Temporomandibular Düzensizlik ve Malokluzyon İlişkisi
Özet
Temporomandibular düzensizlikler (TMD), çiğneme kasları, temporomandibular eklem (TME) ve çevre dokularda görülen ağrılı, fizyolojik ve fonksiyonel bozukluklardır. Ortodontide ideal dentofasiyal estetik ve periodontal sağlığın yanı sıra TME yapılarını koruyacak fonksiyonel okluzyonun kurulması esastır. Literatürde malokluzyon ile TMD arasındaki ilişki uzun yıllardır tartışılmaktadır. Tarihsel süreçte Costen derin kapanış gibi anomalilerin TME'de ağrıya yol açtığını savunurken, Laskin emosyonel stresin dişsel faktörlerden daha etkili olduğunu ileri sürmüştür. TME rahatsızlıklarının etiyolojisi hazırlayıcı, hızlandırıcı ve devam ettirici faktörlerden oluşan multifaktöriyel bir yapıya sahiptir. Yapılan çalışmalarda Sınıf II malokluzyon, çapraz kapanış, artmış overjet, açık kapanış ve derin kapanış gibi ortodontik anomalilerin TME semptomlarını artırabileceği bildirilmiştir. Özellikle tek taraflı arka çapraz kapanış asimetrik kas aktivitesine; bruksizm, parmak emme ve tırnak yeme gibi oral parafonksiyonlar ise TME disfonksiyonuna yol açabilmektedir. Okluzyonun multifaktöriyel etiyolojiye katkısı %10-20 arasında değişmektedir. Güncel araştırmalar, malokluzyonun tek başına TMD sebebi olmadığını, çiğneme sisteminin ortopedik stabilitesi ile dinamik okluzal ilişkilerin statik ilişkilerden daha etkili olduğunu vurgulamaktadır. Sonuç olarak, mükemmel bir kapanışa sahip bireylerde bile ortopedik uyumsuzluk risk yaratabilirken, şiddetli malokluzyonu olan hastalar adaptasyon kapasiteleri sayesinde TMD geliştirmeyebilir.
Temporomandibular disorders (TMD) represent painful, physiological, and functional disturbances occurring within the masticatory muscles, the temporomandibular joint (TMJ), and surrounding tissues. In orthodontics, establishing a functional occlusion that preserves TMJ structures alongside ideal dentofacial esthetics and periodontal health is fundamental. The relationship between malocclusion and TMD has been debated in literature for many years, with historical perspectives shifting from Costen's view that dental anomalies cause TMJ pain to Laskin's psychophysiological theory emphasizing emotional stress over dental factors. The etiology of TMJ disorders is multifactorial, comprising predisposing, precipitating, and perpetuating factors. Studies indicate that orthodontic anomalies such as Class II malocclusion, crossbite, increased overjet, open bite, and deep bite can aggravate TMJ symptoms. Specifically, unilateral posterior crossbite can lead to asymmetric muscle activity, while oral parafunctional habits like bruxism, thumb sucking, and nail biting significantly contribute to TMJ dysfunction. Occlusal factors contribute approximately 10-20% to this multifactorial etiology, and contemporary research highlights that dynamic occlusal relationships are more influential than static ones, meaning that even individuals with ideal alignment may face risks if orthopedic stability is absent, whereas those with severe malocclusions might not develop TMD due to physiological adaptation.
Referanslar
Okeson, Jeffrey P. Management of temporomandibular disorders and occlusion.. 7th ed. Elsevier. 2012.
Utt TW, Meyers CE, Wierzba TF, et al. A three-dimensional comparison of condylar position changes between centric relation and centric occlusion using the mandibular position indicator. Am J Orthod Dentofacial Orthop. 1995;107(3):298–308. doi: 10.1016/s0889-5406(95)70146-x
Miller J, Burgess J, Critchlow C. Association between mandibular retrognathia and TMJ disorders in adult females. J Public Health Dent 2004;64: 157–63. doi: 10.1111/j.1752-7325.2004.tb02746.x
Egermark I, Magnusson T, Carlsson G. A 20-year follow-up of signs and symptoms of temporoman- dibular disorders and malocclusions in subjects with and without orthodontics and orthognathic treatment. Angle Orthod 2003;73:109–15. doi: 10.1043/0003-3219(2003)73<109:ayfosa>2.0.co;2
Park Je Uk, Baık S H. Classification of Angle Class III malocclusion and its treatment modalities. International Journal of Adult Orthodontics and Orthognathic Surgery. 2001;16.1: 19-29.
Celic R, Jerolimov V, Panduric J. A study of influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD. Int J Prosthodont. 2002;15:43–8.
Abrahamssson C, Henrikson T, Nilner M, et al. TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment. Int J Oral Maxillofac Surg. 2013;42:752–8. doi: 10.1016/j.ijom.2012.10.016
Bhavna S. Malocclusion as a cause for temporomandibular disorders and orthodontics as a treatment. Oral and Maxillofacial Surgery Clinics. 2018, 30.3: 299-302. doi: 10.1007/s10266-007-0067-7
Thompson J. Temporomandibular disorders: diag- nosis and treatment. In: Sarnat B, editor. The temporomandibular joint. 2nd edition. Springfield (IL): Charles C. Thomas; 1964. p. 146–84.
Costen JB I. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. Ann Otol Rhinol Laryngol 1934;43(1):1–15. doi: 10.1177/000348949710601002
Schwartz LL. A temporomandibular joint pain-dysfunction syndrome. J Chronic Dis. 1956;3(3):284–93. doi: 10.1016/0021-9681(56)90123-0
Laskin DM. Temporomandibular disorders: the past, present, and future. Odontology 2007;95(1):10–5. doi: 10.1007/s10266-007-0067-7
McNeill C. Craniomandibular disorders. Manag Chicago Quintessence. 2017.
Jerjes W, Upile T, Abbas S, et al. The muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities. Int Arch Med. 2008;1: 23. doi: 10.1186/1755-7682-1-23
Buescher J. Temporomandibular joint disorders. Am Fam Physician. 2007;76:1477-82,1483-84.
Riolo ML, Brandt D, TenHave TR. Associations between occlusal characteristics and signs and symptoms of TMJ dysfunction in children and young adults. Am J Orthod Dentofac Orthop. 1987;92(6):467–77. doi: 10.1016/0889-5406(87)90228-9
Mohlin B, Axelsson S, Paulin G, Pietila T, Bonde- mark L, Brattström V. TMD in relation to malocclusion and orthodontic treatment. Angle Orthod. 200777(3): 542-548. doi: 10.2319/0003-3219(2007)077[0542:tırtma]2.0.co;2
Simon EP, Lewis DM. Medical hypnosis for tempo- romandibular disorders: treatment efficacy and me- dical utilization outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90: 54-63. doi: 10.1067/moe.2000.106692.
McLaughlin RP. Malocclusion and the temporomandibular jointan historical perspective. The Angle orthodontist. 1988;58:185–91. doi: 10.1043/0003-3219
McNamara JA, Seligman DA, Okeson JP. (). Occlusion, Orthodontic treatment, and temporomandibular disorders: a review. Journal of orofacial pain. 1995;9:73–90.
Williamson EH, Caves SA, Edenfield RJ, Morse PK. Cephalometric analysis: Comparisons between maximum intercuspation and centric relation. Am J Orthod. 1978;74(6):672–7. doi: 10.1016/0002-9416(78)90006-4.
Perry HT. Relation of occlusion to temporomandibular joint dysfunction: the orthodontic viewpoint. J Am Dent Assoc. 1969;79(1):137–41. doi: 10.14219/jada.archive.1969.0216
Pullinger AG, Seligman DA, Solberg WK. Temporomandibular disorders. Part II: Occlusal factors associated with temporomandibular joint tenderness and dysfunction. J Prosthet Dent. 1988;59(3):363–7. doi: 10.1016/0022-3913(88)90191-6
Al-Hadi LA. Prevalence of temporomandibular disorders in relation to some occlusal parameters. J Prosthet Dent. 1993;70(4):345–50. doi: 10.1016/0022-3913(93)90220-i
Roberts CA, Tallents RH, Katzberg RW, Sanchez-Woodworth RE, Espeland MA, Handelman SL. Comparison of internal derangements of the TMJ with occlusal findings. Oral Surgery, Oral Med Oral Pathol. 1987;63(6):645–50. doi: 10.1016/0030-4220(87)90361-6
Thilander B, Dr O, Rubio G, Pena L, De Mayorga C. Prevalence of Temporomandibular Dysfunction and Its Association With Malocclusion in Children and Adolescents: An Epidemiologic Study Related to Specified Stages of Dental Development. Angle Orthod. 2002;72(2):146-54. doi: 10.1043/0003-3219(2002)072<0146:potdaı>2.0.co;2
Farrar WB. Diagnosis and treatment of anterior dislocation of the articular disc. N Y J Dent. 1971;41(10):348–51.
Wilkes CH. Structural and functional alterations of the temporomandibular joint. Northwest Dent. 1978;57(5):287-94.
Fichera G, Ronsivalle V, Santonocito S, et al. Class II Skeletal Malocclusion and Prevalence of Temporomandibular Disorders. An Epidemiological Pilot Study on Growing Subjects. Funct Morphol Kinesiol. 2021;20:6(3):63. doi: 10.3390/jfmk6030063.
Sarı Ş, Sönmez H. Investigation of the relationship between oral parafunctions and temporomandibu- lar joint dysfunction in Turkish children with mixed and permanent dentition. J Oral Rehabil. 2002;29: 108- 112. doi: 10.1046/j.1365-2842.2002.00781.x
Odabaş B, Arslan SG. Temporomandibular eklem anatomisi ve rahatsızlıkları. Dicle Tıp Dergisi. 2008;35(1): 77-85.
Motohashi M, Nakajima I, Aboshi H, Honda K, Yanagisawa M, Miyata T, Maeno M, Kuwata F. The oral health of children in a rural area of the Lao People’ s Democratic Republic. J Oral Sci. 2009;51(1): 131-135. doi: 10.2334/josnusd.51.131
Selaimen CMP, Jeronymo JCM, Brilhante DP, Lima EM, Grossi PK, Grossi ML. Occlusal risk factors for temporomandibular disorders. Angle Orthod. 2007;77(3): 471-477. doi: 10.2319/0003-3219(2007)077[0471:orfftd]2.0.co;2
Sarı Ş, Sönmez H, Oksak GO, et al. Temporomandibular joint dysfunction and occlusion in the mixed and permanent dentition. J Clin Pediatr Dent. 1999;24(1); 59-62.
Katsavrias EG, Halazonetis DJ. Condyle and fossa shape in Class II and Class III skeletal patterns: A morphometric tomographic study. Am J Orthod Dentofac Orthop. 2005;128(3):337–46. doi: 10.1016/j.ajodo.2004.05.024
Tanne K, Tanaka E, Sakuda M. Association between malocclusion and temporomandibular disorders in ortodontic patients before treatment. J Orofac Pain. 1993;7:156-62.
Roth R. Temporomandibular pain-dysfunction and occlusal relationships. Angle Orthod [online]. Available from: http://www.angle.org/doi/abs/10.1043/0003-3219 (1973). [Accessed 2017 Jun 22].
Crawford S. Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms of temporomandibular dysfunction. Angle Orthod. [online]. Available from: http://www.angle.org/doi/abs/10.1043/0003-3219 (1999). [Accessed 2017 Jun 23].
Seligman DA, Pullinger AG. The role of functional occlusal relationships in temporomandibular disorders: a review. J Craniomandib Disord. 1991;5(4):265–79.
