THE INFLUENCE OF ORTHODONTIC TREATMENT ON THE DEVELOPMENT OF TEMPOROMANDIBULAR DISORDERS: A NARRATIVE REVIEW

Vollständiger Abstract

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Background The relationship between orthodontic treatment and temporomandibular disorders (TMD) remains controversial. Earlier concepts emphasized occlusal changes and orthodontic mechanics, whereas current evidence supports a multifactorial biopsychosocial model. Causal assessment is complicated by pre-existing symptoms, the natural increase in TMD prevalence during adolescence, and transient adaptive symptoms during treatment. Aims The aim of this narrative review was to evaluate the association between orthodontic treatment and the development of new TMD and to determine whether the risk differs according to treatment modality. Materials and methods A structured search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for English-language publications from January 2000 to February 2025. Earlier landmark publications were also included for historical context. Systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and observational studies were considered. Of 312 identified publications, 74 full-text articles were assessed and 47 publications were included in the narrative synthesis. Results The available evidence does not support orthodontic treatment as an independent etiological factor for new TMD. Premolar extraction therapy was not associated with a higher risk of TMD than non-extraction treatment. Functional orthodontic appliances may produce adaptive changes in the temporomandibular joint, but these changes have not been shown to cause persistent joint dysfunction. Fixed appliances and clear aligners demonstrated comparable safety, and no evaluated treatment modality was consistently associated with a higher risk of new TMD. Transient muscle tenderness, joint discomfort, or joint sounds may occur during treatment but are generally self-limiting. Discussion The findings support a multifactorial interpretation of TMD rather than a direct causal relationship with orthodontic treatment. Baseline examination and documentation of temporomandibular joint signs and symptoms are important for distinguishing pre-existing disorders from symptoms arising during treatment. Conclusion Orthodontic treatment should not be regarded as an independent etiological factor for TMD. Treatment decisions should be based on established orthodontic and skeletal indications. Further long-term prospective studies using standardized DC/TMD diagnostic criteria are needed.