Skip to content

For orthodontics

When complaints remain after correct alignment

There is an old suspicion in both directions between orthodontics and CMD practitioners. We clear it away first – with the evidence, not with diplomacy.

You know these patients

Functional complaints despite good occlusion. TMJ sounds, relapses, complaints after extraction therapy. And the question at the back of your mind whether the treatment has anything to do with it.

The connection

What has been measured

  1. 01Measured / described

    First, the reassurance: orthodontics as a cause of CMD is not proven

    Several systematic reviews find no consistent causal relationship between orthodontic treatment and CMD; a meta-signal shows a negligible effect on incidence. The literature’s verdict ranges “from hypothesis to insufficient data”. We do not make this accusation and do not support it.

  2. 02Measured / described

    What has been measured, however: your appliances change cervical posture

    In a recent review, 75 % of studies on functional orthodontic appliances showed a statistically significant effect on cervical posture, around 50 % for fixed appliances. Orthognathic repositioning acts depending on direction: setback tilts the head and neck backwards, advancement forwards.

  3. 03Measured / described

    The magnitude, so nobody reads too much into it

    The distance between centric condylar position and maximum intercuspation averages 0.86 ± 0.52 mm. The association between malocclusion class and head posture ranges between 1.3 and 2.9 degrees. These are real but small quantities.

  4. 04Where the evidence ends

    Where the evidence ends

    That morphological correctness does not automatically mean functional balance is our clinical interpretation and not a proven causal pathway. Occlusal monocausality is considered outdated; CMD is multifactorial and biopsychosocial. We do not question your treatment outcome.

Indication

When a referral is worthwhile

First, and without exception: red flags and unclear findings belong in specialist work-up, before any functional diagnostics. The CMD perspective complements, it does not replace.

Worthwhile

  • Functional complaints despite good tooth alignment
  • Suspected CMD before the start of treatment – as a documented baseline
  • TMJ sounds or restricted mouth opening during treatment
  • Juvenile idiopathic arthritis: roughly 3.9-fold increased risk of CMD diagnosed according to DC/TMD

Not worthwhile

  • For retrospective review of another practitioner’s treatment – we do not do this
  • With the expectation that we set an orthodontic indication

Your patient remains yours.

After the assessment or after regulation is complete, we always refer back to you. We only provide further treatment at your explicit written request.

Next steps

Three routes – your choice

  • 01

    I want to know more

    The full-text sources, our measurement protocols and the clinical explanatory model with its level of evidence disclosed.

    Request documents
  • 02

    I have a question about a case

    Call-back from the CMD specialist, not from reception.

    Ask a question
  • 03

    I would like to refer

    By phone, email or letter – whatever suits you. The findings report comes back to you.

    Referral

Other specialties

To the overview