Craniomandibular Disorders and Mandibular Reference Position in Orthodontic Treatment

Abstract

The aim of this paper is to bring into focus the literature on the choice of the mandibular reference position in orthodontic treatment; of a particular reference to this paper is intercuspal position, centric relation position, or therapeutic position. To give a comprehensive account of the literature review on craniomandibular disorders (CMD), we have relied on books and articles using both Google Scholar and PubMed. Selection criteria included a combination of Mesh and type of article. Article classification was made by two authors, using the following structure outline: prevalence of craniomandibular disorders, its etiology and pathophysiology, occlusion and craniomandibular disorders, orthodontic treatment and CMD, and the mandibular reference position in orthodontics. An important conclusion that emerged from the present literature review is that CMD do not seem to be directly related to orthodontic treatment, and their appearance cannot be predicted or prevented by any means. Therefore, orthodontists must adopt a mandibular reference suitable to their patients and which best respects the balance existing in the stomatognathic system.

Relationship between orthodontics and temporomandibular disorders

“…A comprehensive medical and dental history and a thorough physical examination of these patients in combination with the appropriate radiographic examinations of the TMJ, constitute the most comprehensive diagnostic evaluation of the TMDs 23,44,64,65 , especially in the case of adult patients 66 .…”

TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia: a cross-sectional study

“…Early detection of TMD in malocclusion, especially related to mandibular asymmetry before establishing orthodontic therapy, is mandatory for interdisciplinary approaches for any dentofacial treatment nowadays 2, 11, 32, 33 . Some questionnaires can be used as a tool to achieve early detection of TMD.…”

“…One element of this balance is craniofacial symmetry, which is frequently subject to discussion between clinicians and is the subject of multiple different studies in the last decades 2, 11, 12 . Although perfect craniofacial symmetry does not exist in nature, gross abnormalities in symmetry are considered as a major cause of non-dental pain in the orofacial pain region 10, 12, 34 .…”

“…Expanding the fields of phenomics and genomic medicine to understand why asymmetric function occurs is required to achieve personalized orthodontic treatment in young orthodontic patients 40 . Stress might also have a role in the appearance of developmental disorders and required comprehensive diagnostic tools 11, 19, 35 .…”

Periodontal Considerations in Adult Orthodontic Patients

“…Finally, despite the importance of considering all periodontal and mechanical features of retentive devices, the authors of the present manuscript consider of primarily importance for long term retention a final orthodontic result that assures occlusal stability, meaning correct teeth positioning, physiological movement with no interferences or dislocating pre-contacts [63]. It is extremely relevant to recognize the importance of a good balance between static and dynamic occlusion and all related craniofacial structures represented by temporomandibular joint (TMJ) and the neuromuscular system for both oral rehabilitation and long-term stability.…”