Alterations of temporomandibular disorders before and after orthognathic surgery - A systematic review
ABSTRACT To answer the question whether orthognathic surgery does affect the prevalence of signs and symptoms of temporomandibular disorders (TMDs).
A literature survey in the PubMed and Cochrane Library electronic databases was performed and covered the period from January 1966 to April 2006. The inclusion criteria were controlled, prospective or retrospective studies comparing TMDs before and after orthognathic surgery in patients with malocclusion. There were no language restrictions, and three reviewers selected and extracted the data independently. The quality of the retrieved articles was evaluated by four reviewers.
The search strategy resulted in 467 articles, of which 3 met the inclusion criteria. Because of few studies with unambiguous results and heterogeneity in study design, the scientific evidence was insufficient to evaluate the effects that orthognathic surgery had on TMD. Moreover, the studies had problems with inadequate selection description, confounding factors, and lack of method error analysis.
To obtain reliable scientific evidence, additional well-controlled and well-designed studies are needed to determine how and if orthognathic surgery alters signs and symptoms of TMD.
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ABSTRACT: INTRODUÇÃO: nos últimos anos, a inter-relação entre a Ortodontia e as disfunções temporomandibulares (DTMs) tem despertado interesse crescente na classe odontológica, sendo tema de discussões e controvérsias. Em um passado recente, a oclusão era considerada como principal fator etiológico das DTMs, sendo o tratamento ortodôntico uma medida terapêutica primária para um restabelecimento fisiológico do sistema estomatognático. Assim, passou-se a investigar o papel da Ortodontia na prevenção, desencadeamento e tratamento das DTMs. Com a realização de estudos científicos com metodologias mais rigorosas e precisas, a relação entre o tratamento ortodôntico e as DTMs pôde ser avaliada e questionada dentro de um contexto baseado em evidências científicas. OBJETIVO: o presente trabalho, através de uma revisão sistemática de literatura, teve como objetivo analisar a inter-relação entre a Ortodontia e as DTMs, verificando se o tratamento ortodôntico é fator contribuinte para o desenvolvimento de DTM. MÉTODOS: foi realizado um levantamento em bases de pesquisa (Medline, Cochrane, Embase, Pubmed, Lilacs e BBO) entre os anos de 1966 e 2009, com enfoque em estudos clínicos randomizados, estudos longitudinais prospectivos não randomizados, revisões sistemáticas e meta-análises. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a 18 artigos, sendo que 12 eram estudos longitudinais prospectivos não randomizados, 4 revisões sistemáticas, 1 estudo clínico randomizado e uma meta-análise, os quais avaliaram a relação entre tratamento ortodôntico e DTM. CONCLUSÕES: pela análise da literatura, conclui-se que o tratamento ortodôntico não pode ser considerado fator contribuinte para o desenvolvimento de disfunções temporomandibulares.12/2010; 15(6):e1-e10.
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ABSTRACT: PURPOSE: to investigate and to describe the functional characterization and temporomandibular disorders (TMD) before and after orthognathic surgery and myofunctional treatment of Class II Dentofacial deformity patients.METHOD: a longitudinal study including 22 subjects with Class II dentofacial deformity, defined after analysis of inclusion and exclusion criteria, was conducted. The investigation was divided in 2 steps: myofunctional evaluation prior to the surgery and a re-evaluation 4 months after the orthognathic surgery and myofunctional treatment. Statistical tests were used to compare the data.RESULTS: initial complaints included functional difficulties. The functional disorders were described. TMD was observed in the majority of the sample. After treatment the complaints decreased; the majority of the patients showed remission of the TMD and functional improvement.CONCLUSION: there are specific myofunctional modifications related to the stomatognathic functions and to TMD in Class II Dentofacial deformity patients. Both the surgery and the speech therapy produced myofunctional modifications, with reduction of initial complaints, as well as a decrease of TMD and correction of functional patterns. The swallowing function was the most benefited by the treatments.Revista CEFAC 12/2011; 13(6):1086-1094. DOI:10.1590/S1516-18462011000600015
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ABSTRACT: Objective: In order to understand the conflicting information on temporomandibular joint (TMJ) pathophysiologic responses after mandibular advancement surgery, an overview of the literature was proposed with a focus on certain risk factors. Methods: A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases in the period from January 1980 through March 2013. Various combinations of keywords related to TMJ changes [disc displacement, arthralgia, condylar resorption (CR)] and aspects of surgical intervention (fixation technique, amount of advancement) were used. A hand search of these papers was also carried out to identify additional articles. Results: A total of 148 articles were considered for this overview and, although methodological troubles were common, this review identified relevant findings which the practitioner can take into consideration during treatment planning: 1- Surgery was unable to influence TMJ with preexisting displaced disc and crepitus; 2- Clicking and arthralgia were not predictable after surgery, although there was greater likelihood of improvement rather than deterioration; 3- The amount of mandibular advancement and counterclockwise rotation, and the rigidity of the fixation technique seemed to influence TMJ position and health; 4- The risk of CR increased, especially in identified high-risk cases. Conclusions: Young adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful TMJ, and are subject to less improvement after surgery and prone to CR. Furthermore, thorough evidenced-based studies are required to understand the response of the TMJ after mandibular advancement surgery.Journal of applied oral science: revista FOB 02/2014; 22(1):2-14. DOI:10.1590/1678-775720130056 · 0.80 Impact Factor