Abstract
BackgroundAlthough many orthodontists have no doubts about the effectiveness of functional appliances for mandibular advancement, the impact on the temporomandibular joint (TMJ) is still in dispute. The objective of this systematic review is to examine the main effects on the TMJ of using functional appliances, both in healthy patients and in patients with a pre-existing disorder.Material and MethodsA systematic review of the literature was conducted in accordance with the PRISMA guidelines. Only systematic reviews, meta-analyses, randomized clinical trials (RCTs), case-control studies and cohort studies were included. A detailed language-independent electronic search was conducted in the Pubmed, Scopus, Cochrane Library and Embase databases. All studies published between 2000 and 2015 were included.ResultsA total of 401 articles were identified. Of these, 159 were duplicates and were excluded. On reading the title and abstract, 213 articles were excluded because they did not answer the research question, leaving a total of 29 articles. These articles were read and assessed. Following critical reading of the full text, eight articles were excluded: seven because they were considered of low quality and one because it published redundant data. As a result, 21 articles were included.ConclusionsAfter treatment with functional appliances, the condyle was found to be in a more advanced position, with remodelling of the condyle and adaptation of the morphology of the glenoid fossa. No significant adverse effects on the TMJ were observed in healthy patients and the appliances could improve joints that initially presented forward dislocation of the disk. Key words:Temporomandibular joint, TMJ, orthodontic appliances, functional, mandibular advancement, herbst appliance, bionator.
Highlights
The use of a mandibular advancement appliance to correct skeletal malocclusions associated with mandibular retrognathism is indicated during the first stage of orthodontic treatment (1)
When the functional appliance is inserted, the condyles are moved to a higher position in the articular eminence, which is capable of adaptation, so it could be hypothesized that some morphological changes may take place (6)
The main objective of this systematic review is to examine the main effects on the temporomandibular joint (TMJ) of different functional appliances for mandibular advancement, both in healthy patients and in patients with a pre-existing disorder
Summary
The use of a mandibular advancement appliance to correct skeletal malocclusions associated with mandibular retrognathism is indicated during the first stage of orthodontic treatment (1). The objective is to stimulate mandibular growth and correct the sagittal misalignment by bringing the condyles forward and downward within the glenoid fossa (2,3), as well as remodelling the condyle and glenoid fossa, causing anterior rotation of the mandible and projecting it forwards (4). During this first stage, mandibular retrognathism can be treated with either fixed or removable functional appliances (3,5). Many authors assert that treatment with these devices does not increase the prevalence of temporomandibular disorders (1,7-9) Another important aspect is the positive or negative effect that functional appliances may have on the TMJ of patients with a pre-existing disorder (1). The main objective of this systematic review is to examine the main effects on the TMJ of different functional appliances for mandibular advancement, both in healthy patients and in patients with a pre-existing disorder
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