YIJOM-3288; No of Pages 8

Int. J. Oral Maxillofac. Surg. 2015; xxx: xxx–xxx

http://dx.doi.org/10.1016/j.ijom.2015.10.016, available online at http://www.sciencedirect.com

Clinical Paper
Orthognathic Surgery

Effects of mandibular A. Bermell-Baviera, C. Bellot-Arcı́s,

J. M. Montiel-Company,
J. M. Almerich-Silla

advancement surgery on the Stomatology Department, Faculty of Medicine

and Dentistry, University of Valencia,
Valencia, Spain

temporomandibular joint and

muscular and articular adaptive
changes—a systematic review
A. Bermell-Baviera, C. Bellot-Arcı́s, J. M. Montiel-Company, J. M. Almerich-Silla:
Effects of mandibular advancement surgery on the temporomandibular joint and
muscular and articular adaptive changes—a systematic review. Int. J. Oral
Maxillofac. Surg. 2015; xxx: xxx–xxx. # 2015 International Association of Oral and
Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. The objective of this study was to assess the anatomical changes to the
condyle and articular disc following mandibular advancement surgery, the
adaptation of the masticatory muscles, and the improvement or worsening of
temporomandibular disorders (TMD) in patients with pre-existing disorders and
those who developed them following surgery. Four databases were searched
systematically: PubMed, Scopus, Embase, and Cochrane Library. Of the 544
articles initially selected, 219 were duplicates and a further 165 were excluded on
the basis of their titles and abstracts. On reading the full text, 89 were excluded
because they were of no interest and 43 because they did not meet the inclusion
criteria. Of the remaining 28 articles, six were excluded because they were
considered of low quality and 22 articles were reviewed. Mandibular advancement
surgery with condyle repositioning is associated with less TMD. Condylar
resorption is a physiological process with a multifactorial aetiology. It is accelerated
Key words: BSSO; orthognathic surgery; man-
following mandibular advancement surgery but is not a contraindication to this dibular advancement surgery; temporomandib-
procedure. Despite the large number of studies on the effects of mandibular ular joint disorders; mandibular osteotomy.
advancement surgery on the temporomandibular joint (TMJ), this surgery can
neither be said to improve nor to worsen TMJ health. Accepted for publication 19 October 2015

Temporomandibular joint (TMJ) health is cal procedure could be unsatisfactory in must be assessed before performing
of prime importance for stable results in terms of function, aesthetics, stability, and orthognathic surgery. The most frequent
orthognathic surgery. If the TMJ is not in pain.1 Consequently, any type of pain and/ temporomandibular disorders (TMDs)
good condition, the outcome of the surgi- or dysfunction in the head, neck, or TMJ are disc displacements, with or without

0901-5027/000001+08 # 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Bermell-Baviera A, et al. Effects of mandibular advancement surgery on the temporomandibular joint and
muscular and articular adaptive changes—a systematic review, Int J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.ijom.2015.10.016
YIJOM-3288; No of Pages 8
2 Bermell-Baviera et al.
reduction. They affect young adult women
to a greater extent,2 and often occur in
patients with mandibular retrognathia.3
The bilateral sagittal split osteotomy
(BSSO) is the surgical procedure of choice
to correct the most complex cases.3 Man-
dibular advancement surgery not only
improves aesthetics and function, but also
brings an improvement in the airways.4,5
Orthognathic surgery to advance the
mandible entails adaptive muscular
changes, but the results are not always
stable.6 Degenerative changes in the con-
dyle play an important part in relapses, but
the biomechanical changes that influence
the length of the oral muscles following
mandibular advancement are also a signif-
icant factor.7,8
Some authors consider that changes in
condyle position during surgery can in-
crease the risk of an early relapse and
encourage the development of TMDs or
worsen existing ones.6,9 Opinions differ
on whether repositioning the condyle prior
to surgery occasions greater or lesser
relapses and/or recovery times.1,9,10
The greater prevalence of TMD follow-
ing orthodontic and surgical treatment of
retrognathic patients continues to be a
subject of debate.1,11,12 Some have stated
that patients present early discomfort fol-
lowing surgery but adapt within a period
of between 6 months and 2 years,13 and
that this adaptation is greater or lesser
depending on the advancement attained
during surgery.2 In contrast, others con-
sider that the symptoms worsen,3 so there
is a clear division of opinions, making it
difficult to draw reliable conclusions.12,14–
17
The objective of this systematic review
was to evaluate muscular and articular
adaptive changes following orthognathic
mandibular advancement surgery and as-
sess the prevalence of TMD signs and
symptoms before and after this surgical
procedure. A further aim was to evaluate
the anatomical changes in the condyle and
the adaptation of the masticatory muscles
following surgery.
Materials and methods
A systematic review of the literature was
carried out in accordance with the PRISMA
(Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) recommen-
dations18 and CONSORT criteria.19
Study selection criteria
The selection criteria for the articles to be
included in the review encompassed arti-
cles, articles in press, and reviews of
Please cite this article in press as: Bermell-Baviera A, et al. Effects of mandibular advancement surgery on the temporomandibular joint and
muscular and articular adaptive changes—a systematic review, Int J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.ijom.2015.10.016
studies conducted in adults. Only the fol- Results
lowing types of study were accepted: sys-
The first stage of the search identified 219
tematic reviews and meta-analyses,
articles in PubMed, 203 in Scopus, 110 in
randomized controlled trials (RCTs), and
Embase, and 12 in Cochrane Library Plus,
cohort studies and case–control studies,
making a total of 544 articles. Of these,
both prospective and retrospective. All
219 were duplicates and were excluded.
those that investigated adaptation and
On critical reading of the title and abstract,
muscular and anatomical changes in the
165 articles were excluded because they
TMJ following mandibular advancement
did not answer the research question, leav-
surgery were accepted. Several articles
ing a total of 160 articles. On reading the
comparing the effects of different surgical
full text of these articles, 89 were excluded
advancement techniques on the TMJ were
because they were of no interest and 43
also included.
because they did not meet the inclusion
criteria. Of the remaining 28 articles, six
Search strategy and screening of articles were excluded because they were consid-
ered of low quality (Fig. 1).
To identify the relevant studies, irrespec-
Of the resulting 22 articles, four were
tive of language, a detailed electronic
systematic reviews (Table 2) and 18 were
search was carried out in the PubMed,
studies: five prospective and 13 retrospec-
Scopus, Embase, and Cochrane Library
tive (Table 1). As regards the quality of the
databases. All studies published between
studies, seven were of high quality and 11
2002 and 2014 were included. The search
of medium quality. The 18 studies includ-
was updated on 1 December 2014.
ed five case–control studies. As regards
The data search included a combination
the diagnostic methods, pre- and postop-
of nine primary terms concerning mandib-
erative clinical examinations were per-
ular advancement surgery: ‘‘orthognathic
formed in all studies. Radiographic
surgery’’, ‘‘maxillofacial surgery’’, ‘‘jaw
methods were employed in 14 studies:
surgery’’, ‘‘mandibular advancement sur-
seven used lateral teleradiology of the
gery’’, ‘‘mandibular advancement’’,
cranium, three used cone beam computed
‘‘mandibular retrognathism’’, ‘‘BSSO’’,
tomography (CBCT), three used comput-
‘‘bilateral sagittal split osteotomies’’,
ed tomography (CT), and three used mag-
and ‘‘malocclusion, Angle class II’’. A
netic resonance imaging (MRI). One study
further six secondary terms referring to
used three-dimensional (3D) photography
the TMJ and articular and muscular pro-
as a complementary diagnostic method. Di
blems were also included: ‘‘temporoman-
Palma et al. used electromyography, and
dibular disorders’’, ‘‘TMD’’,
Van den Braber et al. studied masticatory
‘‘temporomandibular effect’’, ‘‘temporo-
performance. As regards the objectives of
mandibular joint’’, ‘‘TMJ’’, and ‘‘muscu-
the studies, 13 analysed TMD and oral
lar changes’’. All the possible
function following surgery, two investi-
combinations between these words were
gated the effect of advancement surgery
explored.
on muscle length, one focused on muscle
Two reviewers independently assessed
activity after surgery, and five studied the
the titles and abstracts of all the articles. In
stability of mandibular advancement sur-
the event of disagreement, discussions
gery. Table 3 shows the distribution of the
were held until consensus was reached;
studies by their main observations.
however, if the reviewers continued to
disagree, a third reviewer was consulted.
If the abstract did not provide sufficient Discussion
information for a definite decision on in-
Articular changes
clusion or exclusion, the full article was
obtained and reviewed before the final Several authors observed that the position
decision was made. and morphology of the disc are closely
related to the stress suffered by the joint.9
As regards the condyle–disc relation-
Data extraction
ship, Saka et al.10 and Gonçalves et al.1
The variables selected for comparison be- found that patients with preoperative dis-
tween the studies were the following: placement of the disc who underwent
demographic variables (sex and age), sam- mandibular advancement surgery without
ple size, type of study, follow-up time, previous repositioning of the joint could
diagnostic method, and conclusions (Ta- experience a greater relapse and take sig-
ble 1). Lastly, the articles were classified nificantly longer to recover than those with
as being of high, medium, or low quality a repositioned TMJ, in agreement with
according to the CONSORT criteria,19 as Ueki et al.9 In relation to disc position,
adapted by Mattos et al.20 Ueki et al. indicated that fixing the
 YIJOM-3288; No of Pages 8
Table 1. Description of the studies included.
muscular and articular adaptive changes—a systematic review, Int J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.ijom.2015.10.016
Please cite this article in press as: Bermell-Baviera A, et al. Effects of mandibular advancement surgery on the temporomandibular joint and

Follow-up time
Study Sample Age (years)a Diagnostic in months Study
Authors, year type size and sex (M/F) method (T0 = preop.) Conclusions qualityb
Beukes et al. RS Cases 25 Cases 23, 9/16 Lateral T0 = 3–4 days preop. Patients whose medial pterygoid muscle and M
(2013)5 Controls 25 Controls 26.6, 7/18 teleradiology T1 = 0.25 and stylomandibular ligament were stripped
of cranium 6 months postop. during surgery showed greater long-term
stability
Franco et al. PS 27 26.7  13.2, 9/18 CBCT T1 = 12 and The mandibular advancement surgery was M
(2013)17 36 months postop. stable, however after 1–3 years, 20%
presented changes in condyle position
Kobayashi et al. RS 6 21, 1/5 CT, lateral T0 = 0.25 months Condylar resorption following surgery was H
(2012)21 teleradiology preop. observed and caused relapse. It is essential
of cranium T1 = 0.25 and for the condyles to be stable before surgery
12 months postop.
Maal et al. (2012)6 PS 18 32 (17–55), 6/12 CBCT, 3D T0 = 1 month preop. The use of 3D techniques is essential for H
photography T1 = 12 months precise, objective documentation of surgical
postop. changes
Näpänkangas RS 15 51.1, 9/6 Clinical T0 = 1 month preop. In the long-term, TMD did not increase M
et al. (2013)23 examination T1 = 1, 3, 6 and following surgery
24 months postop.
Carvalho PS 27 30.04  13.08, 9/18 CT, CBCT T1 = 0.25, 0.5, Following advancement, postero-superior H
et al. (2010)16 12 months postop. displacement of both condyles and
resorption occurred. 3D assessment showed
great individual variability in bone stability
Abrahamsson RS Cases 121 Cases 22.5  7.4, 51/70 Questionnaire, T0 = preop. Following surgery, myofascial pain without M
et al. (2009)24 Controls 56 Controls 23.4  7.4, 23/33 clinical examination, (not stated) limited opening increased and DDR and
lateral T1 = postop. arthralgia were observed, as well as other
teleradiology (not stated) general signs and symptoms of TMD
Dervis and PS Cases 50 Cases 29.3, 21/29 Clinical examination, T0 = 0.25 months Significant reduction in TMD 2 years after M
Tuncer (2002)26 Controls 50 Controls 29.8, 22/28 TMJ dysfunction indices preop. surgery. TMJ functional status can be

Effects of mandibular advancement surgery

T1 = 0.25, 12 and improved with orthognathic surgery
24 months postop.
Di Palma RS 19 17–34, 9/10 CT, T0 = preop. (not stated) Improvement in TMD signs and symptoms. M
et al. (2009)7 electromyography T1 = 6–8 months Electromyography showed this was due to
greater occlusal stability
Gonçalves RS 72 30, 13/59 Lateral teleradiology T0 = preop. Maxillomandibular advancement is a stable M
et al. (2008)1 of cranium, clinical T1 = 0.2 months procedure for patients with healthy TMJs
examination, MRI T2 = 24 months and for patients undergoing simultaneous
TMJ disc repositioning. Patients with
preoperative TMJ articular disc
displacement who underwent double-jaw
surgery and no TMJ intervention
experienced significant relapse
Dicker et al. RS 18 28, 7/11 Lateral teleradiology T0 = 1 month preop. The volume of the medial pterygoid muscle H
(2008)29 of cranium, MRI T1 = 27 months postop. increased in the brachyfacial patients who
underwent surgery, but decreased in the
dolichofacial cases

3
 4

YIJOM-3288; No of Pages 8
Table 1 (Continued )
muscular and articular adaptive changes—a systematic review, Int J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.ijom.2015.10.016
Please cite this article in press as: Bermell-Baviera A, et al. Effects of mandibular advancement surgery on the temporomandibular joint and

Follow-up time
Age (years)a

Bermell-Baviera et al.
Study Sample Diagnostic in months Study
Authors, year type size and sex (M/F) method (T0 = preop.) Conclusions qualityb
Rezende Frey PS 127 30, 103/24 Lateral teleradiology T0 = 0.5 months preop. Anti-clockwise rotation is related to an M
et al. (2008)4 of cranium T1 = 0.25, 1.5, 6, 12, increase in muscular symptoms following
24, and 60 months postop. BSSO. The distance advanced should not be
considered a risk factor for TMD
development
Dicker et al. RS 12 31, 5/7 MRI T0 = 1 month preop. Reduction in size of mandibular opening H
(2007)27 T1 = 18 months postop. and closing muscles following advancement
Van den Braber RS 12 – Study of masticatory T1 = 12 and 60 months postop. Mandibular advancement had a positive H
et al. (2006)25 performance effect on oral function
Van Lierde RS 8 26.1, 3/5 Clinical study and T0 = 0.25 months preop. After surgery, the patients showed the same M
et al. (2006)15 occlusal examination T1 = 3 months postop. joint pattern (normal or disturbed) as before
the operation
Saka et al. RS Cases 14 – MRI T0 = 1 month preop. Fixing the condylar process in the articular M
(2004)10 Controls 14 T1 = 9.3 months postop. fossa prior to surgery is a risk prevention
factor. Without repositioning, the
postoperative period was longer
Yamada et al. RS Cases 27 22  5 Questionnaire, CT T0 = preop. (not stated) After advancement surgery in patients with M
(2004)30 Controls 22 T1 = postop. (not stated) TMD, flattening of the articular eminence
may occur as a result of erosion, favouring
the appearance of disc displacement without
reduction
Wolford et al. RS 25 49  2, 2/23 CT, lateral T0 = preop. (not stated) The condition of patients suffering from H
(2003)3 teleradiology T1 = 12 months postop. TMD may worsen after this surgery; 24%
of cranium (n = 6) developed condylar resorption
M, male; F, female; preop., preoperative; postop., postoperative; RS, retrospective study; PS, prospective study; CBCT, cone beam computed tomography; CT, computed tomography; 3D, three-
dimensional; TMD, temporomandibular disorder; DDR, disc displacement with reduction; TMJ, temporomandibular joint; MRI, magnetic resonance imaging; BSSO, bilateral sagittal split osteotomy.
a
Age presented as the mean, mean  standard deviation, median (range), or range.
b
Study quality according to the CONSORT criteria (Schulz et al., 201019); H = high, M = medium.
YIJOM-3288; No of Pages 8

Effects of mandibular advancement surgery 5

Fig. 1. Flow diagram of the study selection process (SR, systematic review; PS, prospective study; RS, retrospective study; TMD,
temporomandibular disorder).

condyle in the centre of the fossa during
surgery is a factor in preventing postoper-
ative changes.9
Condylar resorption
Kobayashi et al. considered that idiopathic
condylar resorption is in itself a clinical
entity and that there is a significant risk of
postoperative degeneration.21 They con-
cluded that progressive postoperative con-
dylar resorption is a multifactor process
but follows an established pattern. They
observed a higher incidence in patients
with a dolichofacial pattern and retro-
gnathism and with preoperative erosion,
or condyle deformity, or both. In the same
way, several authors observed that preop-
erative morphological characteristics of
the condyle could be risk factors for re-
lapse and condylar resorption,1,9,21 and
that these same characteristics were often
found in patients with a history of TMD.1
Gonçalves et al. suggested that with pre-
vious condyle repositioning, fewer
changes in joint movement occur follow-
ing surgery: 26% instead of 50%.1 Conse-
quently, despite considering condyle
morphology a risk factor, repositioning
the condyle reduces the risk of relapse
and resorption. Wolford et al. observed
that exact repositioning of the TMJ disc
leads to clinical improvement in many
cases and that very significant relapse
takes place in the absence of TMJ disc
repositioning.3
Subjective and clinical symptoms of
temporomandibular dysfunction
Valladares-Neto et al. found that mandib-
ular advancement surgery did not affect
the TMJ of patients with pre-existing disc
displacement and crepitus.2 Moreover,
clicks and arthralgia are not predictable
following surgery, but there is a greater
probability of improvement after it is per-
formed. In the same way, Madani and

Please cite this article in press as: Bermell-Baviera A, et al. Effects of mandibular advancement surgery on the temporomandibular joint and
muscular and articular adaptive changes—a systematic review, Int J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.ijom.2015.10.016
YIJOM-3288; No of Pages 8

6 Bermell-Baviera et al.

Table 2. Details of the systematic reviews included.

Number of
Authors, year Study type articles included Conclusions
28
Lindenmeyer et al. (2010) Systematic review 32 RCTs are needed in order to reach definite conclusions
concerning the evolution of symptoms following this
surgery
Urs Joss et al. (2010)8 Systematic review 12 In spite of the large number of studies on BSSO and
TMD, the results have not been conclusive
14
Al-Riyami et al. (2009) Systematic review 53 Following surgery, the symptoms of patients with TMD
signs such as crepitus improve and although they
experience very limited jaw opening, this improves with
time; after 2 years, complete recovery has taken place
Abrahamsson et al. (2007)12 Systematic review 3 No conclusions drawn because of the few studies
identified and the heterogeneity of the study designs
RCT, randomized controlled trial; BSSO, bilateral sagittal split osteotomy; TMD, temporomandibular disorder.

Mirmortazavi observed a significant re-
duction in pain in patients who underwent
mandibular advancement surgery.22 These
findings agree with those of Näpänkangas
et al. after a 2-year postoperative follow-
up period.23 Urs Joss et al. also observed
an improvement in symptoms.8 However,
Wolford et al.,3 Rezende Frey et al.,4
Abrahamsson et al.,24 and Näpänkangas
et al.23 noted a worsening of signs and
symptoms of TMJ dysfunction, particular-
ly an increase in headaches and muscular
and joint pain.
Gonçalves et al. noted that mandibular
advancement surgery with counter-clock-
wise rotation is a stable procedure for
patients with healthy TMJs and for those
who simultaneously undergo disc reposi-
tioning.1 However, patients with preoper-
ative articular disc displacement
Table 3. Distribution of studies by main observations.
TMJ
Disorder worsened
Disorder improved
Degree of occlusal plane or
mandibular plane inclination
as a risk factor
Postoperative degenerative
changes in the condyle
Postoperative functional
disorders
Muscle pain
a
H = high, M = medium, SR = systematic review.
experienced a significant relapse (28%) Other studies such as those of Dervis
following surgery. Kobayashi et al. found and Tuncer,26 Van Lierde et al.,15 Abra-
that a small proportion (1:6) of patients hamsson et al.,12 Dicker et al.,27 Al-
with symptom-free joints developed cre- Riyami et al.,14 Lindenmeyer et al.,28
pitus following surgery.21 Yamada et al. and Franco et al.17 obtained very variable
observed that after advancement surgery results that provided no evidence of im-
in patients with TMD, flattening of the provement or worsening of TMJ disorders.
articular eminence may occur as a result of In relation to these findings, Urs Joss et al.
erosion, favouring the appearance of disc concluded that despite the large number of
displacement without reduction.30 studies on short- and long-term effects
Valladares-Neto et al.2 and Beukes following BSSO advancement, the results
et al.5 concluded that young women with concerning changes in TMJ symptoms are
mandibular retrognathism and a higher not conclusive.8
mandibular plane angle are more suscep-
tible to joint pain and show less improve-
Muscular adaptation
ment after advancement surgery.
Nevertheless, a number of authors found As there is known to be a correlation
an improvement in degenerative articular between facial bone structure and muscle
changes following this surgery.2,9,13,22,25 function,3,7,9 the studies took variations in
the musculature of the different skeletal
patterns into account.5,7,27 In general,
patients without preoperative problems
developed induration and pain on palpa-
Study tion of the masticatory muscles, irrespec-
Authors who observed TMJ (year) qualitya tive of facial pattern.
Kobayashi et al. (2012)21 H Rezende Frey et al.4 observed that man-
Näpänkangas et al. (2013)23 M dibular rotation affected by advancement
Rezende Frey et al. (2008)4 M surgery was associated with muscle dis-
Wolford et al. (2003)3 H comfort, particularly in patients where the
Al-Riyami et al. (2009)13 SR advancement was greater, which agrees
Van den Braber et al. (2006)25 H with the findings of Van den Braber
Dervis and Tuncer (2002)26 M et al.25 and Urs Joss et al.8 After this type
Di Palma et al. (2009)7 M of surgery, patients suffer a mandibular
Gonçalves et al. (2008)1 M hypomobility that eventually ends with
Franco et al. (2013)17 M improvements in muscular adaptation
Beukes et al. (2013)5 M and masticatory performance. Neverthe-
less, it has not proved possible to demon-
strate increased maximum jaw closing
Franco et al. (2013)17 M
force.8,25 Di Palma et al. found a better
Kobayashi et al. (2012)21 H
Carvalho et al. (2010)16 H balance of the masseter and anterior tem-
Yamada et al. (2004)30 M poralis muscles, although the improve-
ment in the parameters measured was
Al-Riyami et al. (2009)13 SR not significant.7 Dicker et al. observed a
Van den Braber et al. (2006)25 H
significant reduction in the size of masse-
Van Lierde et al. (2006)15 M
ter and medial pterygoid muscles, more so
Abrahamsson et al. (2009)24 M in the masseter muscles and more intense-
Wolford et al. (2003)3 H ly in dolichofacial patterns, causing mas-
ticatory changes to which the patient

Please cite this article in press as: Bermell-Baviera A, et al. Effects of mandibular advancement surgery on the temporomandibular joint and
muscular and articular adaptive changes—a systematic review, Int J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.ijom.2015.10.016
YIJOM-3288; No of Pages 8
adapted between 6 months and 2 years
later.27 In the same way, Dicker et al.
observed significant changes in lateral
pterygoid volume, which increased in bra-
chyfacial patients and decreased in doli-
chofacial cases.27 Di Palma et al. also
showed that the results for the anterior
digastric muscle varied considerably
depending on the skeletal pattern studied.7
It is not clear whether this muscle is
lengthened or shortened.29
Study limitations
To assess muscular and articular adaptive
changes following mandibular advance-
ment surgery, longitudinal studies with
medium- to long-term follow-up periods
are required.12 These studies need to be
conducted with more rigorous and homo-
geneous methods.
The studies reviewed show consider-
able heterogeneity and a lack of informa-
tion on the sample, radiography technique,
follow-up time, and type of TMJ disorder
present before surgery. As a result, it is
difficult to assess the outcomes of the
surgical procedures and arrive at results
and conclusions.
The volume of data collected on the
effects of mandibular advancement sur-
gery on the TMJ and on adaptive changes
to this joint and its muscles is not vast. The
rigorous screening of methodologically
acceptable articles undertaken for this sys-
tematic review limited the number of arti-
cles included.
In conclusion, surgical mandibular ad-
vancement with condyle repositioning is
associated with less TMD, while this sur-
gery without repositioning carries a higher
risk of relapse.
Condylar resorption is a physiological
process with a multifactorial aetiology. It
is accelerated following mandibular ad-
vancement surgery, but is not a contrain-
dication to this procedure.
Despite the large number of studies on
the effects of mandibular advancement
surgery on the TMJ, because of the con-
siderable heterogeneity of the methods
employed and the diversity of their
answers to the research question, mandib-
ular advancement surgery can neither be
said to improve nor to worsen TMJ health.
Funding
No sources of funding were needed.
Competing interests
The authors declare no conflict of interest.
Please cite this article in press as: Bermell-Baviera A, et al. Effects of mandibular advancement surgery on the temporomandibular joint and
muscular and articular adaptive changes—a systematic review, Int J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.ijom.2015.10.016
Effects of mandibular advancement surgery
Ethical approval
This research is a systematic review, so we
consider ethical approval not to be neces-
sary.
Patient consent
Not required.
Acknowledgement. The authors wish to
thank Mary Georgina Hardinge for trans-
lating the manuscript into English.
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Address:
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Departamento de Estomatologı́a
Unidad Docente de Ortodoncia
Clı́nica Odontológica
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Spain
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