Orthognathic treatment and temporomandibular disorders: A systematic review. Part 1. A new quality-assessment technique and analysis of study characteristics and classifications


      Orthognathic treatment is undertaken to correct jaw discrepancies and involves a combination of orthodontics and surgery. The effects of orthodontic treatment on temporomandibular disorders (TMD) have been widely debated in the literature, but fewer studies focus on the effects of orthognathic treatment on TMD.


      A systematic review was conducted to (1) determine the percentage of orthognathic patients with signs or symptoms of TMD, (2) establish the range of signs or symptoms, and (3) examine studies that followed patients longitudinally through treatment to determine the effect of orthognathic intervention on TMD symptoms.


      Of 480 identified articles, 53 were eligible for inclusion in this review. Part 1 of this 2-part article describes the methodology of conducting this review, the difficulties encountered (including the quality-assessment issues), and a narrative analysis of study characteristics and classification methods. Part 2 reports the remaining results, evidence tables, and meta-analyses.


      The diversity of diagnostic criteria and classification methods used in the included studies makes interstudy comparisons difficult. There is a definitive need for well-designed studies with standardized diagnostic criteria and classification methods for TMD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Orthodontics and Dentofacial Orthopedics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Riolo M.
        • Brandt D.
        • TenHave T.
        Associations between occlusal characteristics and signs and symptoms of TMJ dysfunction in children and young adults.
        Am J Orthod Dentofacial Orthop. 1987; 92: 467-477
        • Luther F.
        Orthodontics and the temporomandibular joint: where are we now? Part I. Orthodontic treatment and temporomandibular disorders.
        Angle Orthod. 1998; 68: 295-304
        • van der Weele L.T.
        • Dibbets J.
        Helkimo's index: a scale or just a set of symptoms?.
        J Oral Rehabil. 1987; 14: 229-237
        • McNamara Jr., J.A.
        • Seligman D.
        • Okeson J.P.
        Occlusion, orthodontic treatment, and temporomandibular disorders: a review.
        J Orofac Pain. 1995; 9: 73-90
        • Rinchuse D.J.
        • Rinchuse D.J.
        • Kandasamy S.
        Evidence-based versus experience-based views on occlusion and TMD.
        Am J Orthod Dentofacial Orthop. 2005; 127: 249-254
        • Proffit W.
        Contemporary orthodontics.
        3rd ed. Mosby, St Louis2000 (p. 16)
        • Mohlin B.
        • Ingervall B.
        • Thilander B.
        Relation between malocclusion and mandibular dysfunction in Swedish men.
        Eur J Orthod. 1980; 2: 229-238
        • Mohlin B.
        • Thilander B.
        The importance of the relationship between malocclusion and mandibular dysfunction and some clinical applications in adults.
        Eur J Orthod. 1984; 6: 192-204
        • Sadowsky C.
        • Theisen T.A.
        • Sakols E.I.
        Orthodontic treatment and temporomandibular joint sounds—a longitudinal study.
        Am J Orthod Dentofacial Orthop. 1991; 99: 441-447
        • Mohlin B.
        • Derweduwen K.
        • Pilley R.
        • Kingdon A.
        • Shaw W.
        • Kenealy P.
        Malocclusion and temporomandibular disorder: a comparison of adolescents with moderate to severe dysfunction with those without signs and symptoms of temporomandibular disorder and their further development to 30 years of age.
        Angle Orthod. 2004; 74: 319-327
        • Egermark I.
        • Carlsson G.
        • Magnusson T.
        A prospective long-term study of signs and symptoms of temporomandibular disorders in patients who received orthodontic treatment in childhood.
        Angle Orthod. 2005; 75: 645-650
        • Wolford L.
        • Reiche-Fischel O.
        • Mehra P.
        Changes in temporomandibular joint dysfunction after orthognathic surgery.
        J Oral Maxillofac Surg. 2003; 61: 655-660
        • White C.
        • Dolwick M.
        Prevalence and variance of temporomandibular dysfunction in orthognathic surgery patients.
        Int J Adult Orthod Orthognath Surg. 1992; 7: 7-14
      1. Ottawa Health Research Institute. Available at: Accessed on October 10, 2008

        • Sackett D.L.
        Bias in analytic research.
        J Chronic Dis. 1979; 32: 51-63
        • Helkimo M.
        Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state.
        Sven Tandlak Tidskr. 1974; 67: 101-121
        • Karabouta I.
        • Martis C.
        The TMJ dysfunction syndrome before and after sagittal split osteotomy of the rami.
        J Maxillofac Surg. 1985; 13: 185-188
        • Raveh J.
        • Vuillemin T.
        • Lädrach K.
        • Sutter F.
        New techniques for reproduction of the condyle relation and reduction of complications after sagittal ramus split osteotomy of the mandible.
        J Oral Maxillofac Surg. 1988; 46: 751-757
        • Kerstens H.
        • Tuinzing D.
        • van der Kwast W.
        Temporomandibular joint symptoms in orthognathic surgery.
        J Craniomaxillofac Surg. 1989; 17: 215-218
        • Flynn B.
        • Brown D.
        • Lapp T.
        • Bussard D.
        • Roberts W.
        A comparative study of temporomandibular symptoms following mandibular advancement by bilateral sagittal split osteotomies: rigid versus nonrigid fixation.
        Oral Surg Oral Med Oral Pathol. 1990; 70: 372-380
        • Hwang S.
        • Haers P.
        • Sailer H.
        The role of a posteriorly inclined condylar neck in condylar resorption after orthognathic surgery.
        J Craniomaxillofac Surg. 2000; 28: 85-90
        • Hwang S.
        • Haers P.
        • Seifert B.
        • Sailer H.
        Non-surgical risk factors for condylar resorption after orthognathic surgery.
        J Craniomaxillofac Surg. 2004; 32: 103-111
        • Herbosa E.
        • Rotskoff K.
        • Ramos B.
        • Ambrookian H.
        Condylar position in superior maxillary repositioning and its effect on the temporomandibular joint.
        J Oral Maxillofac Surg. 1990; 48: 690-696
        • Azumi Y.
        • Sugawara J.
        • Takahashi I.
        • Mitani H.
        • Nagasaka H.
        • Kawamura H.
        Positional and morphologic changes of the mandibular condyle after mandibular distraction osteogenesis in skeletal Class II patients.
        World J Orthod. 2004; 5: 32-39
        • Gaggl A.
        • Schultes G.
        • Santler G.
        • Kärcher H.
        • Simbrunner J.
        Clinical and magnetic resonance findings in the temporomandibular joints of patients before and after orthognathic surgery.
        Br J Oral Maxillofac Surg. 1999; 37: 41-45
        • Ueki K.
        • Marukawa K.
        • Nakagawa K.
        • Yamamoto E.
        Condylar and temporomandibular joint disc positions after mandibular osteotomy for prognathism.
        J Oral Maxillofac Surg. 2002; 60: 1424-1432
        • Fricton J.
        • Schiffman E.
        Reliability of a craniomandibular index.
        J Dent Res. 1986; 65: 1359-1364
        • Dworkin S.
        • LeResche L.
        Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique.
        J Craniomandib Disord. 1992; 6: 301-355
        • Wahlund K.
        • List T.
        • Dworkin S.
        Temporomandibular disorders in children and adolescents: reliability of a questionnaire, clinical examination, and diagnosis.
        J Orofac Pain. 1998; 12: 42-51
      2. European Academy of Craniomandibular Disorders. Available at: Accessed on October 24, 2008.

        • De Clercq C.
        • Abeloos J.
        • Mommaerts M.
        • Neyt L.
        Temporomandibular joint symptoms in an orthognathic surgery population.
        J Craniomaxillofac Surg. 1995; 23: 195-199
        • Fricton J.
        • Schiffman E.
        Epidemiology of temporomandibular disorders.
        in: Fricton J.R. Dubner R. Orofacial pain and temporomandibular disorders. Advances in pain research and therapy. Volume 21. Raven Press, New York1995
        • Dworkin S.F.
        • Huggins K.H.
        • LeResche L.
        • Von Korff M.
        • Howard J.
        • Truelove E.
        • et al.
        Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls.
        J Am Dent Assoc. 1990; 120: 273-281
        • Carlsson G.
        Epidemiological studies of signs and symptoms of temporomandibular joint-pain-dysfunction. A literature review.
        Aust Prosthodont Soc Bull. 1984; 14: 7-12
        • Carlsson G.E.
        • LeResche L.
        Epidemiology of temporomandibular disorders.
        in: Sessle B.J. Bryant P.S. Dionne R.A. Temporomandibular disorders and related pain conditions. Progress in pain research and management. Volume 4. Munksgaard, Copenhagen1995: 211-226
        • Moher D.
        • Cook D.
        • Jadad A.
        • Tugwell P.
        • Moher M.
        • Jones A.
        • et al.
        Assessing the quality of reports of randomised trials: implications for the conduct of meta-analyses.
        Health Technol Assess. 1999; 3: 1-98
        • Moja L.
        • Telaro E.
        • D'Amico R.
        • Moschetti I.
        • Coe L.
        • Liberati A.
        Assessment of methodological quality of primary studies by systematic reviews: results of the metaquality cross sectional study.
        BMJ. 2005; 330: 1053
        • Egger M.
        • Juni P.
        • Bartlett C.
        • Holenstein F.
        • Sterne J.
        How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study.
        Health Technol Assess. 2003; 7: 1-76
        • Moher D.
        • Jadad A.R.
        • Nichol G.
        • Penman M.
        • Tugwell P.
        • Walsh S.
        Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists.
        Control Clin Trials. 1995; 16: 62-73
        • Jüni P.
        • Witschi A.
        • Bloch R.
        • Egger M.
        The hazards of scoring the quality of clinical trials for meta-analysis.
        JAMA. 1999; 282: 1054-1060
      3. The EQUATOR network. Available at: Accessed October 24, 2008.

        • von Elm E.
        • Altman D.
        • Egger M.
        • Pocock S.
        • Gøtzsche P.
        • Vandenbroucke J.
        The strengthening the reporting of observational studies in epidemiology (strobe) statement: guidelines for reporting observational studies.
        Ann Intern Med. 2007; 147: 573-577

      Linked Article