Volume 30, Issue S1 p. 5-11
Original Manuscript

Does the Stomatognathic System Adapt to Changes in Occlusion? Best Evidence Consensus Statement

Charles J. Goodacre DDS, MSD

Corresponding Author

Charles J. Goodacre DDS, MSD

Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA

Correspondence

Charles J. Goodacre, DDS, MSD, Distinguished Professor, Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA 92350. E-mail: [email protected]

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W. Eugene Roberts DDS, PhD

W. Eugene Roberts DDS, PhD

Mechanical Engineering, Indiana University & Purdue University, Indianapolis, IN

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Gary Goldstein DDS

Gary Goldstein DDS

New York University, New York, NY

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Jonathan P. Wiens MPH, MS

Jonathan P. Wiens MPH, MS

Department of Restorative Dentistry, University of Detroit Mercy School of Dentistry, Detroit, MI

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First published: 17 December 2020
Citations: 7

Conflict of Interest: The authors deny any conflicts of interest related to this paper.

Abstract

Purpose

The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature on the stomatognathic system's ability to adapt to occlusal changes.

Materials and Methods

The search term stomatognathic system was not useful as it resulted in over 400,000 results nor was the search term temporomandibular joint adaptation with 738 results due to the large number of references not related to the topic. The terms stomatognathic system adaptation to occlusal changes (186 results), teeth flexion (139 results), muscle adaptation to dental occlusion (278 results), and occlusal changes and neuroplasticity (11 results) provided the best selection of articles related to the topic. Limiting the above searches to systematic reviews and randomized controlled clinical trials resulted in multiple publications that were related to the question. Other literature reviews, data-based publications, and expert opinion resources have been included due to their relationship to the question.

Results

From the extensive list of search results, 242 articles were determined to be potentially related to the focus question and were evaluated with 56 being included in this paper. It was determined that the stomatognathic system adapts to occlusal changes through the temporomandibular joint, muscles, teeth and bone. The dynamically modified periosteum on the articulator surfaces of the condyle and fossa has a unique load-bearing morphology with 3 subarticular layers of fibrocartilage that absorb and dissipate both peak (impact) and sustained loads. Adaptability of the TMJs and muscles can be documented through studies where artificially produced occlusal interferences were placed in patients and those study participants with normal temporomandibular joints (TMJs) adapted fairly well whereas those with a previous history of temporomandibular disorders (TMD) did not adapt as well.

Conclusions

Available evidence indicates patients generally adapt to the occlusal change inherent in orthodontic treatment, mandibular advancement surgery, and the use of mandibular advancement devices. The head and neck muscles also adapt to occlusal changes in patients without a history of TMD. The dentition adapts to changes through the bone and periodontal ligaments as well as the ability of teeth to undergo slight flexion under masticatory loading.

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