Sheldon Friel Memorial Lecture 2025-Orthodontics and Temporomandibular Disorders: evolving views on risk factors, diagnosis, and management.

BACKGROUND AND OBJECTIVES

The role of occlusion and orthodontic treatment as potential risk factors for temporomandibular disorders (TMD) continues to be a subject of considerable debate within the scientific community. Nonetheless, current evidence suggests that the association between occlusion and TMD is generally weak and inconsistent and therefore should not be overemphasized.

MATERIALS AND METHODS

This article represents the Ernest Sheldon Friel Memorial Lecture presented in 2025 at the 100th Congress of the European Orthodontic Society. It is focused on the critical and updated evaluation of the relationship among occlusion, orthodontics and TMD. Starting from the historical perspective it analyses the role of condylar position, occlusal disharmonies and occlusal interferences as risk factors of TMD and highlights the need to move beyond a narrow mechanical interpretation of occlusion towards a more integrative approach that considers the central nervous system's processing of peripheral stimuli. In this broader context, individual differences in neuromuscular adaptability must be considered to reduce the likelihood of maladaptive outcomes following dental procedures.

CONCLUSIONS AND IMPLICATIONS

Orthodontists should be well-informed about the multifactorial aetiology of TMD, should know the validated diagnostic criteria for TMD and be prepared with evidence-based strategies for patient management at all stages of treatment.