saeedi, Shahad Hassan Fayyumi, Alanoud Turki Alhelali, Abdulelah Ahmed Alnami, Raed Abdullah Alamri


Evidence in the literature indicates the significant association between temporomandibular joint disorders and orthodontic treatment. As a result of the epidemiological investigations that indicated the high prevalence of temporomandibular disorders among patients with malocclusions, it has been suggested that there might be a cause-and-effect correlation between both of these conditions. Evidence in the literature is inconsistent regarding the association between temporomandibular joint disorders and malocclusion, and orthodontic treatment. In the present literature review, we have discussed the different aspects of temporomandibular disorders and malocclusion and their relation to orthodontic treatment approaches. Among the different studies in the literature, solid evidence indicates a significant association between temporomandibular joint disorders and malocclusion, and accordingly, research aimed to study the impact of orthodontic treatment on curing and preventing the development of these disorders. The current evidence seems to be neutral regarding the impact of orthodontic treatment approaches on curing and preventing temporomandibular disorders. Therefore, it has been suggested that further investigations are still needed for adequate further evaluation. Finally, as we previously discussed, the attending orthodontist should adequately take care of certain parameters in these patients, including centric relation, maximal intercuspal position, simultaneous contact points, and evaluating the direction of forces applied on the relevant teeth.


Orthodontics, Malocclusion, Temporomandibular, Management, Orofacial

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Celić R, Jerolimov V, Pandurić J. A study of the influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD. Int J Prosthodont. 2002;15(1):43-8.

Miller JR, Burgess JA, Critchlow CW. Association between mandibular retrognathia and TMJ disorders in adult females. J Public Health Dent. 2004;64(3):157-63.

Egermark I, Magnusson T, Carlsson GE. A 20-year follow-up of signs and symptoms of temporomandibular disorders and malocclusions in subjects with and without orthodontic treatment in childhood. Angle Orthod. 2003;73(2):109-15.

Abrahamsson C, Henrikson T, Nilner M, Sunzel B, Bondemark L, Ekberg EC. TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment. Int J Oral Maxillofac Surg. 2013;42(6):752-8.

Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants. 2013;28(6):393-414.

Taylor LP, Sletten WO, Dumont TD. The effect of specially designed and managed occlusal devices on patient symptoms of tinnitus: A cohort study. Cranio. 2019;37(2):101-10.

Rinchuse DJ, Kandasamy S. Centric relation: A historical and contemporary orthodontic perspective. J Am Dent Assoc. 2006;137(4):494-501.

Seligman DA, Pullinger AG. Analysis of occlusal variables, dental attrition, and age for distinguishing healthy controls from female patients with intracapsular temporomandibular disorders. J Prosthet Dent. 2000;83(1):76-82.

Clark GT, Adler RC. A critical evaluation of occlusal therapy: occlusal adjustment procedures. J Am Dent Assoc. 1985;110(5):743-50.

Wyatt WE. Preventing adverse effects on the temporomandibular joint through orthodontic treatment. Am J Orthod Dentofacial Orthop. 1987;91(6):493-9.

Morales WC, Goldman BM. Are speech-based techniques for determination of occlusal vertical dimension reliable?. Compend Contin Educ Dent. 1997;18(12):1214-5.

Williamson EH, Lundquist DO. Anterior guidance: its effect on electromyographic activity of the temporal and masseter muscles. J Prosthet Dent. 1983;49(6):816-23.

Burgett FG. Trauma from occlusion. Periodontal concerns. Dent Clin North Am. 1995;39(2):301-11.

Haydar B, Ciğer S, Saatçi P. Occlusal contact changes after the active phase of orthodontic treatment. Am J Orthod Dentofacial Orthop. 1992;102(1):22-8.

Kandasamy S, Greene CS. The evolution of temporomandibular disorders: A shift from experience to evidence. J Oral Pathol Med. 2020;49(6):461-9.

Macfarlane TV, Kenealy P, Kingdon HA, Mohlin BO, Pilley JR, Richmond S, et al. Twenty-year cohort study of health gain from orthodontic treatment: temporomandibular disorders. Am J Orthod Dentofacial Orthop. 2009;135(6):692.

Ruf S, Bock NC. Long-term (≥15 years) effects of Class II treatment: a longitudinal and cross-sectional study on signs and symptoms of temporomandibular disorders. Eur J Orthod. 2019;41(2):172-9.

Pancherz H, Salé H, Bjerklin K. Signs and symptoms of TMJ disorders in adults after adolescent Herbst therapy: a 6-year and 32-year radiographic and clinical follow-up study. Angle Orthod. 2015;85(5):735-42.

Huang X, Cen X, Liu J. Effect of protraction facemask on the temporomandibular joint: a systematic review. BMC Oral Health. 2018;18(1):38.

Alhammadi MS, Fayed MS, Labib A. Three-dimensional assessment of condylar position and joint spaces after maxillary first premolar extraction in skeletal Class II malocclusion. Orthod Craniofac Res. 2017;20(2):71-8.

Gurbanov V, Bas B, Öz AA. Evaluation of Stresses on Temporomandibular Joint in the Use of Class II and III Orthodontic Elastics: A Three-Dimensional Finite Element Study. J Oral Maxillofac Surg. 2020;78(5):705-16.

Bucci R, Rongo R, Levatè C, Michelotti A, Barone S, Razionale AV, D'Antò V. Thickness of orthodontic clear aligners after thermoforming and after 10 days of intraoral exposure: a prospective clinical study. Prog Orthod. 2019;20(1):36.

Macedo CR, Silva AB, Machado MA, Saconato H, Prado GF. Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database Syst Rev. 2007;(4):5514.

Manfredini D, Lombardo L, Vigiani L, Arreghini A, Siciliani G. Effects of invisible orthodontic retainers on masticatory muscles activity during sleep: a controlled trial. Prog Orthod. 2018;19(1):24.

Liu P, Wu G, Liu J, Jiao D, Guo J. Assessment of oral parafunctional behaviors and electromyographic activities of the masticatory muscles in young female patients with orthodontic invisalign treatment. Int J Clinic Exp Med. 2017;10:15323-8.

Castroflorio T, Bargellini A, Lucchese A, Manuelli M, Casasco F, Cugliari G, et al. Effects of clear aligners on sleep bruxism: randomized controlled trial. J Biol Regul Homeost Agents. 2018;32(2):21-9.

Michelotti A, Rongo R, Antò V, Bucci R. Occlusion, orthodontics, and temporomandibular disorders: Cutting edge of the current evidence. J World Fed Orthod. 2020;9(3):15-8.

Grünheid T, Gaalaas S, Hamdan H, Larson BE. Effect of clear aligner therapy on the buccolingual inclination of mandibular canines and the intercanine distance. Angle Orthod. 2016;86(1):10-6.

Hennessy J, Garvey T, Awadhi EA. A randomized clinical trial comparing mandibular incisor proclination produced by fixed labial appliances and clear aligners. Angle Orthod. 2016;86(5):706-12.

Suvinen TI, Reade PC, Kemppainen P, Könönen M, Dworkin SF. Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain. 2005;9(6):613-33.

Manfredini D, Lombardo L, Siciliani G. Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era? J Oral Rehabil. 2017;44(11):908-23.

Kanter RJAM, Battistuzzi PGFCM, Truin GJ. Temporomandibular Disorders: "Occlusion" Matters! Pain Res Manag. 2018;2018:8746858.

Bucci R, Koutris M, Lobbezoo F, Michelotti A. Occlusal sensitivity in individuals with different frequencies of oral parafunction. J Prosthet Dent. 2019;122(2):119-22.

Bucci R, Koutris M, Palla S, Sepúlveda RGF, Lobbezoo F, Michelotti A. Occlusal tactile acuity in temporomandibular disorder pain patients: A case-control study. J Oral Rehabil. 2020;47(8):923-9.

Bucci R, Lobbezoo F, Michelotti A, Orfanou C, Koutris M. Delayed-onset muscle soreness does not influence occlusal sensitivity and position sense of the mandible. J Oral Rehabil. 2017;44(9):655-63.

Dibbets JM, Weele LT, Uildriks AK. Symptoms of TMJ dysfunction: indicators of growth patterns? J Pedod. 1985;9(4):265-84.

Sadowsky C, Theisen TA, Sakols EI. Orthodontic treatment and temporomandibular joint sounds--a longitudinal study. Am J Orthod Dentofacial Orthop. 1991;99(5):441-7.

Paquette DE, Beattie JR, Johnston LE. A long-term comparison of nonextraction and premolar extraction edgewise therapy in "borderline" Class II patients. Am J Orthod Dentofacial Orthop. 1992;102(1):1-14.

Beattie JR, Paquette DE, Johnston LE Jr. The functional impact of extraction and nonextraction treatments: a long-term comparison in patients with "borderline," equally susceptible Class II malocclusions. Am J Orthod Dentofacial Orthop. 1994;105(5):444-9.

Luppanapornlarp S, Johnston LE. The effects of premolar-extraction: a long-term comparison of outcomes in "clear-cut" extraction and nonextraction Class II patients. Angle Orthod. 1993;63(4):257-72.

Mohlin B, Axelsson S, Paulin G, Pietilä T, Bondemark L, Brattström V, Hansen K, et al. TMD in relation to malocclusion and orthodontic treatment. Angle Orthod. 2007;77(3):542-8.