Temporomandibular Joint Disorders in Patients With Different Facial Morphology. A Systematic Review of the Literature

Manfredini, Daniele; Segù, Marzia; Arveda, Niki; Lombardo, Luca; Siciliani, Gíuseppe; Rossi, Alessandro; Guarda-Nardini, Luca

doi:10.1016/j.joms.2015.07.006

Cited by 93 publications

(66 citation statements)

References 38 publications

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“…This means that in patients with TMJ disorders, the presence of cross‐bite is not causative of the joint pathology, but it could be even viewed as the consequence of a certain skeletal morphology. A similar conclusion can be reached in the case of sagittal skeletal profiles that are associated with an increased risk for disc displacement . Such suggestion is in line with recent observations that orthodontics is neutral as far as the temporomandibular disorders are concerned .…”

Section: Discussionsupporting

confidence: 88%

Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era?

Manfredini

Lombardo

Siciliani

2017

J of Oral Rehabilitation

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271

183

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To answer a clinical research question: 'is there any association between features of dental occlusion and temporomandibular disorders (TMD)?' A systematic literature review was performed. Inclusion was based on: (i) the type of study, viz., clinical studies on adults assessing the association between TMD (e.g., signs, symptoms, specific diagnoses) and features of dental occlusion by means of single or multiple variable analysis, and (ii) their internal validity, viz., use of clinical assessment approaches to TMD diagnosis. The search accounted for 25 papers included in the review, 10 of which with multiple variable analysis. Quality assessment showed some possible shortcomings, mainly related with the unspecified representativeness of study populations. Seventeen (N = 17) articles compared TMD patients with non-TMD individuals, whilst eight papers compared the features of dental occlusion in individuals with TMD signs/symptoms and healthy subjects in non-patient populations. Findings are quite consistent towards a lack of clinically relevant association between TMD and dental occlusion. Only two (i.e., centric relation [CR]-maximum intercuspation [MI] slide and mediotrusive interferences) of the almost forty occlusion features evaluated in the various studies were associated with TMD in the majority (e.g., at least 50%) of single variable analyses in patient populations. Only mediotrusive interferences are associated with TMD in the majority of multiple variable analyses. Such association does not imply a causal relationship and may even have opposite implications than commonly believed (i.e., interferences being the result, and not the cause, of TMD). Findings support the absence of a disease-specific association. Based on that, there seems to lack ground to further hypothesise a role for dental occlusion in the pathophysiology of TMD. Clinicians are encouraged to abandon the old gnathological paradigm in TMD practice.

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Section: Discussionsupporting

confidence: 88%

Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era?

Manfredini

Lombardo

Siciliani

2017

J of Oral Rehabilitation

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271

183

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“…However, Manfredini in a recent systematic review supports the existence of TMDs in the skeletal pattern (Angle Class II malocclusions) with increased anterior lower height due to displacement of the articular disc 34 . Henrikton 40 also refers that patients with untreated Angle Class II malocclusions who suffer from muscular signs of TMJ experience decrease in symptoms after the orthodontic treatment.…”

Section: Epidemiology Of the Temporomandibular Disordersmentioning

confidence: 98%

Relationship between orthodontics and temporomandibular disorders

Tagkli¹,

Paschalidi²,

Katsadouris³

et al. 2017

Balkan J Dent Med

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“…The measurement of risk is further complicated by the multitude of factors that interact in a biological model and that can moderate the effects of bruxism positively or negatively. Examples of the latter are represented by poorly lubricated low‐PH oral environments that greatly increased the observed enamel wear due to tooth grinding, or by the unfavourable muscle force vectors described in the orthodontic and maxillofacial surgery literature that predispose hyperdivergent individuals to TMJ disorders …”

Section: How To Identify Clinically Relevant Bruxismmentioning

confidence: 99%

The bruxism construct: From cut‐off points to a continuum spectrum

Manfredini

Ahlberg

Wetselaar

et al. 2019

J of Oral Rehabilitation

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111

153

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This commentary discusses the need to move on from the adoption of cut‐off points for the definition of the presence/absence of bruxism and justifies the need to embrace an evaluation based on the continuum of jaw motor behaviours. Currently, the number of events per hour, as identified by polysomnography (PSG), is used to define the presence of sleep bruxism (SB). Whilst PSG still remains the indispensable equipment to study the neurophysiological correlates of SB, the scoring criteria based on a cut‐off point are of questionable clinical usefulness for the study of oral health outcomes. For awake bruxism (AB), criteria for a definite diagnosis have never been proposed. Some goal‐oriented strategies are proposed to identify bruxism behaviours that increase the risk of negative oral health outcomes (eg, tooth wear, muscle and/or temporomandibular joint [TMJ] pain, restorative complications). One possible strategy would embrace an improved knowledge on the epidemiology and natural variability of bruxism, even including study of the amount of PSG/SB and electromyography masticatory muscle activity (EMG/MMA) during sleep and the frequency/prevalence of bruxism behaviours during wakefulness that are needed to represent a risk factor for clinical consequences, if any. There should not be any preclusion about the diagnostic strategies to pursue that goal, and a combination of instrumental and non‐instrumental approaches may even emerge as the best available option. Once data are available, large‐scale, non‐selected population samples representing the entire continuum of EMG/MMA activities are also needed, in the attempt to estimate untreated health risks in the population.

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Temporomandibular Joint Disorders in Patients With Different Facial Morphology. A Systematic Review of the Literature

Cited by 93 publications

References 38 publications

Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era?

Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era?

Relationship between orthodontics and temporomandibular disorders

The bruxism construct: From cut‐off points to a continuum spectrum

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