Updates in orthodontic treatment of temporomandibular joint disc displacement in adolescents: review of the literature

Temporomandibular joint disc displacement represents the most prevalent form of temporomandibular disorders. This condition often manifests with symptoms such as joint clicking, joint pain, restricted mandibular mobility, and abnormal mouth opening. A significant bilateral correlation exists between disc displacement and dentofacial deformity in adolescents, prompting the gradual integration of orthodontic approaches into clinical disc displacement management. The combination of orthodontic appliances and conventional joint treatment methods can actively contribute to pain mitigation, functional restoration, enhancement of disc-condyle relationships, and the sustained efficacy of treatment. This article explores the relationship between temporomandibular joint disc displacement and orthodontics, delves into the current state of the field, examines the advantages and disadvantages, and sheds light on the future prospects of orthodontic interventions in disc displacement therapy.

Temporomandibular joint; Disc displacement; Malocclusion; Dentofacial deformity; Orthodontics; Functional jaw orthopedics; Therapeutics

[1] Zheng YH, Zhang ZG, Kong FJ, Long X, Yang C, Wang MQ, et al. Summary of Chinese expert consensus workshop on temporomandibular joint disc displacement. Chinese Journal of Stomatology. 2017; 52: 443–444. (In Chinese)

[2] Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical Oral Investigations. 2021; 25: 441–453.

[3] Bueno CH, Pereira DD, Pattussi MP, Grossi PK, Grossi ML. Gender differences in temporomandibular disorders in adult populational studies: a systematic review and meta-analysis. Journal of Oral Rehabilitation. 2018; 45: 720–729.

[4] Marpaung C, van Selms MKA, Lobbezoo F. Temporomandibular joint anterior disc displacement with reduction in a young population: prevalence and risk indicators. International Journal of Paediatric Dentistry. 2019; 29: 66–73.

[5] Zhang D, Shen P, Yang C. Characteristics of adolescent patients with temporomandibular joint anterior disc displacement. China Journal of Oral and Maxillofacial Surgery. 2022; 20: 443–448. (In Chinese)

[6] Hu YK, Yang C, Cai XY, Xie QY. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?: a magnetic resonance imaging retrospective study. Medicine. 2016; 95: e4715.

[7] Xie Q, Yang C, He D, Cai X, Ma Z, Shen Y, et al. Will unilateral temporomandibular joint anterior disc displacement in teenagers lead to asymmetry of condyle and mandible? A longitudinal study. Journal of Cranio-Maxillo-Facial Surgery. 2016; 44: 590–596.

[8] Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. Journal of Dentistry. 2010; 38: 392–399.

[9] La Touche R, Boo-Mallo T, Zarzosa-Rodríguez J, Paris-Alemany A, Cuenca-Martínez F, Suso-Martí L. Manual therapy and exercise in temporomandibular joint disc displacement without reduction. A systematic review. CRANIO®. 2022; 40: 440–450.

[10] Fu KY, Hu M, Yu Q, Yang C, Cheng Y, Long X, et al. Experts consensus on MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement. Chinese Journal of Stomatology. 2020; 55: 608–612. (In Chinese)

[11] Manfredini D, Lombardo L, Siciliani G. Temporomandibular disorders and dental occlusion. a systematic review of association studies: end of an era? Journal of Oral Rehabilitation. 2017; 44: 908–923.

[12] Jeon DM, Jung WS, Mah SJ, Kim TW, Ahn SJ. The effects of TMJ symptoms on skeletal morphology in orthodontic patients with TMJ disc displacement. Acta Odontologica Scandinavica. 2014; 72: 776–782.

[13] Bi R, Li Q, Li H, Wang P, Fang H, Yang X, et al. Divergent chondro/osteogenic transduction laws of fibrocartilage stem cell drive temporomandibular joint osteoarthritis in growing mice. International Journal of Oral Science. 2023; 15: 36.

[14] Wang Q. Correlation between temporomandibular joint dics displacement and craniomaxillofacial morphology in adults [master’s thesis]. China Medical University. 2019.

[15] Zhu H, Song X, He D, Yang Z, Shan Y. Research progress in the relationship between temporomandibular joint anterior disc displacement and dentofacial deformities in juveniles. Chinese Journal of Practical Stomatology. 2017; 10: 754–759.

[16] Wan S, Li P, Xie Q, Chen J, Qian Z, Yang C. Characteristics of mandible deviation in adolescent patients with temporomandibular joint anterior disc displacement. Journal of Shanghai Jiao Tong University. 2022; 42: 1557–1561.

[17] Liu Z, Xie Q, Yang C, Chen M, Bai G, Abdelrehem A. The effect of arthroscopic disc repositioning on facial growth in juvenile patients with unilateral anterior disc displacement. Journal of Cranio-Maxillo-Facial Surgery. 2020; 48: 765–771.

[18] Ooi K, Inoue N, Matsushita K, Yamaguchi H, Mikoya T, Minowa K, et al. Incidence of anterior disc displacement without reduction of the temporomandibular joint in patients with dentofacial deformity. International Journal of Oral and Maxillofacial Surgery. 2018; 47: 505–510.

[19] Tagawa DT, Franco AA, Puchnick A, Wolosker AMB, Florez BM, Dominguez GC, et al. Temporomandibular joint articular disc position and shape in skeletal Class III. Orthodontics & Craniofacial Research. 2023; 26: 185–196.

[20] Gökalp H. Disc position in clinically asymptomatic, pretreatment adolescents with Class I, II, or III malocclusion: a retrospective magnetic resonance imaging study. Journal of Orofacial Orthopedics. 2016; 77: 194–202.

[21] Castroflorio T, Talpone F, Deregibus A, Piancino MG, Bracco P. Effects of a functional appliance on masticatory muscles of young adults suffering from muscle-related temporomandibular disorders. Journal of oral Rehabilitation. 2004; 31: 524–529.

[22] Al-Groosh DH, Abid M, Saleh AK. The relationship between orthodontic treatment and temporomandibular disorders: a dental specialists’ perspective. Dental Press Journal of Orthodontics. 2022; 27: e2220406.

[23] Jung WS, Kim H, Jeon DM, Mah SJ, Ahn SJ. Magnetic resonance imaging-verified temporomandibular joint disk displacement in relation to sagittal and vertical jaw deformities. International Journal of Oral and Maxillofacial Surgery. 2013; 42: 1108–1115.

[24] Ooi K, Inoue N, Matsushita K, Mikoya T, Minowa K, Kawashiri S, et al. Relations between anterior disc displacement and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle. The British Journal of Oral & Maxillofacial Surgery. 2020; 58: 1084–1090.

[25] Coronel-Zubiate FT, Marroquín-Soto C, Geraldo-Campos LA, Aguirre-Ipenza R, Urbano-Rosales LM, Luján-Valencia SA, et al. Association between orthodontic treatment and the occurrence of temporomandibular disorders: a systematic review and meta-analysis. Journal of Clinical and Experimental Dentistry. 2022; 14: e1032–e1043.

[26] Ding L, Chen R, Liu J, Wang Y, Chang Q, Ren L. The effect of functional mandibular advancement for adolescent patients with skeletal class II malocclusion on the TMJ: a systematic review and meta-analysis. BMC Oral Health. 2022; 22: 51.

[27] Toll DE, Popović N, Drinkuth N. The use of MRI diagnostics in orthognathic surgery: prevalence of TMJ pathologies in Angle Class I, II, III patients. Journal of Orofacial Orthopedics. 2010; 71: 68–80.

[28] Jiménez-Silva A, Carnevali-Arellano R, Venegas-Aguilera M, Tobar-Reyes J, Palomino-Montenegro H. Temporomandibular disorders in growing patients after treatment of class II and III malocclusion with orthopaedic appliances: a systematic review. Acta Odontologica Scandinavica. 2018; 76: 262–273.

[29] Katzberg RW, Westesson PL, Tallents RH, Drake CM. Orthodontics and temporomandibular joint internal derangement. American Journal of Orthodontics and Dentofacial Orthopedics. 1996; 109: 515–520.

[30] Lei J, Yap AU, Liu MQ, Fu KY. Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: a randomised controlled study. Journal of Oral Rehabilitation. 2019; 46: 704–714.

[31] Shen P, Bai G, Xie Q, Fang Y, Pan L, Geng Y, et al. Efficacy of arthroscopic discopexy on condylar growth in temporomandibular joint anterior disc displacement: a randomized clinical trial. Plastic and Reconstructive Surgery. 2023; 154: 544e–555e.

[32] Ma Z, Yang C, Xie Q, Shen Y, Shen P, Fang B, et al. MRI evaluation of functional treatment in juvenile disk displacement with reduction. China Journal of Oral and Maxillofacial Surgery. 2013; 11: 131–135.

[33] Hu X, Zhu Y, He L, Gu Y, Liang Z, Zheng C. Skeletal effects of modified twin-block on patients in non-growth period with disc displacement with reduction. Journal of Oral Science Research. 2017; 33: 550–553.

[34] Yu X, Liu JQ, Yuan LJ, Mao LX, Zhu M, Fang B. MRI analysis of the effect on mandibular retrusion with anterior disc displacement treated by using Herbst appliance. Chinese Journal of Stomatology. 2017; 52: 171–175. (In Chinese)

[35] Chen K. ‘Evaluation of Forsus in the treatment of adult patients with Angle class Ⅱ division 2 accompanied with anterior disc displacement with reduction’, 2017 International Orthodontic Congress and the 16th national conference of Orthodontics. Shanghai, China. 2017.

[36] Alsulaimani FF, Alswajy WA. Orthodontic management of anterior disc displacement without reduction. Journal of Orthodontic Science. 2022; 11: 30.

[37] Rohida NS, Bhad W. A clinical, MRI, and EMG analysis comparing the efficacy of twin blocks and flat occlusal splints in the management of disc displacements with reduction. World Journal of Orthodontics. 2010; 11: 236–244.

[38] Ma Z, Shen Y, Yang C, Xie Q, Zhang S, Cai X. Changes in temporomandibular joint space after disk repositioning with functional appliance. China Journal of Oral and Maxillofacial Surgery. 2014; 12: 233–238.

[39] Tecco S, Teté S, Crincoli V, Festa MA, Festa F. Fixed orthodontic therapy in temporomandibular disorder (TMD) treatment: an alternative to intraoral splint. CRANIO®. 2010; 28: 30–42.

[40] Ma Z, Xie Q, Yang C, Zhang S, Shen Y, Cai X. Changes in the temporomandibular joint space after functional treatment of disk displacement with reduction. The Journal of Craniofacial Surgery. 2015; 26: e78–e81.

[41] Trenouth MJ. Distraction of the mandibular condyle during Twin-block appliance treatment. Cranioview. 205; 14: 25–31.

[42] Akan B, Kurun Bn. Structural changes in the trabecular bone of the mandibular condyle of growing patients with sagittal jaw discrepancy treated with the twin-block appliance. Orthodontics & Craniofacial Research. 2022; 25: 142–149.

[43] Zhu H, Yang Z, He D, Hu N, Cheng Z. The effect of TMJ disk repositioning by suturing through open incision on adolescent mandibular asymmetry with and without a functional orthodontic appliance. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021; 131: 405–414.

[44] Yan Y, Liu Y. Evaluation of temporomandibular joint in clear aligner. Chinese Journal of Practical Stomatology. 2023; 16: 385–388.

[45] Schupp W, Haubrich J, Neumann I. Invisalign(®) treatment of patients with craniomandibular disorders. International Orthodontics. 2010; 8: 253–267.

[46] Michelotti A, Iodice G. The role of orthodontics in temporomandibular disorders. Journal of Oral Rehabilitation. 2010; 37: 411–429.

[47] Guo YN, Cui SJ, Zhou YH, Wang XD. An overview of anterior repositioning splint therapy for disc displacement-related temporomandibular disorders. Current Medical Science. 2021; 41: 626–634.

[48] Zonnenberg AJ, Mulder J. The efficacy of a specific stabilization splint. CRANIO®. 2014; 32: 68–74.

[49] Song Y, Duan Z, Ma Y. Progress in the occlusal treatment of temporomandibular joint reversible disc displacement. Stomatology. 2022; 42: 188–192.

[50] Ma Z, Xie Q, Yang C, Zhang S, Shen Y, Abdelrehem A. Can anterior repositioning splint effectively treat temporomandibular joint disc displacement? Scientific Reports. 2019; 9: 534.

[51] Alajbeg I, Živković K, Gikić M. The role of stabilization splint in the treatment of temporomandibular disorders. Acta Medica Croatica. 2015; 69: 33–43. (In Croatian)

[52] Stiesch-Scholz M, Kempert J, Wolter S, Tschernitschek H, Rossbach A. Comparative prospective study on splint therapy of anterior disc displacement without reduction. Journal of Oral Rehabilitation. 2005; 32: 474–479.

[53] Devi J, Verma M, Gupta R. Assessment of treatment response to splint therapy and evaluation of TMJ function using joint vibration analysis in patients exhibiting TMJ disc displacement with reduction: a clinical study. Indian Journal of Dental Research. 2017; 28: 33–43.

[54] Shen P, Chen X, Xie Q, Zhang S, Yang C. Assessment of occlusal appliance for the reposition of temporomandibular joint anterior disc displacement with reduction. The Journal of Craniofacial Surgery. 2019; 30: 1140–1143.

[55] Chen HM, Liu MQ, Yap AU, Fu KY. Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis. Journal of Oral Rehabilitation. 2017; 44: 664–672.

[56] Tanaka E, Kikuchi K, Sasaki A, Tanne K. An adult case of TMJ osteoarthrosis treated with splint therapy and the subsequent orthodontic occlusal reconstruction: adaptive change of the condyle during the treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 2000; 118: 566–571.

[57] Kurt H, Oztaş E, Gençel B, Taşan DA, Oztaş D. An adult case of temporomandibular joint osteoarthritis treated with splint therapy and the subsequent orthodontic occlusal reconstruction. Contemporary Clinical Dentistry. 2011; 2: 364–367.

[58] Nemes B, Frank D, Puigdollers A, Martín D. Occlusal splint therapy followed by orthodontic molar intrusion as an effective treatment method to treat patients with temporomandibular disorder: a retrospective study. Applied Sciences. 2021; 11: 7249.

[59] Sheikh O, Logan G, Komath D, Grossman P, Ayliffe P. Splint-assisted disc plication surgery. Ann Stomatol (Roma). 2016; 7: 73–78.

[60] Wang X, Chen X, Mao Y, Shen D, Zhang S. Difference in recurrence rates after temporomandibular joint disc repositioning surgery with miniscrew anchor at different developmental stages in adolescents. Journal of Shanghai Jiaotong University. 2022; 42: 173–177.

[61] Liu Z, Xie Q, Yang C, Chen M, Bai G, Shen P, et al. Functional orthodontics after arthroscopic disk repositioning in adolescent anterior disk displacement with mandibular retrusion. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2020; 130: 357–362.

[62] Wang BL, Yang C, Cai XY, Chen MJ, Zhang SY, Fang B, et al. Malocclusion as a common occurrence in temporomandibular joint arthroscopic disc repositioning: outcomes at 49 days after surgery. Journal of Oral and Maxillofacial Surgery. 2011; 69: 1587–1593.

[63] Perez D, Brown ZL, Amarista FJ, Pham M. Treatment of malocclusion after TMJ disc repositioning with Mitek anchors. A retrospective review. Journal of Stomatology, Oral and Maxillofacial Surgery. 2019; 120: 540–544.

[64] Gao W, Tong W, Fang Y, Pan L, Shao X. Clinical aesthetic observation of the arthroscopic disc repositioning and suturing technique combined with functional appliances in the management of ADDWoR of TMJ. Journal of Oral and Maxillofacial Surgery. 2021; 31: 56–162.

[65] Zhang L, Xue L, Bao Y, Chen Y, Sun C, Ding Y. Effect of comprehensive rehabilitation combined with soft and hard occlusion therapy for disc anchor surgery of anterior disc displacement with reduction. Journal of Kunming Medical University. 2022; 43: 90–98.

[66] Nale JC. Orthognathic surgery and the temporomandibular joint patient. Oral and Maxillofacial Surgery Clinics of North America. 2014; 26: 551–564.

[67] di Paolo C, Pompa G, Arangio P, di Nunno A, Di Carlo S, Rosella D, et al. Evaluation of temporomandibular disorders before and after orthognathic surgery: therapeutic considerations on a sample of 76 patients. Journal of International Society of Preventive & Community Dentistry. 2017; 7: 125–129.

[68] Sharma R, Muralidharan CG, Verma M, Pannu S, Patrikar S. MRI changes in the temporomandibular joint after mandibular advancement. Journal of Oral and Maxillofacial Surgery. 2020; 78: 806–812.

[69] Al-Moraissi EA, Wolford LM, Perez D, Laskin DM, Ellis E 3rd. Does orthognathic surgery cause or cure temporomandibular disorders? A systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2017; 75: 1835–1847.

[70] Al-Moraissi EA, Wolford LM. Does temporomandibular joint pathology with or without surgical management affect the stability of counterclockwise rotation of the maxillomandibular complex in orthognathic surgery? A systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2017; 75: 805–821.

[71] Greene CS. Managing patients with temporomandibular disorders: a new “standard of care”. American Journal of Orthodontics and Dentofacial Orthopedics. 2010; 138: 3–4.

[72] Brenkert DR. Orthodontic treatment for the TMJ patient following splint therapy to stabilize a displaced disk(s): a systemized approach. Part I, TMJ orthodontic diagnosis. CRANIO®. 2010; 28: 193–199.

[73] Liu Y, Bi W. Orthodontic treatment of the malocclusion after TMJ arthroscopic disc reposition and fixation. Chinese Journal of Practical Stomatology. 2008; 1: 88–89.

[74] Okeson JP. Evolution of occlusion and temporomandibular disorder in orthodontics: past, present, and future. American Journal of Orthodontics and Dentofacial Orthopedics. 2015; 147: S216–S223.