Three-dimensional Quantitative Temporomandibular Joint Changes in Skeletal Class I Malocclusion Treated with Extraction and Non-extraction Protocols: a Comparative Study of Fixed Orthodontic Appliances and Clear Aligners

Overview

Journal Prog Orthod

Publisher Springer

Date 2025 Jan 19

PMID 39828796

Authors

Majedh Abdo Ali Al-Somairi

Bowen Zheng

Xaiofeng Yang

Yongxin Zhang

Maged S Alhammadi

Hao Xu

Najah Alhashimi

Bushra Sufyan ALmaqrami

Naseem Ali Al-Worafi

Enas Senan ALyafrusee

Barakat Al-Tayar

Yi Liu

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to evaluate the positional and morphological changes in the temporomandibular joint (TMJ) in adult patients with skeletal Class I malocclusion treated with fixed orthodontic appliances (FAs) and clear aligners (CAs), both with and without premolar extractions.

Methods: This retrospective study involved 120 adult patients divided into non-extraction and extraction groups, each further subdivided equally into those treated with FAs and CAs. Cone beam computed tomography (CBCT) was used to assess the TMJ measurements before (T0) and after treatment (T1). Statistical analyses were conducted to compare the mean changes in intra- and inter-groups. A significance level of p ≤ 0.05 was considered.

Results: In the non-extraction group, specifically in FAs, significant increases were observed in TMJ parameters; anteroposterior condylar position (APCP) and mediolateral condylar inclination (MCI). Conversely, significant decreases were noted in vertical condylar position (VCP) and vertical condylar inclination (VCI). In the extraction group, significant increases were noted in APCP and anterior joint space (AJS), while posterior joint space (PJS) and anteroposterior condylar joint position (APCJP) decreased. For inter-group comparisons, the extraction group showed significant increases in APCP in FAs compared to CAs, and a significant decrease in APCJP in FAs compared to CAs.

Conclusion: FAs significantly impact condylar positions and joint spaces, especially in extraction cases. Monitoring TMJ parameters during orthodontic treatment is crucial to ensure positive outcomes and prevent TMJ disorders (TMDs). These findings may guide the selection of orthodontic appliances based on individual malocclusion characteristics.

References

Merida-Velasco J, Rodriguez-Vazquez J, Merida-Velasco J, Sanchez-Montesinos I, Espin-Ferra J, Jimenez-Collado J . Development of the human temporomandibular joint. Anat Rec. 1999; 255(1):20-33. DOI: 10.1002/(SICI)1097-0185(19990501)255:1<20::AID-AR4>3.0.CO;2-N. View

ALmaqrami B, Alhammadi M, Tang B, ALyafrusee E, Hua F, He H . Three-dimensional morphological and positional analysis of the temporomandibular joint in adults with posterior crossbite: A cross-sectional comparative study. J Oral Rehabil. 2021; 48(6):666-677. DOI: 10.1111/joor.13156. View

Staggers J . Vertical changes following first premolar extractions. Am J Orthod Dentofacial Orthop. 1994; 105(1):19-24. DOI: 10.1016/S0889-5406(94)70095-8. View

GIANELLY A, Anderson C, Boffa J . Longitudinal evaluation of condylar position in extraction and nonextraction treatment. Am J Orthod Dentofacial Orthop. 1991; 100(5):416-20. DOI: 10.1016/0889-5406(91)70080-G. View

Carlton K, Nanda R . Prospective study of posttreatment changes in the temporomandibular joint. Am J Orthod Dentofacial Orthop. 2002; 122(5):486-90. DOI: 10.1067/mod.2002.128863. View

Alhammadi M, Fayed M, Labib A . Three-dimensional assessment of condylar position and joint spaces after maxillary first premolar extraction in skeletal Class II malocclusion. Orthod Craniofac Res. 2017; 20(2):71-78. DOI: 10.1111/ocr.12141. View

Al-Worafi N, Al-Nasri A, Al-Warafi L, Alsomairi M, ALyafrusee E, Alhashimi N . Effect of maxillary molars distalization using clear aligners and fixed orthodontic appliances on the positional and dimensional temporomandibular joint parameters: a three-dimensional comparative study. BMC Oral Health. 2024; 24(1):1372. PMC: 11562603. DOI: 10.1186/s12903-024-05148-y. View

Cangialosi T, Riolo M, Owens Jr S, Dykhouse V, Moffitt A, Grubb J . The ABO discrepancy index: a measure of case complexity. Am J Orthod Dentofacial Orthop. 2004; 125(3):270-8. DOI: 10.1016/j.ajodo.2004.01.005. View

Abdulqader A, Ren L, Alhammadi M, Abdu Z, Saleh Mohamed A . Three-dimensional analysis of temporomandibular joint in Chinese adults with normal occlusion and harmonious skeleton. Oral Radiol. 2019; 36(4):371-382. DOI: 10.1007/s11282-019-00415-z. View

10.

Rustia S, Lam J, Tahir P, Kharafi L, Oberoi S, Ganguly R . Three-dimensional morphologic changes in the temporomandibular joint in asymptomatic patients who undergo orthodontic treatment: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022; 134(3):397-406. DOI: 10.1016/j.oooo.2022.05.003. View

11.

Kouvelis G, Dritsas K, Doulis I, Kloukos D, Gkantidis N . Effect of orthodontic treatment with 4 premolar extractions compared with nonextraction treatment on the vertical dimension of the face: A systematic review. Am J Orthod Dentofacial Orthop. 2018; 154(2):175-187. DOI: 10.1016/j.ajodo.2018.03.007. View

12.

Barghan S, Tetradis S, Mallya S . Application of cone beam computed tomography for assessment of the temporomandibular joints. Aust Dent J. 2012; 57 Suppl 1:109-18. DOI: 10.1111/j.1834-7819.2011.01663.x. View

13.

Lione R, Balboni A, Di Fazio V, Pavoni C, Cozza P . Effects of pendulum appliance versus clear aligners in the vertical dimension during Class II malocclusion treatment: a randomized prospective clinical trial. BMC Oral Health. 2022; 22(1):441. PMC: 9552402. DOI: 10.1186/s12903-022-02483-w. View

14.

Wen J, Liu S, Ye X, Xie X, Li J, Li H . Comparative study of cephalometric measurements using 3 imaging modalities. J Am Dent Assoc. 2017; 148(12):913-921. DOI: 10.1016/j.adaj.2017.07.030. View

15.

Wyatt W . Preventing adverse effects on the temporomandibular joint through orthodontic treatment. Am J Orthod Dentofacial Orthop. 1987; 91(6):493-9. DOI: 10.1016/0889-5406(87)90006-0. View

16.

Matias M, Flores-Mir C, Almeida M, Vieira B, Freitas K, Nunes D . Miniscrew insertion sites of infrazygomatic crest and mandibular buccal shelf in different vertical craniofacial patterns: A cone-beam computed tomography study. Korean J Orthod. 2021; 51(6):387-396. PMC: 8607118. DOI: 10.4041/kjod.2021.51.6.387. View

17.

Ito T, Gibbs C, Lupkiewicz S, Young H, LUNDEEN H, MAHAN P . Loading on the temporomandibular joints with five occlusal conditions. J Prosthet Dent. 1986; 56(4):478-84. DOI: 10.1016/0022-3913(86)90393-8. View

18.

Alhammadi M, Almashraqi A, Thawaba A, Fayed M, Aboalnaga A . Dimensional and positional temporomandibular joint osseous characteristics in normodivergent facial patterns with and without temporomandibular disorders. Clin Oral Investig. 2023; 27(9):5011-5020. PMC: 10492742. DOI: 10.1007/s00784-023-05120-0. View

19.

Shen G . [The orthodontic therapeutic principles for malocclusions concurring with temporomandibular joint disorders]. Shanghai Kou Qiang Yi Xue. 2021; 30(4):337-343. View

20.

Bowbeer G . The 6th key to facial beauty and TMJ health. Funct Orthod. 1987; 4(4):10-1, 13-5, 18 passim. View