Abstract
The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.
Highlights
Temporomandibular disorders (TMDs) are a series of clinical problems that affect the temporomandibular joint (TMJ), masticatory musculatures, the surrounding bony and soft tissue structures, or multiple combinations of these
Exclusion criteria were patients with syndromes or craniofacial deformities, such as cleft lip and palate, previous history of orthognathic surgery, the place of orthodontic treatment performed other than the same institution (Department of Orthodontics, Chonnam National University Dental Hospital (CNUDH)), and no complete orthodontic treatment durations record
Of the 182 patients who received surgical orthodontic treatment, 116 patients with orthodontics-first approach (OFA) consisted of 62 males
Summary
Temporomandibular disorders (TMDs) are a series of clinical problems that affect the temporomandibular joint (TMJ), masticatory musculatures, the surrounding bony and soft tissue structures, or multiple combinations of these. Several reviews indicate various occlusal factors contribute to development of TMD signs and symptoms, and reported that prevalence of TMD symptoms in patients with dentofacial deformities is higher than that in the general population [3,4,5]. Surgical-orthodontic treatment is a common treatment protocol for patients with dentofacial deformities, and orthognathic surgery is performed to reposition the maxilla and/or mandible to a more balanced position. There is still not good agreement about whether surgical-orthodontic treatment will improve or aggravate the signs and symptoms of TMD, or have no significant effect on them. Some studies reported that the positional changes of the condyle in the glenoid fossa during orthognathic surgery may cause TMD symptoms, even causing further deleterious effects on the TMJ and worsening pre-existing symptoms and dysfunction [14, 15]
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