Mandibular protrusion and temporomandibular disorders

a review of the relationship with tooth preservation and a multidisciplinary approach

Abstract

Tooth loss can trigger significant changes in mandibular morphology and position, predisposing to the development of temporomandibular disorders (TMDs). The absence of stable occlusal contact points favors muscle overload, musculoskeletal imbalance, and the emergence of compensatory movements, resulting in pain, joint wear, and mandibular instability. This literature review aimed to analyze the relationship between mandibular protrusion and tooth loss, highlighting its implications for TMDs and the need for a multidisciplinary approach in diagnosis and treatment. A systematic search was conducted in databases such as PubMed and SciELO, in addition to consulting relevant books and reviews in the field of dentistry, emphasizing the importance of interaction between various specialties to promote effective interventions. The findings demonstrate that dental integrity does not guarantee mandibular stability; therefore, it is essential to consider the interaction between muscles, joints, and occlusion. The role of early diagnosis and rehabilitation strategies, such as the restoration of anterior guidance and the vertical dimension of occlusion, in preventing functional and aesthetic changes is also highlighted. Integrated management of TMDs should involve dentistry, physical therapy, and speech therapy, aiming to restore joint function, minimize muscle overload, and reduce the risk of dysfunction progression, as well as diminish the presence of painful symptoms. We conclude that despite advances, this review identified gaps in the literature, especially regarding diagnostic criteria for mandibular protrusion in individuals with tooth loss. Clinical evaluation should prioritize functional and biomechanical aspects, ensuring mandibular stability and quality of life.