Occlusion, orthodontic treatment, and temporomandibular disorders: A review

A review of the current literature regardmg the interaction of morphologic and functional occlusal factors relative to TMD indicates tbat tbere is a relatively low association of occlusal factors m characterizmg TMD. Skeletal anterior open hite, overjets greater than 6 to 7 mm, retruded cuspal posttion/intercuspal position slides greater than 4 mm, unilateral lingual crossbite, and five or more missing posterior teeth are the five occlusal features that have heen associated with specific diagnostic groups of TMD conditions. The first three factors often are associated with TMJ arthropathies and may be the result of osseous or ligamentous changes within the temporomandibular articulation. With regard to tbe relationship of orthodontic treatment to TMD, the current literature indicates that orthodontic treatment performed during adolescence generally does not increase or decrease the odds of developing TMD later in life. There is no elevated risk of TMD associated with any particular type of orthodontic mechanics or with extraction protocols. Althougb a stable occlusion is a reasonable orthodontic treatment goal, not achieving a specific gnathologically ideal occlusion does not result in TMD signs and symptoms. Thus, according to tbe 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.