Prosthodontic planning in patients with temporomandibular disorders and/or bruxism: A systematic review.

STATEMENT OF PROBLEM: The presence of temporomandibular disorders (TMDs) and/or bruxism signs and symptoms may present multifaceted concerns for the prosthodontist.

PURPOSE: The purpose of this systematic review was to evaluate the relationship between prosthetic rehabilitation and TMDs and bruxism.

MATERIAL AND METHODS: Three research questions were identified based on different clinical scenarios. Should prosthodontics be used to treat TMD and/or bruxism? Can prosthodontics cause TMDs and/or bruxism? How can prosthodontics be performed (for prosthetic reasons) in patients with TMDs and/or bruxism? A systematic search in the PubMed database was performed to identify all randomized clinical trials (RCTs) comparing the effectiveness of prosthodontics with that of other treatments in the management of TMDs and/or bruxism (question 1); clinical trials reporting the onset of TMDs and/or bruxism after the execution of prosthetic treatments in healthy individuals (question 2); and RCTs comparing the effectiveness of different prosthodontics strategies in the management of the prosthetic needs in patients with TMDs and/or bruxism (question 3).

RESULTS: No clinical trials of the reviewed topics were found, and a comprehensive review relying on the best available evidence was provided. Bruxism is not linearly related to TMDs, and both of these conditions are multifaceted. Based on the diminished causal role of dental occlusion, prosthetic rehabilitation cannot be recommended as a treatment for the 2 conditions. In theory, they may increase the demand for adaptation beyond the stomatognathic system's tolerability. No evidence-based guidelines were available for the best strategy for managing prosthetic needs in patients with TMDs and/or bruxism.

CONCLUSIONS: This systematic review of publications revealed an absence of RCTs on the various topics concerning the relationship between TMD and bruxism and prosthodontics. Based on the best available evidence, prosthetic changes in dental occlusion are not yet acceptable as strategies for solving TMD symptoms or helping an individual stop bruxism. Clinicians should take care when performing irreversible occlusal changes in healthy individuals and in patients with TMD and/or bruxism.