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Objective <p>This systematic review aimed to synthesize current evidence on the short- and long-term effects of orthodontic treatment techniques—functional appliances, fixed appliances, clear aligners, premolar extractions, and orthognathic surgery—on temporomandibular joint disorders (TMD). It further examined how patient demographics (age, sex, craniofacial morphology) modulate TMJ responses, focusing on morphological, functional, and symptomatic outcomes.</p> Methodology <p>Following PRISMA 2020 guidelines, databases (PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, Google Scholar) were searched for prospective/retrospective cohorts, RCTs, and longitudinal imaging studies (MRI/CBCT) evaluating TMJ outcomes after orthodontic intervention with demographic considerations. Inclusion required validated TMJ assessment and pre-/post-treatment data. Quality appraisal used Cochrane RoB, Newcastle-Ottawa Scale, and AMSTAR 2 tools. Due to study heterogeneity, narrative synthesis was performed.</p> Results <p>Twenty-five studies met inclusion criteria. Functional appliances commonly caused transient, reversible condylar repositioning in adolescents, with no increased TMD risk and occasional functional improvement. Fixed appliances demonstrated stable long-term outcomes (15–20 years) without elevated TMD prevalence. Clear aligners had limited objective data, mainly self-reported bruxism. Premolar extractions were associated with subtle posterior condylar shifts and joint space narrowing, but without consistent symptom worsening. Orthognathic surgery frequently reduced pain, noise, and headaches in adults. Adolescents showed superior adaptive remodeling compared to adults; females had higher baseline TMD prevalence but no treatment-related deterioration; Class II retrognathia linked to elevated pre-treatment risk yet favorable post-correction responses.</p> Importance <p>Orthodontic treatment appears generally TMJ-neutral or beneficial when appropriately selected by growth status and skeletal pattern. Findings emphasize demographic-tailored planning and highlight needs for standardized TMD diagnostics, extended aligner studies, and confounder control (e.g., parafunction) to refine future evidence and clinical decision-making.</p>

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The Effects of Orthodontic Treatment Techniques on Temporomandibular Joint Disorders: a Systematic Review of Long-Term and Short-Term Outcomes Across Patient Demographics

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Shaaf Rezaee,
  • Darya Aghamolaei,
  • Shabnam Ghasemzadeh,
  • Aisan Eskandari-Yaghbastlo,
  • Parham Mahamed,
  • Sahand Saeidpour Masouleh,
  • Hassan Mivehchi,
  • Anis Elhami

摘要

Objective

This systematic review aimed to synthesize current evidence on the short- and long-term effects of orthodontic treatment techniques—functional appliances, fixed appliances, clear aligners, premolar extractions, and orthognathic surgery—on temporomandibular joint disorders (TMD). It further examined how patient demographics (age, sex, craniofacial morphology) modulate TMJ responses, focusing on morphological, functional, and symptomatic outcomes.

Methodology

Following PRISMA 2020 guidelines, databases (PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, Google Scholar) were searched for prospective/retrospective cohorts, RCTs, and longitudinal imaging studies (MRI/CBCT) evaluating TMJ outcomes after orthodontic intervention with demographic considerations. Inclusion required validated TMJ assessment and pre-/post-treatment data. Quality appraisal used Cochrane RoB, Newcastle-Ottawa Scale, and AMSTAR 2 tools. Due to study heterogeneity, narrative synthesis was performed.

Results

Twenty-five studies met inclusion criteria. Functional appliances commonly caused transient, reversible condylar repositioning in adolescents, with no increased TMD risk and occasional functional improvement. Fixed appliances demonstrated stable long-term outcomes (15–20 years) without elevated TMD prevalence. Clear aligners had limited objective data, mainly self-reported bruxism. Premolar extractions were associated with subtle posterior condylar shifts and joint space narrowing, but without consistent symptom worsening. Orthognathic surgery frequently reduced pain, noise, and headaches in adults. Adolescents showed superior adaptive remodeling compared to adults; females had higher baseline TMD prevalence but no treatment-related deterioration; Class II retrognathia linked to elevated pre-treatment risk yet favorable post-correction responses.

Importance

Orthodontic treatment appears generally TMJ-neutral or beneficial when appropriately selected by growth status and skeletal pattern. Findings emphasize demographic-tailored planning and highlight needs for standardized TMD diagnostics, extended aligner studies, and confounder control (e.g., parafunction) to refine future evidence and clinical decision-making.