Alterations of Temporomandibular Disorders before and after Orthognathic Surgery
Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö , Sweden. The Angle Orthodontist
(Impact Factor: 1.23).
08/2007; 77(4):729-34. DOI: 10.2319/052906-215
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.
Available from: José Rino Neto
- "Systematic reviews on temporomandibular disorder (TMD) both before and after
orthognathic surgery have also reported a heterogeneous study design and
controversial results1,6. Hackney, et al.61(1989) did not find any significant
difference in the incidence of TM pain or clicking following bilateral sagittal split
osteotomy and rigid fixation. "
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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.
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.
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.
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.
Available from: Charles S Greene
- "Insufficient evidence to support or refute the use of arthrocentesis and joint lavage for TMJ disorders treatment Stapelmann, 2008 (61) NTI-tss device 9 Qualitative systematic NTI-tss device may be successfully used for the management of bruxism and TMDs Caution to avoid potential unwanted effects Guarda-Nardini, 2008 (62) TMJ total prosthesis 30 Systematic Encouraging outcomes for all the three total prosthetic systems currently available on market Too few research groups involved Abrahamsson, 2007 (63) Orthognathic surgery 3 Systematic Low methodological quality of included studies No conclusions on how and if orthognathic surgery affects TMD "
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ABSTRACT: The defining characteristic of a profession - and especially a health-care profession - is that the behaviour of its members is proscribed by a formal code of ethics. The main purpose of such codes is to guide practitioners' interactions with patients, assuring that patient interests are protected. In other words, the ethical code requires practitioners to place their patients' needs for proper diagnosis and appropriate treatment ahead of their own needs for income and advancement. The dental profession has a code of ethics that was developed by the American Dental Association many years ago; in most clinical situations, determination of proper behaviour is self-evident. However, the field of temporoman-dibular disorders (TMDs) has been the subject of considerable controversy for over half a century, and many people have argued that this makes it impossible to evaluate various approaches to treatment of TMDs within an ethical framework. In this article, the authors argue that the large volume of scientific evidence in the contemporary TMD literature provides an ethical framework for the diagnosis and treatment of patients with TMDs within a biopsychosocial medical model. They present a summary of the research with contemporary scientific integrity, which has produced that information over a period of many years. Based on that research, they conclude that dentists may provide conservative and reversible treatments that will be successful for most TMDs and in doing so will comply with the profession's code of ethics. Conversely, the authors claim that those dentists who continue to follow the older mechanistic models of TMD aetiology and treatment are not only out of step scientifically, but are placing their patients' welfare at risk by providing unnecessary irreversible bite-changing and jaw-repositioning interventions. Therefore, debate of these issues should not be solely focused on scientific merit, but also upon the compelling ethical obligations that dentists have as a result of the contemporary scientific literature regarding TMDs.
Available from: Matthias Lange
- "Too few research groups involved. Abrahamsson, 2007 90 Orthognathic surgery 3 Systematic Low methodological quality of included studies No conclusions on how and if orthognathic surgery affects TMD. "
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ABSTRACT: Zusammenfassung Temporomandibuläre Dysfunktionen (TMD) sind ein häu-figer Befund im Fall von Gesichtstraumata beziehungs-weise bei zahnärztlichen Behandlungsfehlern. Die Zahl der Fälle, in denen Rechtsansprüche im Zusammenhang mit einer TMD-Schädigung geltend gemacht werden, hat mit den Jahren zugenommen. Die Behandlung von TMD im medizinrechtlichen Kontext wird durch die Besonder-heiten dieser Erkrankungen kompliziert, deren Symptome heterogen, fluktuierend und von multifaktorieller Genese sind. Eine systematische Suche in Medline, der PubMed-Datenbank der National Library of Medicine, ergab, dass trotz der wachsenden Aufmerksamkeit, die den medi-zinrechtlichen Aspekten des Zahnarztberufs zuteil wird, wenig Literatur über die Beurteilung von TMD-Patienten vorhanden ist. Aus diesen Gründen wurde das evidenz-basierte Wissen im Bereich der TMD-Behandlung in der vorliegenden Arbeit zusammengefasst, um sinnvolle Vor-schläge für eine medizinrechtliche Herangehensweise an die temporomandibulären Dysfunktionen vorzulegen.
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