When complaints remain after correct alignment
Between orthodontists and CMD practitioners there is an old suspicion in both directions. We clear it away here first – with the published evidence, not with diplomacy.
You know these patients
Functional complaints despite good occlusion. Jaw joint noises, relapses, complaints after extraction therapy. And the question at the back of your mind whether the treatment has anything to do with it.
What has been measured
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 assessment ranges “from hypothesis to insufficient data”. We do not raise this accusation and do not support it.
What has been measured, by contrast: your appliances change neck posture
In a recent review, 75 % of studies on functional orthodontic appliances showed a statistically significant effect on cervical posture, and around 50 % for fixed appliances. Orthognathic repositioning acts according to direction: setback tilts the head and neck backwards, advancement forwards.
The order of magnitude, so that 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 lies between 1.3 and 2.9 degrees. These are real but small quantities.
Where the evidence ends
That morphological correctness does not automatically mean functional balance is our clinical reading and not a proven causal pathway. Occlusal monocausality is considered outdated; CMD is multifactorial and biopsychosocial. We do not call your treatment result into question.
When a referral is useful
First and without exception: red flags and unclear findings belong in a specialist work-up, before any functional diagnostics. The CMD perspective is complementary, not a substitute.
Useful
- functional complaints despite good tooth alignment
- suspected CMD before treatment begins – as a documented baseline
- jaw joint noises or restricted mouth opening during treatment
- juvenile idiopathic arthritis: around 3.9-fold increased risk of CMD diagnosed according to DC/TMD
Not useful
- for a retrospective appraisal of someone else's treatment – we do not do that
- with the expectation that we set an orthodontic indication
Your patient remains yours. After the assessment, or after the regulation is complete, we always refer back to you. We take on any treatment beyond this exclusively at your express, written request.
Three routes – you choose
I want to know more
The sources in full text, our measurement protocols and the clinical explanatory model with the level of evidence disclosed.
I have a question about a case
A call back from the CMD specialist, not from reception.
I would like to refer
By phone, e-mail or letter – whichever suits you. The findings report comes back to you.