Evaluating the Effectiveness of Orthognathic Surgery on the Pre-existing Temporomandibular Disorders in Patients with Malocclusion: A Systematic Review and Meta-analysis

Mehraban, Saeed Hasani; Jamali, Samira; Azizi, Amir; Nasrabadi, Navid

doi:10.1590/pboci.2020.138

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Pesquisa Brasileira em Odontopediatria e Clínica Integrada

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SYSTEMATIC REVIEW • Pesqui. Bras. Odontopediatria Clín. Integr. 20 • 2020 • https://doi.org/10.1590/pboci.2020.138 copy

Evaluating the Effectiveness of Orthognathic Surgery on the Pre-existing Temporomandibular Disorders in Patients with Malocclusion: A Systematic Review and Meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the prevalence of temporomandibular disorders (TMDs) for those patients with dentofacial deformities, who underwent orthognathic surgery, and the control group. It also identified whether orthognathic surgery had a positive or negative impact on TMD symptoms by comparing TMD patients, who underwent orthognathic surgery, and people did not experience this surgery. Finally, this systematic review and meta-analysis aimed to evaluate the effectiveness of orthognathic surgery on the pre-existing TMDs in malocclusion patients.

Material and Methods:

MEDLINE, PubMed, Cochrane Library, Embase, ISI, google scholar have been utilized as the electronic databases for systematically reviewing the literature between 2001 and February 2019. Inclusion criteria were undergoing orthognathic surgery, patients with/without pre-existing TMDs, and physical disabilities.

Results:

A total of 669 abstracts and titles with potential relevance have been identified in the course of the manual and electronic searches. It has been found that five studies met our inclusion criteria for a systematic review. Temporomandibular disorders (TMDs) before orthognathic surgery in comparison to the controls (RR=0.02; 95% CI -0.08-0.13) and heterogeneity among the papers has been I2 = 42.86% (p=0.64).

Conclusion:

Malocclusion by orthognathic and orthodontics surgeries had a considerable rate of TMD compared to the controls.

Keywords:
Malocclusion; Orthognathic Surgery; Temporomandibular Joint Disorders

P	Patients	Patients were undergoing orthognathic surgery with various dentofacial deformities.
I	Intervention	Patients with/without pre-existing TMDs.
C	Compare	Patients with no congenital distortions, physical inabilities, previous jaw surgery, and great maxillomandibular relations and normal occlusion.
O	Outcomes	Report all Outcomes for TMD subgroups.
S	Study Design	Randomized controlled trials studies, prospective and retrospective cohort studies, and controlled clinical trials.

	Design	Sample Size		Male		Female		Age		Follow-up Period	Dentofacial Deformities
Study/Year		G1	G2	G1	G2	G1	G2	G1	G2		Class III	Class II	Class I	Conclusions
Dervis et al. (2002) [¹⁴[14] Dervis E, Tuncer E. Long-term evaluations of temporomandibular disorders in patients undergoing orthognathic surgery compared with a control group. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94(5):554-60. https://doi.org/10.1067/moe.2002.128021 https://doi.org/10.1067/moe.2002.128021... ]	Prospective	50	50	21	29	22	28	29.3	29.8	1w 12m 24m		NA		Not Statistical differences between symptoms and the type of dentofacial deformity
Abrahamsson et al. (2013) [¹⁵[15] Abrahamsson C, Henrikson T, Nilner M, Sunzel B, Bondemark L, Ekberg EC. TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment. Int J Oral Maxillofac Surg 2013; 42(6):752-8. https://doi.org/10.1016/j.ijom.2012.10.016 https://doi.org/10.1016/j.ijom.2012.10.0... ]	Prospective	98	38	38	23	60	33	22.4	23.4	18mo-24mo	58	20	13	The positive effects of the treatment on the TMD pain
Mladenovic et al. (2014) [¹⁶[16] Mladenović I, Dodić S, Stošić S, Petrović D, Čutović T, Kozomara R. TMD in class III patients referred for orthognathic surgery: psychological and dentition-related aspects. J Craniomaxillofac Surg 2014; 42(8):1604-9. https://doi.org/10.1016/j.jcms.2014.04.029 https://doi.org/10.1016/j.jcms.2014.04.0... ]	Prospective	44	44	25	19	25	19	23.2	23.5	NR	44	-	-	TMD in class III dentofacial deformities had the same rate of prevalence.
Al-Ahmad et al. (2014) [¹⁷[17] Al-Ahmad HT, Al-Bitar ZB. The effect of temporomandibular disorders on condition-specific quality of life in patients with dentofacial deformities. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117(3):293-301. https://doi.org/10.1016/j.oooo.2013.11.493 https://doi.org/10.1016/j.oooo.2013.11.4... ]	Prospective	39	39	12	17	21	18	23.8	23	21mo	24	6	7	TMDs following the treatment could negatively influence life quality.
Sebastiani et al. (2016) [¹⁸[18] Scolozzi P, Wandeler PA, Courvoisier DS. Can clinical factors predict postoperative temporomandibular disorders in orthognathic patients? A retrospective study of 219 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119(5):531-8. https://doi.org/10.1016/j.oooo.2015.01.006 https://doi.org/10.1016/j.oooo.2015.01.0... ]	Retrospective	119	106	10	7	35	2	30.2	23	6-12mo	33	17	4	Statistical differences for pre-surgery and post-surgery outcomes were not clearly reported.

Study/Year	Random Selection	Defined Inclusion/ Exclusion Criteria	Loss to Follow-Up	Validated Measurement	Statistical Analysis	The Estimated Potential Risk of Bias
Dervis et al. (2002) [¹⁴[14] Dervis E, Tuncer E. Long-term evaluations of temporomandibular disorders in patients undergoing orthognathic surgery compared with a control group. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94(5):554-60. https://doi.org/10.1067/moe.2002.128021 https://doi.org/10.1067/moe.2002.128021... ]	Yes	Yes	Yes	Yes	Yes	Low
Abrahamsson et al. (2013) [¹⁵[15] Abrahamsson C, Henrikson T, Nilner M, Sunzel B, Bondemark L, Ekberg EC. TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment. Int J Oral Maxillofac Surg 2013; 42(6):752-8. https://doi.org/10.1016/j.ijom.2012.10.016 https://doi.org/10.1016/j.ijom.2012.10.0... ]	No	Yes	Yes	Yes	Yes	Moderate
Mladenovic et al. (2014) [¹⁶[16] Mladenović I, Dodić S, Stošić S, Petrović D, Čutović T, Kozomara R. TMD in class III patients referred for orthognathic surgery: psychological and dentition-related aspects. J Craniomaxillofac Surg 2014; 42(8):1604-9. https://doi.org/10.1016/j.jcms.2014.04.029 https://doi.org/10.1016/j.jcms.2014.04.0... ]	No	Yes	Yes	Yes	Yes	Moderate
Al-Ahmad et al. (2014) [¹⁷[17] Al-Ahmad HT, Al-Bitar ZB. The effect of temporomandibular disorders on condition-specific quality of life in patients with dentofacial deformities. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117(3):293-301. https://doi.org/10.1016/j.oooo.2013.11.493 https://doi.org/10.1016/j.oooo.2013.11.4... ]	No	Yes	Yes	Yes	Yes	Moderate
Sebastiani et al. (2016) [¹⁸[18] Scolozzi P, Wandeler PA, Courvoisier DS. Can clinical factors predict postoperative temporomandibular disorders in orthognathic patients? A retrospective study of 219 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119(5):531-8. https://doi.org/10.1016/j.oooo.2015.01.006 https://doi.org/10.1016/j.oooo.2015.01.0... ]	No	Yes	Yes	Yes	Yes	Moderate

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[1] Author to whom correspondence should be addressed: Samira Jamali, Department of Endodontics, Stomatological Hospital, College of Stomatology, Xi'an Jiaotong University, Shaanxi 710004, PR China. E-mail: samira.jamali90@yahoo.com.