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Background:
Systematic Review

The Relationship Between Adolescent Orthodontic Treatment and Temporomandibular Disorders: A Systematic Review with Meta-Analysis

by
Seorin Jeong
1,†,
Myeong-Kwan Jih
2,†,
Ji-Won Ryu
3,
Jong-Mo Ahn
3 and
Hyun-Jeong Park
3,*
1
Department of Orthodontics, School of Dentistry, Chosun University, Gwangju 61452, Republic of Korea
2
Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwangju 61452, Republic of Korea
3
Department of Oral Medicine, School of Dentistry, Chosun University, Gwangju 61452, Republic of Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Appl. Sci. 2024, 14(23), 11430; https://doi.org/10.3390/app142311430
Submission received: 5 November 2024 / Revised: 28 November 2024 / Accepted: 5 December 2024 / Published: 9 December 2024
(This article belongs to the Special Issue Recent Advances in Pediatric Orthodontics and Pediatric Dentistry)
Browse Figures
Figure 1
<p>The PRISMA flowchart.</p> "> Figure 2
<p>Forest plot of the meta-analysis [<a href="#B33-applsci-14-11430" class="html-bibr">33</a>,<a href="#B34-applsci-14-11430" class="html-bibr">34</a>,<a href="#B42-applsci-14-11430" class="html-bibr">42</a>,<a href="#B45-applsci-14-11430" class="html-bibr">45</a>].</p> "> Figure 3
<p>ROB domains [<a href="#B33-applsci-14-11430" class="html-bibr">33</a>,<a href="#B34-applsci-14-11430" class="html-bibr">34</a>,<a href="#B42-applsci-14-11430" class="html-bibr">42</a>,<a href="#B45-applsci-14-11430" class="html-bibr">45</a>].</p> "> Figure 3 Cont.
<p>ROB domains [<a href="#B33-applsci-14-11430" class="html-bibr">33</a>,<a href="#B34-applsci-14-11430" class="html-bibr">34</a>,<a href="#B42-applsci-14-11430" class="html-bibr">42</a>,<a href="#B45-applsci-14-11430" class="html-bibr">45</a>].</p> ">
Review Reports Versions Notes

Abstract

:
The relationship between fixed orthodontic treatment and the development of temporomandibular disorders (TMDs) in adolescents has been a topic of considerable debate. This systematic review and meta-analysis aimed to evaluate the impact of fixed orthodontic treatment on the prevalence of TMDs in adolescents. A comprehensive literature search was conducted using PubMed, Web of Science, EMBASE, Google Scholar, and the Cochrane Library, yielding 886 records. After duplicate removal, 665 records were screened, and 8 studies were assessed for eligibility. Following quality assessment using the Joanna Briggs Institute checklist, 4 studies were included in the final analysis. Data were analyzed using a random-effects model in RevMan software. The meta-analysis revealed an overall odds ratio of 0.75 (95% CI: 0.37–1.51, p = 0.42), indicating no statistically significant association between fixed orthodontic treatment and the risk of developing TMDs. Substantial heterogeneity was observed (I2 = 73%), attributed to variations in study designs, populations, and outcome measures. The risk of bias analysis highlighted concerns in several domains, particularly selection bias and measurement of outcomes. While confounding bias and missing data bias were generally well-controlled, deviations in intervention and inconsistent outcome measurements were noted across the studies. These findings suggest that fixed orthodontic treatment does not significantly alter the risk of developing TMDs in adolescents. However, the substantial heterogeneity and potential biases across the included studies emphasize the need for further high-quality, standardized research to confirm these results and provide clearer clinical guidance.

1. Introduction

The temporomandibular joint (TMJ) is a highly specialized ginglymoarthrodial joint that facilitates both rotational and translational movements essential for mastication, speech, and other jaw functions [1]. The TMJ consists of the mandibular condyle and the glenoid fossa of the temporal bone, separated by a fibrocartilaginous articular disc [2,3]. This disc divides the joint into superior and inferior compartments, allowing complex movements such as opening, closing, and lateral excursions [2,3]. The joint is stabilized by the joint capsule and reinforced by ligaments, including the temporomandibular ligament, which limits excessive posterior and inferior displacement [2,3].
The TMJ functions in close coordination with the masticatory muscles, including the masseter, temporalis, and medial and lateral pterygoids, which collectively generate the forces required for mandibular movements essential in mastication and articulation [2,3]. These muscles, innervated by the mandibular division of the trigeminal nerve, play a pivotal role in jaw stabilization and movement [2,3].
The vascularization of the TMJ is derived predominantly from branches of the external carotid artery [3]. The superficial temporal artery and maxillary artery supply the joint capsule, surrounding tissues, and synovial membrane, ensuring adequate perfusion for joint function and repair [3]. Sensory innervation to the TMJ is primarily provided by the auriculotemporal nerve, a branch of the mandibular nerve, which conveys proprioceptive and nociceptive inputs. Additional contributions may arise from the masseteric and deep temporal nerves, ensuring comprehensive motor and sensory control of the joint [3].
Temporomandibular disorders (TMDs) encompass a spectrum of conditions affecting the TMJ, masticatory muscles, or associated structures, often characterized by symptoms such as pain, joint noises, and restricted mandibular movement [4,5]. The etiology of TMDs is multifactorial, involving biological, mechanical, psychological, and environmental factors [6,7]. Key contributors include trauma, bruxism, malocclusion, and stress-induced muscle tension, alongside systemic conditions such as arthritis and genetic predispositions [8,9]. These diverse factors underscore the complexity of TMDs, which range from muscle-related pain to joint pathologies such as disc displacement, degenerative changes, and inflammatory conditions [3,10].
Adolescents are particularly vulnerable to TMDs due to craniofacial growth, hormonal fluctuations, and musculoskeletal adaptations during critical developmental stages [5,11,12]. Common symptoms include joint pain, restricted mandibular movement, and muscle tenderness, often accompanied by headaches and neck discomfort, significantly impacting daily functioning [11,13,14].
The prevalence of TMDs among adolescents ranges from 20% to 74%, influenced by diagnostic criteria and population demographics [13,14,15]. Egermark et al. (2001) noted that untreated symptoms often persist into adulthood, highlighting the need for early diagnosis and intervention [15]. Severe cases, such as TMDs associated with juvenile idiopathic arthritis (JIA), can result in joint damage, requiring targeted management strategies [16]. Minimally invasive procedures, such as arthrocentesis and intra-articular injections, have proven effective in symptom relief and functional improvement in pediatric populations [17].
Females exhibit a higher prevalence of TMDs, linked to hormonal factors such as estrogen, which increases pain sensitivity and tissue inflammation [5,11,12]. Additionally, psychological factors, including stress and anxiety, and parafunctional habits like bruxism exacerbate TMDs symptoms [5,13,14]. Structural differences, such as smaller joint structures and reduced muscle mass, further increase susceptibility to mechanical overload [5].
The multifactorial nature of adolescent TMDs—encompassing growth, hormonal, psychological, and behavioral influences—underscores the importance of tailored diagnostic and therapeutic approaches. Emerging minimally invasive treatments offer promising solutions, particularly for severe or chronic cases [16,17].
Orthodontic treatment during adolescence is widely regarded as essential for improving both oral health and quality of life by addressing malocclusions, enhancing oral function, and supporting psychological well-being [18,19]. The period of growth in adolescence amplifies the effectiveness of orthodontic intervention, allowing for the correction of aberrant occlusal patterns and functional anomalies, which may otherwise lead to long-term complications such as TMDs or dental attrition [20]. Frequently observed malocclusion types among adolescents, including open bite, deep bite, and dental crowding, can be effectively managed through orthodontic interventions aimed at optimizing both structural and aesthetic aspects of the oral cavity during growth [21].
Orthodontic appliances used during this developmental stage primarily include fixed and removable options [22]. Fixed appliances, such as brackets and archwires, provide effective guidance for tooth movement and occlusal improvement but necessitate prolonged treatment duration and rigorous oral hygiene maintenance [20]. In contrast, removable appliances offer ease of maintenance but are generally limited to early orthodontic intervention in younger children [23]. The selection of an orthodontic appliance depends on various factors, including the patient’s oral health status, growth patterns, and lifestyle considerations [21].
Despite these recognized benefits, the impact of orthodontic treatment on TMDs remains a topic of ongoing debate. Fixed appliances are commonly used during adolescence to address malocclusions, improve occlusal function, and enhance facial aesthetics [24]. However, some studies propose that orthodontic forces might elevate the risk of TMDs by altering occlusion or stressing the TMJ, especially in cases involving elastic bands or significant occlusal adjustments [25,26,27,28]. In contrast, other research suggests that correcting malocclusions may reduce TMDs risk by enhancing occlusal stability and decreasing functional strain on the TMJ [29,30]. These conflicting findings underscore the complexity of the relationship between orthodontic treatment and TMDs, suggesting that additional factors may influence the onset of TMDs symptoms in orthodontically treated patients.
Diagnosing TMDs in adolescents presents unique challenges due to variations in clinical presentation and the influence of growth-related factors [12]. Although diagnostic tools such as the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), originally developed for adults, have recently been adapted for younger populations to enhance diagnostic accuracy, diagnostic variability persists [12,31]. While some studies employ clinical examinations or imaging tools like magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) to diagnose TMDs, others rely on self-reported symptoms or general clinical assessments, leading to inconsistencies in TMDs identification and prevalence estimates [32,33]. This variability complicates the assessment of TMDs, especially in adolescents undergoing significant physiological changes, emphasizing the need for standardized diagnostic criteria across studies [31].
Adolescence is a critical developmental phase marked by rapid growth and hormonal changes that can affect musculoskeletal health, including the TMJ [24,31]. Given the potential interplay between these developmental factors and orthodontic interventions, understanding the relationship between fixed orthodontic treatment and TMDs in this age group is particularly important [24,28]. Widely used during adolescence to correct malocclusions and enhance occlusal function, orthodontic treatment has been discussed as a possible contributor to TMDs due to factors such as occlusal adjustments and biomechanical forces [25,27]. However, findings in the literature vary: while some studies suggest that orthodontic interventions may increase TMDs risk [25,27], others report that treatment may alleviate TMDs symptoms [29,30], and still others find no significant association between orthodontic treatment and TMDs incidence [33,34,35,36].
This systematic review and meta-analysis aim to evaluate the impact of fixed orthodontic treatment during adolescence on the development of TMDs. By investigating the association between fixed appliances and TMDs incidence, this study provides insights into the potential effects of orthodontic intervention on TMJ function and disorder risk.

2. Materials and Methods

2.1. Eligibility Criteria

To address the research question, this systematic review followed the PICO strategy to define the eligibility criteria for study selection as follows:
  • Population (P): Adolescents aged 10 to 19 years who have undergone fixed orthodontic treatment.
  • Intervention (I): Use of fixed orthodontic appliances for dental correction.
  • Comparison (C): Adolescents who did not receive any orthodontic treatment.
  • Outcome (O): Assessment of TMDs prevalence, symptom alleviation, and functional improvement post-treatment.
  • Study Types: Cross-sectional, cohort, and case-control studies published in peer-reviewed journals were included. Systematic reviews, meta-analyses, case reports, and non-English publications were excluded.

2.2. Search Strategy

This systematic review was meticulously conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines [37] and adhered to the Joanna Briggs Institute (JBI) systematic review methodology [38]. The PRISMA 2020 framework was implemented to ensure transparency, accuracy, and replicability across all stages of the review process, including study identification, screening, eligibility assessment, and inclusion. The PRISMA 2020 flow diagram was used to detail the inclusion and exclusion process. A comprehensive literature search was performed across five major databases—PubMed, Web of Science, EMBASE, Google Scholar, and Cochrane Library—using targeted keywords and their combinations. The search strategy was designed to capture all relevant studies within the predefined eligibility criteria.
  • Population Keywords: “adolescents”, “children”, “boys”, “girls”, “youth”, “teenagers”.
  • Intervention Keywords: “orthodontics”, “fixed orthodontic treatment”, “fixed orthodontic appliance”, “fixed orthodontic alignment”, “braces”.
  • Outcome Keywords: “TMDs”, “Temporomandibular disorders”, “Temporomandibular Joint disorders”, “jaw pain”, “masticatory muscle disorder”, “joint sound”, “TMJ dysfunction”, “Jaw disorders”.
  • Study Focus Keywords: “Prevalence”, “relationship”, “association”.
  • The search was finalized in December 2023, covering publications from 2000 to 2023. Duplicates were removed, and studies were screened by title and abstract to ensure they met the eligibility criteria.

2.3. Data Extraction

Data extraction was conducted independently by three reviewers (H.-J.P., J.-W.R., and S.J.) to reduce bias. Disagreements were resolved through discussion until consensus was reached. A standardized data extraction form was used to collect the following details:
  • Study Characteristics: Author, publication year, country of study, sample size, and study design.
  • Population Details: Age range, gender distribution, and sample demographics.
  • Intervention Details: Type of orthodontic treatment, duration, and specific techniques employed.
  • Outcome Measurements: TMDs diagnostic criteria, assessment tools, prevalence rates, and symptom improvements.
All extracted data were compiled in a Microsoft Excel spreadsheet for systematic analysis.

2.4. Criteria for Quality Assessment

The quality of the final four quantitative studies was evaluated using the JBI checklist for Analytical Cross-Sectional Studies and Cohort Studies [39,40,41]. This evaluation considered key criteria such as the appropriateness of the sample frame, recruitment methods, diagnostic validity, and the accuracy of data analysis. To ensure the inclusion of reliable evidence, only studies rated as moderate to high quality were selected for the meta-analysis.
During the review process, it was observed that three of the initially included studies were authored by the same researcher and analyzed overlapping populations [42,43,44]. To prevent duplication and maintain the robustness of the analysis, only one of these studies was retained for the final review. This decision ensured that the meta-analysis was based on independent data and provided a more accurate evaluation of the relationship between fixed orthodontic treatment and TMDs.

2.5. Statistical Analysis

Quantitative analysis was conducted using Review Manager software (RevMan 8.8.0; Cochrane Collaboration, London, UK), employing a random-effects model to address variability across the included studies. The primary outcome evaluated was the odds ratio (OR) for the prevalence of TMDs symptoms in adolescents treated with fixed orthodontic appliances compared to untreated controls.
Heterogeneity across studies was assessed using the I² statistic and categorized as low (<30%), moderate (30–60%), or high (>60%). The analysis revealed substantial heterogeneity, with an I² value of 73%, indicating significant differences in study designs, populations, and outcome measures. Forest plots were utilized to present effect sizes and 95% confidence intervals (CIs) visually, facilitating a clear interpretation of the results. The overall OR was 0.75 (95% CI: 0.37–1.51; p = 0.42), suggesting no statistically significant association between fixed orthodontic treatment and the risk of TMDs development.
Statistical significance was determined at a threshold of p < 0.05. Sensitivity analyses were performed to evaluate the robustness of the findings and ensure that results were not disproportionately influenced by individual studies or methodological biases. The risk of bias (ROB) was assessed comprehensively across all studies, with particular concerns noted in selection bias and measurement of outcomes, as shown in the accompanying visual summaries. These analyses underscore the importance of standardizing study designs and outcome measures in future research.

3. Results

3.1. Study Selection

A comprehensive search was conducted across PubMed, Web of Science, EMBASE, Google Scholar, and the Cochrane Library databases, yielding an initial 886 studies. After removing duplicates, 665 studies remained for screening. Abstracts were reviewed in detail, leading to the shortlisting of 8 articles for further evaluation (Figure 1). Following a thorough assessment using the JBI checklist for Analytical Cross-Sectional Studies and Cohort Studies, 4 studies were included in the final selection based on their study design and methodological quality (Table 1).
During the review, three studies authored by the same researcher were found to analyze overlapping populations. To avoid redundancy, these studies were combined into a single dataset before final inclusion. All selected studies met the criteria for providing adequate data for meta-analysis.

3.2. Results of Quality Assessment

The quality of the included studies was assessed using the JBI Checklist for Cohort Studies and the JBI Checklist for Analytical Cross-Sectional Studies, based on their respective designs (Table 1). The evaluation emphasized sample adequacy, recruitment methods, and the validity of diagnostic approaches for TMDs. The following key strengths and weaknesses were identified:
Strengths: Most studies demonstrated robust recruitment methods, enhancing the representativeness of adolescent populations. Participant demographics and orthodontic interventions were thoroughly documented, ensuring reliable comparisons. Additionally, longitudinal studies, such as Egermark et al. [34], provided comprehensive follow-up measures over extended periods, adding depth to the findings. Henrikson and Nilner [42] and Conti et al. [45] effectively documented orthodontic outcomes in relation to TMDs symptoms.
Weaknesses: A critical limitation across the studies was the inconsistency in diagnostic criteria for TMDs. Only Mušanović et al. [33] utilized standardized RDC/TMD protocols, while others relied on varied clinical methods or subjective measures, introducing heterogeneity into the meta-analysis (I2 = 73%). Furthermore, the overlap in populations, as seen in some studies by the same authors, posed risks of data redundancy. For example, overlapping findings were consolidated during the analysis to avoid duplication.
The assessment underscores the need for future research employing standardized diagnostic tools, such as RDC/TMD or DC/TMD, to ensure consistent and comparable outcomes in TMDs studies.

3.3. Data Extraction and Synthesis

Data extracted from the selected studies included study design, sample characteristics, diagnostic tools, and measures of TMDs prevalence (Table 2). Two cohort studies (Egermark et al. [34], Henrikson and Nilner [42]) and two cross-sectional studies (Conti et al. [45], and Mušanović et al. [33]) were analyzed. Diagnostic methods varied significantly, with Mušanović et al. [33] adhering to RDC/TMD criteria, while others relied on clinical examinations (e.g., palpation, auscultation) or subjective questionnaires.

3.3.1. TMDs Prevalence in Treated vs. Untreated Adolescents

Henrikson and Nilner [42] observed higher TMDs prevalence in untreated Class II malocclusion groups compared to treated ones, suggesting that orthodontic treatment may alleviate symptoms in certain populations. Similarly, Conti et al. [45] found no significant increase in the prevalence of TMDs post-treatment, supporting the notion that orthodontic treatment does not elevate TMDs risks. Egermark et al. [34] reported low TMDs incidence in orthodontically treated individuals, further reinforcing these findings.

3.3.2. Effect of Treatment Type on TMDs Outcomes

Henrikson and Nilner [42] examined the effects of extraction versus non-extraction treatments, finding no significant differences in TMDs outcomes. These findings challenge traditional concerns about extraction protocols negatively impacting TMJ function.

3.3.3. Gender and Pre-Existing TMDs as Risk Factors

Egermark et al. [34] highlighted gender differences, with females exhibiting a higher likelihood of TMDs development (hazard ratio: 2.1). Pre-existing TMDs symptoms significantly increased the risk of long-term TMDs persistence, emphasizing the importance of thorough pre-treatment evaluations.

3.3.4. Diagnostic Approaches and Standardization Challenges

Diagnostic variability was a notable limitation. While Mušanović et al. [33] utilized RDC/TMD protocols, others relied on non-standardized methods, contributing to inconsistencies in TMDs prevalence reporting. This highlights the need for future studies to adopt validated diagnostic frameworks.

3.4. Quantitative Analysis

A meta-analysis was conducted using RevMan software (Version 8.8.0, Cochrane Collaboration, London, UK) employing a random-effects model to account for variability among the included studies. This analysis incorporated data from 4 eligible studies, comprising a total of 629 participants.

3.4.1. Overall Effect

The pooled analysis generated an OR of 0.75 (95% CI: 0.37–1.51), indicating no statistically significant difference in the prevalence of temporomandibular disorders (TMDs) between orthodontically treated adolescents and untreated controls (p = 0.42). These findings suggest that fixed orthodontic treatment does not significantly increase or decrease the risk of developing TMDs symptoms in adolescents.
The forest plot (Figure 2) illustrates the effect sizes for each included study, alongside the pooled estimate. High heterogeneity was observed (I2 = 73%), which may be attributed to differences in study designs, diagnostic criteria, and sample populations. Despite these variations, the overall analysis indicates a lack of a strong association between orthodontic treatment and the development of TMDs symptoms.

3.4.2. Heterogeneity

A high level of heterogeneity was observed in the meta-analysis, with an I2 statistic of 73% and a Chi2 value of 11.00 (df = 3, p = 0.01). This substantial heterogeneity reflects considerable variability across the included studies, which can be attributed to several factors:
  • Differences in Study Design: Variations in sample recruitment, selection methods, and study methodologies contributed to inconsistencies in outcomes.
  • Diagnostic Criteria for TMDs: The included studies employed a range of diagnostic tools, such as clinical examinations, self-reported questionnaires, and imaging techniques, with only one study using standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). This lack of standardization likely influenced TMDs prevalence reporting.
  • Sample Characteristics: Differences in participant age, malocclusion types, and orthodontic interventions further contributed to the variability in outcomes.
Although the issue of overlapping populations was addressed by including only one study per population group in the final meta-analysis, high heterogeneity persisted due to methodological and diagnostic differences among the included studies. Future research should consider subgroup analyses and sensitivity testing to account for these variations and enhance the reliability of pooled estimates. Additionally, adopting standardized diagnostic criteria, such as RDC/TMD or DC/TMD, would improve the comparability of findings across studies.

3.4.3. Impact of Treatment Modalities

An essential consideration in TMDs research is whether different orthodontic protocols, such as extraction versus non-extraction approaches, have distinct impacts on TMDs development. Among the included studies, one specifically investigated the effects of extraction-based versus non-extraction-based treatments. The results indicated no significant differences in TMDs symptoms between the two protocols, suggesting that well-executed extraction therapy does not increase the risk of TMDs. This finding aligns with the existing literature, which emphasizes the importance of individualized treatment planning to maintain occlusal stability and TMJ health while addressing the patient’s specific orthodontic needs.

3.5. ROB

The ROB for the included studies was systematically evaluated using the ROBINS-I tool, focusing on seven key domains [46]. The assessment revealed varying levels of bias across the studies, summarized as follows (Figure 3):

3.5.1. Bias Due to Confounding

Confounding bias was identified as a significant issue in two studies. Egermark et al. [34] and Henrikson and Nilner [42] demonstrated moderate risk due to limited adjustments for variables such as age, gender, and malocclusion type. In contrast, Mušanović et al. [33] and Conti et al. [45] exhibited high risk of confounding bias due to insufficient control of these factors, which may have influenced the reported outcomes.

3.5.2. Bias in Selection of Participants

Most studies showed moderate ROB in participant selection. Egermark et al. [34] and Henrikson and Nilner [42] applied well-defined inclusion criteria but lacked comprehensive reporting of exclusion criteria, which may have introduced selection bias. Mušanović et al. [33] also demonstrated moderate risk, while Conti et al. [45] exhibited similar limitations in sample recruitment strategies.

3.5.3. Bias in Classification of Interventions

Bias related to intervention classification was generally low across the studies. All included studies clearly documented the type of orthodontic interventions (e.g., extraction vs. non-extraction protocols). Mušanović et al. [33] and Henrikson and Nilner [42] exhibited the lowest risk in this domain, while Egermark et al. [34] and Conti et al. [45] demonstrated moderate risk due to variability in treatment reporting.

3.5.4. Bias Due to Deviations from Intended Interventions

All studies demonstrated low ROB related to deviations from intended interventions. Treatment protocols were consistently implemented as planned, and there was no evidence of significant deviations during the study periods.

3.5.5. Bias Due to Missing Data

Egermark et al. [34] and Henrikson and Nilner [42] showed moderate ROB due to incomplete follow-up data, with dropout rates potentially affecting the validity of their findings. Conversely, Mušanović et al. [33] and Conti et al. [45] exhibited low risk, as their analyses accounted for missing data effectively.

3.5.6. Bias in Measurement of Outcomes

Outcome measurement bias varied significantly among the studies. Mušanović et al. adhered to standardized diagnostic criteria (RDC/TMD), ensuring low ROB. However, Egermark et al. [34] and Conti et al. [45] relied on less validated tools, such as clinical examinations and subjective questionnaires, resulting in moderate bias.

3.5.7. Bias in Selection of Reported Results

None of the studies demonstrated selective reporting bias. All reported outcomes aligned with their objectives, ensuring transparency in the data presentation.

3.5.8. Overall ROB

The ROBINS-I evaluation identified an overall moderate ROB across the included studies. While most domains demonstrated acceptable levels of methodological rigor, confounding bias and variability in diagnostic methods were the most significant contributors to the moderate risk level. Future research should focus on controlling for confounders and adopting standardized diagnostic tools, such as RDC/TMD or DC/TMD, to improve the reliability and comparability of findings.
Applsci 14 11430 g003aApplsci 14 11430 g003b
Figure 3. ROB domains [33,34,42,45].
Figure 3. ROB domains [33,34,42,45].
Applsci 14 11430 g003aApplsci 14 11430 g003b

3.6. Key Findings

3.6.1. Lack of Significant Association

The meta-analysis demonstrated that fixed orthodontic treatment does not significantly increase the risk of temporomandibular disorders (TMDs) in adolescents. The pooled OR was 0.75 (95% CI: 0.37–1.51, p = 0.42), indicating no statistically significant association between orthodontic treatment and TMDs development. While some individual studies suggested varying risks, the overall analysis aligns with the conclusion that fixed orthodontic treatment is not a substantial risk factor for TMDs.

3.6.2. High Heterogeneity

The analysis revealed substantial heterogeneity (I2 = 73%, Chi2 = 11.00, df = 3, p = 0.01), reflecting variability across the included studies. This heterogeneity suggests that other factors, such as anatomical differences, genetic predispositions, or external environmental influences, may have a more significant role in the pathogenesis of TMDs than orthodontic treatment itself.

3.6.3. ROB Considerations

The ROB assessment identified notable concerns, particularly in confounding, selection, and measurement domains. Variability in diagnostic criteria, with only one study using standardized RDC/TMD protocols, likely contributed to inconsistencies in TMDs prevalence reporting. Additionally, incomplete control of confounders, such as psychosocial and behavioral factors, may have influenced the findings. These limitations underscore the need for future research to adopt standardized diagnostic tools, robust randomization, and comprehensive reporting to enhance the reliability of results.

4. Discussion

This systematic review and meta-analysis examined the relationship between fixed orthodontic treatment during adolescence and the development of TMDs. The findings indicate that fixed orthodontic treatment does not significantly increase the risk of TMDs in adolescents, aligning with the multifactorial understanding of TMDs etiology. While orthodontic interventions in adolescence offer benefits for oral health and quality of life, their association with TMDs remains complex and warrants further investigation.

4.1. TMDs Prevalence and Etiology

TMDs are complex conditions influenced by multiple interrelated factors, including age, sex, occlusion, genetic predisposition, psychological stress, and behavioral habits. Understanding these multifactorial contributors is critical for developing personalized treatment approaches.

4.1.1. Age and Growth-Related Changes

TMDs symptoms frequently emerge or fluctuate during adolescence, largely due to rapid craniofacial growth that impacts TMJ structure and function [47,48]. Structural changes in the TMJ and surrounding musculature during puberty, such as condylar growth and remodeling, are associated with symptoms including joint sounds, muscle tenderness, and restricted mandibular movement [47,48]. For instance, Graf et al. (2019) highlighted that pubertal development influences TMJ hypermobility and clicking sounds, which are commonly observed during this growth period [47]. These growth-related changes are dynamic, meaning that the TMJ adapts to rapid skeletal and dental development, potentially exacerbating or resolving TMDs symptoms over time [47,49].
Adolescence represents a critical window for TMDs development, with pubertal staging often correlating more closely with TMDs symptoms than chronological age [48,50]. For example, studies have shown that the prevalence of temporomandibular pain increases with advancing pubertal development stages [48,50]. Recognizing the impact of craniofacial growth during this period is essential for early diagnosis and the development of treatment strategies that accommodate the ongoing anatomical and functional changes in the TMJ [47,49].

4.1.2. Sex-Related Differences

Females exhibit a consistently higher prevalence of TMDs compared to males during adolescence [48,50]. Studies suggest that adolescent girls experience a significantly higher risk of TMDs symptoms due to hormonal influences, such as estrogen’s effect on TMJ cartilage metabolism and pain sensitivity [47,50]. Shen et al. (2020) found that increased prolactin levels in females were associated with a higher prevalence of anterior disc displacement (ADD), a common TMDs subtype, during puberty [50]. Similarly, Graf et al. (2019) observed that hypermobility and TMJ clicking sounds were more prevalent in females than in males, likely due to the modulating effects of sex hormones such as estradiol and sex-hormone-binding globulin (SHBG) [47].
Although specific odds ratios for female TMDs prevalence were not consistently reported, multiple studies support the notion that hormonal fluctuations, including those linked to estrogen, contribute to the observed gender disparity in TMDs prevalence [47,50]. Estrogen’s role in enhancing pain sensitivity and modulating inflammatory responses underscores the importance of considering gender-specific approaches to TMDs diagnosis and management [47,50]. Tailored interventions are crucial for addressing the unique physiological and hormonal factors influencing female adolescents [48,50].

4.1.3. The Role of Occlusion

Malocclusions, particularly untreated Class II and III cases, have been associated with increased TMDs prevalence [51]. Orthodontic treatment, while previously thought to contribute to TMDs risk, has been shown to stabilize TMJ function and mitigate symptoms in severe malocclusion cases [52]. However, contemporary evidence suggests that occlusal factors act more as risk modifiers than primary etiological agents [53].

4.1.4. Genetic Contributions

Genetic predisposition plays a significant role in TMDs susceptibility. The OPPERA studies identified polymorphisms in key genes, such as COMT (catechol-O-methyltransferase), which modulates pain sensitivity and stress response [54,55]. Variants in serotonergic pathway genes like HTR2A and SLC6A4 have also been implicated, linking genetic factors to psychological resilience and nociceptive processing [55]. Additionally, genes associated with inflammation (PTGS1) and connective tissue integrity (COL1A1, COL5A1) further highlight the genetic complexity of TMDs [55].

4.1.5. Psychological Factors

Psychological distress is a well-established risk factor for TMDs. The OPPERA studies emphasized the predictive role of somatic symptoms, stress, and negative affectivity in TMDs onset [54,55]. Adolescents experiencing high levels of psychological distress or maladaptive coping strategies, such as pain catastrophizing, are at increased risk of developing chronic TMDs symptoms [56]. Addressing these psychological dimensions is crucial for effective TMDs management.

4.1.6. Behavioral Habits

Behavioral habits are significant contributors to TMDs risk, with various oral behaviors playing a crucial role in the development and exacerbation of symptoms. Bruxism, both awake and during sleep, is a primary contributor to TMJ overloading, resulting in muscle fatigue and joint stress. Fernandes et al. (2016) demonstrated that bruxism significantly increases the odds of painful TMDs, particularly when combined with other parafunctional habits, such as nail biting or gum chewing [57]. Similarly, Sun et al. (2024) found that specific oral behaviors, such as clenching teeth or holding the jaw in a rigid position, were strongly associated with painful TMDs (OR: 4.478 and 3.209, respectively) [58].
Parafunctional habits, such as excessive yawning, jaw propping, and biting objects, have also been identified as risk factors for TMDs. Manjunatha et al. (2023) reported a strong correlation between harmful oral habits like nail and lip biting and the development of TMJ pain and dysfunction [59]. Additionally, Winocur et al. (2006) highlighted that female adolescents are more likely to engage in parafunctional activities, such as intense gum chewing, which may partly explain the higher prevalence of TMDs symptoms in females compared to males [60].
Behavioral modifications, including reducing bruxism and other parafunctional activities, are essential components of TMDs prevention and management [61]. Addressing underlying psychosocial stressors is equally critical, as psychological factors often interplay with physical habits to exacerbate symptoms. These findings underline the need for comprehensive interventions targeting both behavioral and psychosocial aspects of TMDs risk [57,58,59,60].

4.1.7. Gene-Environment Interactions

The interplay between genetic predisposition and environmental factors further complicates TMDs etiology. Slade et al. demonstrated that individuals with specific COMT variants exhibit heightened susceptibility to TMDs when exposed to stress or orthodontic interventions [51,55]. This highlights the potential for genetic screening and personalized orthodontic planning to mitigate risks in predisposed individuals.
TMDs etiology reflects a complex interplay of biological, psychological, and behavioral factors. While orthodontic treatment does not appear to exacerbate TMDs symptoms, its interaction with genetic predispositions and developmental changes warrants careful consideration. Integrating genetic screening, psychological assessment, and behavioral interventions into TMDs management could enhance treatment outcomes and reduce long-term risks. Future research should focus on validating genetic markers, exploring epigenetic mechanisms, and further delineating the role of behavioral habits in TMDs progression.

4.2. Impact of Orthodontic Treatment on TMDs Development in Adolescents

Adolescents represent a unique demographic for orthodontic treatment due to their ongoing craniofacial growth, which can directly influence TMJ stability and morphology. This growth phase enables orthodontic interventions to maximize skeletal adjustments, achieving functional and aesthetic improvements that may otherwise be challenging in adulthood. Batista et al. [62] emphasized that early orthodontic treatment for Class II malocclusion, particularly in cases with a retrusive mandible, can guide jaw growth to achieve a harmonious maxillomandibular relationship, potentially enhancing TMJ stability. Abreu [63] further noted that early intervention reduces functional issues, such as chewing and speaking difficulties, and lowers the risk of dental trauma, especially with protruding incisors. This proactive approach may contribute to long-term TMJ health by addressing underlying malocclusions that could otherwise lead to TMDs [64].
In addition to functional benefits, orthodontic treatment during adolescence has been shown to improve oral health-related quality of life (OHRQoL) by addressing physical and social challenges. Sharma et al. [65] reported that both traditional fixed appliances and clear aligners significantly enhanced overall satisfaction among adolescent patients, with aligners providing quicker adaptation and greater social confidence—attributes particularly valued by adolescents. These psychosocial benefits highlight that orthodontic treatment contributes not only to functional improvements but also to an enhanced quality of life.
Moreover, Kim et al. [66] emphasized that correcting abnormal occlusal patterns and functional issues during the critical adolescent growth period is crucial for preventing future dental complications, such as TMDs and tooth wear. These corrections are particularly effective during this phase, as ongoing craniofacial development can be utilized to achieve functional and structural harmony [66]. However, the success of such interventions largely depends on careful biomechanical considerations [66]. Poorly controlled forces or the use of appliances that disrupt natural mandibular movements can increase TMJ loading, potentially causing microtrauma and exacerbating vulnerabilities in individuals predisposed to TMDs [66].
Similarly, Aldayel et al. [67] highlight mechanisms that may link orthodontic treatment to TMDs, reinforcing the importance of precise biomechanical management. For example, malocclusions such as unilateral posterior crossbite (UPCB) can disrupt occlusal balance, potentially contributing to TMDs onset [67]. However, the correction of such malocclusions does not always resolve symptoms, pointing to additional contributing factors [67]. Biomechanically, interventions like intermaxillary elastics may increase TMJ strain, particularly in Class II cases, while appliances like clear aligners can heighten masticatory muscle activity during early treatment [67]. These findings underscore the need for orthodontic approaches that not only correct structural irregularities but also account for neuromuscular adaptation [67]. The central nervous system’s role in adjusting to occlusal changes and individual variability in occlusal tactile acuity further highlights the complex interplay between mechanical and neurological factors in TMDs susceptibility [67]. Integrating these perspectives ensures a more comprehensive understanding and effective management of TMDs risks during orthodontic treatment [67].
Koaban et al. [22] noted that common malocclusions in adolescents, including open bite, excessive overbite, prominent maxilla, and crowding, are effectively managed through orthodontic interventions. These treatments aim to optimize oral structures and aesthetics during growth. Treatment methods range from fixed appliances, which are effective for occlusal correction but require diligent oral hygiene, to removable appliances, often employed in early interventions for younger children [68,69].
Despite these recognized benefits, the relationship between orthodontic treatment and TMDs development remains controversial. Some studies suggest that orthodontic forces might elevate TMDs risk by altering occlusion or stressing the TMJ, particularly in cases where elastic bands are used or where significant occlusal adjustments are made [25,27]. This risk may arise from changes in bite dynamics or excessive force application on the jaw, potentially increasing stress on the TMJ. Conversely, other research indicates that correcting malocclusions may reduce TMDs risk by enhancing occlusal stability and decreasing functional strain on the TMJ [70,71].
Monika et al. [71] discussed the multifactorial etiology of TMDs, noting that while occlusal instability and certain malocclusions may contribute to TMDs susceptibility, their correction alone does not consistently prevent TMDs due to the significant influence of psychological and hormonal factors. Similarly, Mohlin et al. [70] conducted a systematic review revealing that untreated malocclusions, such as crossbites and large overjets, are mildly associated with TMDs symptoms. While occlusal correction might reduce TMJ strain in select cases, it does not provide a definitive reduction in TMDs risk due to the complex interplay of other contributing factors.
By improving occlusal balance, orthodontic treatment could alleviate TMDs symptoms in patients with underlying occlusal discrepancies [61]. However, these opposing findings underscore the complex interaction between orthodontic forces and TMJ health, suggesting that factors such as individual growth patterns, appliance type, and force application influence the outcomes of orthodontic treatment on TMDs. This systematic review thus examines the interplay between adolescent orthodontic treatment and TMDs development, aiming to clarify whether orthodontic treatment serves as a risk factor or mitigator for TMDs.

4.3. Heterogeneity in TMDs Diagnosis

A key challenge in evaluating the relationship between orthodontic treatment and TMDs is the variation in diagnostic criteria across studies. Diagnostic methods ranged from clinical examinations and self-reported questionnaires to imaging techniques, with only one study utilizing standardized RDC/TMD criteria. This diagnostic heterogeneity likely contributed to the observed variability in TMDs prevalence and outcome measures.
Moreover, studies assessed different outcomes, with some focusing solely on TMDs prevalence and others examining symptom severity or functional impairment (Table 2). These discrepancies underscore the need for a unified diagnostic framework to ensure consistency and comparability. The recent adoption of the DC/TMD criteria for adolescent populations provides a promising standard to reduce variability and support reliable comparisons across studies [61,72].

4.4. Limitations

4.4.1. Exclusion of Overlapping Populations

To address the issue of overlapping study populations, three studies conducted by the same author on similar cohorts were excluded from the analysis to avoid redundancy and ensure diverse representation [42,43,44]. While this decision mitigates the ROB associated with repeated populations, it also reduced the number of included studies, limiting the statistical power of the findings. Future research should prioritize independent replication across diverse populations to enhance the robustness and generalizability of conclusions.

4.4.2. Limited Number of Studies

The small number of included studies posed a challenge in conducting a comprehensive systematic review. This limitation reduces the ability to draw strong conclusions about the relationship between orthodontic treatment and TMDs. Furthermore, the limited number of studies amplifies the impact of individual study quality and methodology on the overall findings.

4.4.3. Predominance of Older Studies

With the exception of one, the majority of the included studies were published over a decade ago. Advances in diagnostic criteria, orthodontic technology, and treatment protocols may limit the applicability of these older studies to current clinical practice. This time gap underscores the need for updated research to reflect contemporary orthodontic practices and diagnostic standards.

4.4.4. Temporal Limitations of Study Design

The included studies featured a mix of longitudinal and cross-sectional designs. While these methodologies provide valuable insights, they are limited in establishing causal relationships. Cross-sectional studies, in particular, are unable to infer temporality, making it difficult to determine whether orthodontic treatment preceded or followed the development of TMDs. Longitudinal studies with extended follow-up periods are needed to better understand the temporal dynamics of TMDs progression and orthodontic interventions.

4.4.5. Diagnostic Variability

A significant limitation of the included studies is the variability in diagnostic criteria for TMDs, which affects the consistency and comparability of findings. Some studies relied on clinical evaluations or self-reported questionnaires, while only one employed standardized RDC/TMD criteria. This heterogeneity complicates efforts to synthesize results and conduct meta-analyses.
The recent adoption of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) offers a promising standardized approach to address this variability. Initially developed for adults, the DC/TMD criteria have been adapted for younger populations, enhancing diagnostic accuracy and consistency [73]. Applying these criteria broadly could improve the comparability of studies and provide clearer insights into TMDs prevalence and outcomes in adolescents [73].

4.5. Clinical Implications

The findings of this review align with the existing literature, suggesting that orthodontic treatment does not typically exacerbate TMDs symptoms. However, the presence of pre-existing TMDs significantly influences the likelihood of symptom progression following treatment. Macfarlane et al. conducted a 20-year cohort study, reporting that patients without TMDs symptoms prior to orthodontic intervention were less likely to develop new symptoms post-treatment. In contrast, those with pre-existing symptoms exhibited variable outcomes, which depended on the severity and type of TMDs [35]. Similarly, research indicates that while mild TMDs symptoms may remain stable during orthodontic treatment, moderate to severe TMDs pose a higher risk for symptom aggravation, particularly when occlusal adjustments are substantial or treatment biomechanics increase joint loading [35].
These findings underscore the critical importance of comprehensive pre-treatment assessments for TMDs in orthodontic patients. A diagnostic approach integrating detailed patient history, clinical examination, and advanced imaging, such as MRI or CBCT when indicated, is essential to identify the type and severity of any existing TMDs [74]. Identifying these factors allows clinicians to individualize treatment plans, including adjustments to appliance types, force application, or treatment sequencing, to minimize TMJ stress and improve long-term outcomes. Furthermore, the potential influence of orthodontic interventions on TMJ health highlights the importance of addressing not only physical but also psychological and behavioral factors in patient care.

4.6. Future Directions

Future research should address the limitations identified in this review by prioritizing high-quality longitudinal studies that monitor adolescents during and beyond orthodontic treatment. Such studies are crucial to clarifying causal relationships between orthodontic interventions and TMDs development. The consistent use of standardized diagnostic criteria, such as the DC/TMD adapted for adolescents, is imperative to improve study comparability and ensure reliable outcomes.
Additionally, research should explore how individual factors—including genetic predispositions, stress, bruxism, and other behavioral habits—interact with orthodontic interventions and influence TMDs progression. These investigations could provide valuable insights into the multifactorial etiology of TMDs in adolescent populations and guide personalized orthodontic treatment strategies.
To address the challenge posed by the limited number of recent studies, future research should also aim to reflect advancements in orthodontic techniques and diagnostic tools. More diverse and contemporary datasets would enhance the applicability of findings to current clinical practices. Exploring the impact of biological and behavioral changes during adolescence, including hormonal fluctuations and craniofacial growth patterns, on the interaction between orthodontic forces and TMJ health is particularly important.
Finally, resolving diagnostic variability remains a critical objective. Adopting uniform, evidence-based diagnostic frameworks, such as the DC/TMD criteria, will reduce inconsistencies across studies and support more robust analyses of TMDs prevalence and outcomes. By addressing these research gaps, future studies can refine clinical guidelines, enhance TMJ outcomes, and ensure optimal oral health for adolescents undergoing orthodontic treatment.

5. Conclusions

Current evidence suggests that fixed orthodontic treatment has a limited impact on the prevalence of TMDs in adolescents. While orthodontic interventions provide significant functional and aesthetic benefits, their role in TMDs development remains complex and multifactorial. The findings of this review emphasize that TMDs are influenced by a combination of genetic, psychological, behavioral, and anatomical factors, rather than orthodontic treatment alone.
However, the limitations of this review must be acknowledged. The reliance on a small number of studies, many of which are older, alongside methodological variability and the exclusion of overlapping populations, highlights the need for more comprehensive research. Future studies should prioritize longitudinal designs to clarify the temporal relationship between orthodontic treatment and TMDs development. Such studies should also adopt standardized diagnostic criteria, such as the DC/TMD framework, to ensure consistency and comparability across research.
Addressing these gaps will be crucial for developing evidence-based clinical guidelines that optimize patient care. By integrating advancements in orthodontic technology, diagnostic tools, and an understanding of the multifactorial nature of TMDs etiology, future research can support individualized treatment strategies and improve long-term outcomes for adolescent patients undergoing orthodontic treatment.

Author Contributions

Conceptualization, S.J. and H.-J.P.; methodology, H.-J.P. and M.-K.J.; software, H.-J.P.; validation, J.-W.R. and J.-M.A.; formal analysis, S.J.; investigation, M.-K.J.; resources, S.J.; data curation, H.-J.P.; writing—original draft preparation, S.J. and M.-K.J.; writing—review and editing, H.-J.P.; visualization, S.J.; supervision, H.-J.P.; project administration, J.-W.R. and J.-M.A.; funding acquisition, H.-J.P. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by a research fund from Chosun University Dental Hospital, 2024.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors on request.

Conflicts of Interest

The authors declare no conflicts of interest.

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Applsci 14 11430 g001
Figure 1. The PRISMA flowchart.
Figure 1. The PRISMA flowchart.
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Figure 2. Forest plot of the meta-analysis [33,34,42,45].
Figure 2. Forest plot of the meta-analysis [33,34,42,45].
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Table 1. Quality Assessment of Included Studies Using the JBI Checklist. (a) JBI checklist for Cross-sectional study. (b) JBI checklist for Cohort study.
Table 1. Quality Assessment of Included Studies Using the JBI Checklist. (a) JBI checklist for Cross-sectional study. (b) JBI checklist for Cohort study.
(a)
CriteriaMušanović et al. (2021) [33]Conti et al. (2003) [45]
Were the criteria for inclusion in the sample clearly defined?YesYes
Were the study subjects and the setting described in detail?YesYes
Was the exposure measured in a valid and reliable way?YesYes
Were objective, standard criteria used for measurement of the condition?YesYes
Were confounding factors identified?YesYes
Were strategies to deal with confounding factors stated?YesYes
Were the outcomes measured in a valid and reliable way?YesYes
Was appropriate statistical analysis used?YesYes
(b)
JBI Checklist ItemsHenrikson T and Nilner M. (2003) [42]Egermark et al. (2005) [34]
1. Were the two groups similar and recruited from the same population?YesYes
2. Were the exposures measured similarly to assign people to both exposed and unexposed groups?YesYes
3. Was the exposure measured in a valid and reliable way?YesYes
4. Were confounding factors identified?YesYes
5. Were strategies to deal with confounding factors stated?YesYes
6. Were the groups/participants free of the outcome at the start of the study (or at the moment of exposure)?YesYes
7. Were the outcomes measured in a valid and reliable way?YesPartially addressed.
8. Was the follow-up time reported and sufficient to be long enough for outcomes to occur?YesYes
9. Was follow-up complete, and if not, were the reasons for loss to follow-up described and explored?YesYes
10. Were strategies to address incomplete follow-up utilized?YesYes
11. Was appropriate statistical analysis used?YesYes
Each study was evaluated using the appropriate JBI Checklist for its design: the JBI Checklist for Cohort Studies or the JBI Checklist for Analytical Cross-Sectional Studies. These assessments considered key methodological criteria, including the validity and reliability of findings. Partial fulfillment indicates areas where additional clarity or rigor could improve the study’s methodological robustness.
Table 2. Summary of Temporomandibular Disorders (TMDs) Prevalence in Orthodontic and Non-Orthodontic Populations: A Comparative Review of Key Studies.
Table 2. Summary of Temporomandibular Disorders (TMDs) Prevalence in Orthodontic and Non-Orthodontic Populations: A Comparative Review of Key Studies.
AuthorsType of StudyDiagnostic Tools UsedTotal Sample SizeTMDs Prevalence n (%)Sex and TMDs Prevalence n (%)Malocclusion and TMDs Prevalence n (%)Authors’ Conclusion
Conti et al. (2003) [45]Cross-sectional analyticalAnamnestic questionnaire and clinical examination200 (100 orthodontic, 100 control)34% mild, 3.5% moderate, 62.5% TMDs-freeHigher prevalence in females: 54% TMDs-free vs. 75% in malesNo association between malocclusion type and TMDs symptomsOrthodontic treatment not associated with TMDs; parafunctional habits/emotional tension linked to TMDs
Egermark et al. (2005) [34]Longitudinal prospective studyQuestionnaire, standardized clinical examination126 (40 orthodontic, 85 control)Low prevalence before and after treatment, 1% annual incidence requiring treatmentMore women than men participated; specific prevalence not detailedPrevalence of malocclusions low after treatment, similar to control groupOrthodontic treatment in childhood does not increase the risk of developing TMDs later in life
Henrikson and Nilner (2003) [42]Prospective observational cohortClinical assessment of TMDs and occlusal changes183 (65 orthodontic, 58 untreated Class II, 60 normal occlusion)Varied: Decrease in muscle tenderness post-treatment, but clicking increased in all groupsNo significant sex differences reportedClass II group had higher initial prevalence of TMDs symptoms than normal occlusionOrthodontic treatment did not increase or worsen TMDs symptoms; large individual variation observed
Mušanović et al. (2021) [33]Cross-sectional analyticalRDC/TMD Protocol120 (60 orthodontic, 60 control)56.4% with clicking in orthodontic group, 46.6% in control groupHigher prevalence of headaches in females (p < 0.03)No significant correlation between malocclusion type and TMDs prevalenceNo correlation between fixed orthodontic treatment and TMDs development
Each study was summarized based on its type, diagnostic tools, sample size, TMDs prevalence, and key findings. The studies utilized a mix of clinical assessments, questionnaires, and standardized criteria (e.g., RDC/TMD). Variations in diagnostic tools and sample demographics contributed to differences in reported TMDs prevalence. Limitations include the use of non-standardized methods in some studies and variability in malocclusion classifications. These differences were accounted for in the final meta-analysis to ensure consistency and reliability of the pooled results.
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Jeong, S.; Jih, M.-K.; Ryu, J.-W.; Ahn, J.-M.; Park, H.-J. The Relationship Between Adolescent Orthodontic Treatment and Temporomandibular Disorders: A Systematic Review with Meta-Analysis. Appl. Sci. 2024, 14, 11430. https://doi.org/10.3390/app142311430

AMA Style

Jeong S, Jih M-K, Ryu J-W, Ahn J-M, Park H-J. The Relationship Between Adolescent Orthodontic Treatment and Temporomandibular Disorders: A Systematic Review with Meta-Analysis. Applied Sciences. 2024; 14(23):11430. https://doi.org/10.3390/app142311430

Chicago/Turabian Style

Jeong, Seorin, Myeong-Kwan Jih, Ji-Won Ryu, Jong-Mo Ahn, and Hyun-Jeong Park. 2024. "The Relationship Between Adolescent Orthodontic Treatment and Temporomandibular Disorders: A Systematic Review with Meta-Analysis" Applied Sciences 14, no. 23: 11430. https://doi.org/10.3390/app142311430

APA Style

Jeong, S., Jih, M. -K., Ryu, J. -W., Ahn, J. -M., & Park, H. -J. (2024). The Relationship Between Adolescent Orthodontic Treatment and Temporomandibular Disorders: A Systematic Review with Meta-Analysis. Applied Sciences, 14(23), 11430. https://doi.org/10.3390/app142311430

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