Non-Cochrane · intervention · PM42396093
Assessment of temporomandibular joint morphological alterations after bilateral sagittal split ramus osteotomy - A systematic review and meta-analysis.
Azees Rasha, Sarika K, James Anju, et al. · Journal of oral biology and craniofacial research · 2026 · PubMed · doi:10.1016/j.jobcr.2026.101483
Findings
15 findings
| Population | ||||
|---|---|---|---|---|
| Adults with skeletal Class II malocclusion undergoing BSSRO (mandibular advancement) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Superior joint space 1 year (long-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class II | SMD 0.46 [-0.08, 1.0] GRADE not reported 2 studies · 67 participants |
| Adults with skeletal Class II malocclusion undergoing BSSRO (mandibular advancement) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Posterior joint space Within 1 month (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class II | SMD 0.42 [-0.05, 0.9] GRADE not reported 2 studies · 67 participants |
| Adults with skeletal Class II malocclusion undergoing BSSRO (mandibular advancement) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Superior joint space Within 1 month (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class II | SMD -0.35 [-1.72, 1.02] GRADE not reported 2 studies · 67 participants |
| Adults with skeletal Class II malocclusion undergoing BSSRO (mandibular advancement) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Posterior joint space 12-18 months (long-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class II | SMD 0.97 [0.61, 1.33] GRADE not reported 2 studies · 67 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Posterior joint space Within 1 month (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD -0.72 [-1.68, 0.23] GRADE not reported 2 studies · 61 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Superior joint space 1 year (long-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD 0.26 [-0.14, 0.67] GRADE not reported 2 studies · 47 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Superior joint space Within 1 month (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD -0.57 [-1.45, 0.31] GRADE not reported 2 studies · 61 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Anterior joint space Within 1 month (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD -0.03 [-0.38, 0.33] GRADE not reported 2 studies · 61 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Condylar height 1 year (long-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD 0.37 [0.08, 0.66] GRADE not reported 2 studies · 93 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Posterior joint space 2-8 months (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD -0.26 [-0.63, 0.1] GRADE not reported 4 studies · 115 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Condylar height Within 1 month (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD 0.12 [-0.17, 0.4] GRADE not reported 2 studies · 96 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Posterior joint space 12-18 months (long-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD 0.23 [-0.17, 0.64] GRADE not reported 2 studies · 47 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Axial condylar axis angle 1-2 weeks (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD 0.77 [0.44, 1.1] GRADE not reported 3 studies · 76 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Superior joint space 6-8 months (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD 0.04 [-0.25, 0.34] GRADE not reported 3 studies · 104 participants |
| Adults with skeletal Class III malocclusion undergoing BSSRO (mandibular setback) | BSSRO (post-surgery TMJ measurement) | Pre-surgery (baseline) TMJ measurement | Anterior joint space 6-8 months (short-term) · Orthognathic surgery, 3D imaging (CBCT, CT, MRI) · Class III | SMD -0.21 [-0.83, 0.41] GRADE not reported 3 studies · 87 participants |
Included primary studies 29
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Chen 2013 Short- and long-term changes of condylar position after bilateral sagittal split ramus osteotomy for mandibular advancement in combination… PMID:23973047 | 2013 | this review only | Superior joint space; Posterior joint space | not extracted yet |
| Fang 2009 Changes in condylar and joint disc positions after bilateral sagittal split ramus osteotomy for correction of mandibular prognathism. PMID:19375280 | 2009 | this review only | not stated | not extracted yet |
| Gulcek 2023 Changes in the condylar head after orthognathic surgery in Class III patients: a retrospective three-dimensional study. PMID:36409284 | 2023 | this review only | Axial condylar axis angle; Condylar height | not extracted yet |
| Hupp 2023 Modeling the effect of bilateral sagittal split osteotomy on posterior, superior and medial space dimensions of the temporomandibular… PMID:37198590 | 2023 | this review only | Superior joint space; Posterior joint space | not extracted yet |
| Iguchi 2017 Comparison of temporomandibular joint and ramus morphology between class II and class III cases before and after bi-maxillary osteotomy. PMID:29046240 | 2017 | this review only | Superior joint space; Posterior joint space; Condylar height | not extracted yet |
| Kawamata 1998 Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy. PMID:9574943 | 1998 | this review only | not stated | not extracted yet |
| Kikuta 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kikuta 2024 Mechanism of reactivation and refolding of glyceraldehyde-3-phosphate dehydrogenase from yeast after denaturation and dissociation. PMID:202463 | 1977 | this review only | not stated | not extracted yet |
| Kim 2009 Changes in the temporomandibular joint disc position after orthognathic surgery. PMID:19451004 | 2009 | this review only | not stated | not extracted yet |
| Kim 2010 The assessment of the short‐ and long‐term changes in the condylar position following sagittal split ramus osteotomy (SSRO) with rigid… DOI:10.1111/j.1365-2842.2009.02056.x | 2010 | this review only | Axial condylar axis angle | not extracted yet |
| Kim 2010 The assessment of the short- and long-term changes in the condylar position following sagittal split ramus osteotomy (SSRO) with rigid… PMID:20113391 | 2010 | this review only | not stated | not extracted yet |
| Kim 2011 Cone-beam computerized tomography evaluation of condylar changes and stability following two-jaw surgery: Le Fort I osteotomy and… PMID:21055977 | 2011 | this review only | Superior joint space; Posterior joint space; Anterior joint space; Axial condylar axis angle | not extracted yet |
| Kim 2024 Quantitative determination of myoinositol, inositol 1-phosphate, inositol cyclic 1 : 2-phosphate and glycerylphosphoinositol in normal and… PMID:202462 | 1977 | this review only | not stated | not extracted yet |
| Lekroengsin 2023 Relationship between Changes in Condylar Morphology and Masticatory Muscle Volume after Skeletal Class II Surgery. PMID:37510990 | 2023 | this review only | not stated | not extracted yet |
| Luo 2023 Changes of Temporomandibular Joint Morphology and Symptoms in Class II Malocclusion Patients With Bilateral Sagittal Split Ramous Osteotomy. PMID:37801718 | 2023 | this review only | not stated | not extracted yet |
| Ma 2019 Effect of sagittal split ramus osteotomy on morphologic parameters of temporomandibular joint in patients with mandibular prognathism. PMID:31145325 | 2019 | this review only | not stated | not extracted yet |
| Ma 2020 Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam… PMID:31728734 | 2020 | this review only | not stated | not extracted yet |
| Mavreas 1992 Tomographic assessment of alterations of the temporomandibular joint after orthognathic surgery. PMID:1563472 | 1992 | this review only | Superior joint space; Posterior joint space; Anterior joint space | not extracted yet |
| Panpitakkul 2024 Three-Dimensional Changes of Condylar Position After Bimaxillary Surgery to Correct Skeletal III Malocclusion: Cone Beam Computed… PMID:38889883 | 2024 | this review only | Posterior joint space | not extracted yet |
| Ren 2023 Effect of the magnitude of condylar head displacement on the TMJ function in skeletal class II patients undergoing different degrees of… PMID:37352620 | 2023 | this review only | not stated | not extracted yet |
| Sobouti 2022 Short-term and long-term alterations of condylar position after bilateral sagittal split ramus osteotomy for mandibular setback: A… PMID:35308442 | 2022 | this review only | Superior joint space; Posterior joint space; Anterior joint space | not extracted yet |
| Takahara 2016 MRI changes in the temporomandibular joint following mandibular setback surgery using sagittal split ramus osteotomy with rigid fixation. PMID:27077250 | 2017 | this review only | not stated | not extracted yet |
| Ueki 2007 Condylar and disc positions after sagittal split ramus osteotomy with and without Le Fort I osteotomy. PMID:17321444 | 2007 | this review only | not stated | not extracted yet |
| Ueki 2008 Horizontal changes in the condylar head after sagittal split ramus osteotomy with bent plate fixation. PMID:18602292 | 2008 | this review only | not stated | not extracted yet |
| Ueki 2009 Assessment of ramus, condyle, masseter muscle, and occlusal force before and after sagittal split ramus osteotomy in patients with… PMID:19699116 | 2009 | this review only | not stated | not extracted yet |
| Ueki 2020 Change of lateral pterygoid muscle and temporomandibular disc position after bi-maxillary surgery in class II and III patients. PMID:32661575 | 2021 | this review only | not stated | not extracted yet |
| Ueki 2021 Computed tomography assessment of mandibular morphologic changes and the inferior mandibular border defect after sagittal split ramus… PMID:34274287 | 2021 | this review only | Condylar height | not extracted yet |
| Ueki 2023 Assessment of temporomandibular joint disc position and skeletal stability after bimaxillary surgery. PMID:37280442 | 2024 | this review only | not stated | not extracted yet |
| Yin 2019 Changes in the position of the condyle after bilateral sagittal split ramus osteotomy in patients with mandibular retrusion and… PMID:31623933 | 2019 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adult patients undergoing orthognathic surgery for skeletal Class II or Class III malocclusion; excluded facial asymmetry or pre-existing TMJ disorders | Adults with skeletal Class II (179 patients) and Class III (568 patients) malocclusion; 872 patients across all studies |
| Intervention | BSSRO for mandibular advancement (Class II) or setback (Class III), alone or with maxillary procedures; surgery-first and orthodontics-first protocols | BSSRO (some with Le Fort I or IVRO); CBCT, CT or MRI assessment |
| Comparison | Pre-surgery (baseline) measurements | Pre-surgery measurements in the same patients |
| Outcomes | TMJ morphology on 3D imaging: joint space, condylar height, condylar axial angle, disc position, masseter/lateral pterygoid muscle changes; glenoid fossa changes added as outcome | Pooled: superior, posterior and anterior joint space, axial condylar axis angle, condylar height (10 studies); narrative: condylar position, disc position, masseter and pterygoid muscle changes (16 studies) |
| Study designs | Cross-sectional, quasi-experimental and cohort studies; RCTs not included | 26 studies: 11 analytical cross-sectional, 8 quasi-experimental, 7 cohort; 10 in meta-analysis |
| Timing | Short-term (<1 year) and long-term (>1 year) follow-up | Follow-up from 1-2 weeks to 1 year or more |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: Yes | NRSI: Partial Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: No | NRSI: No · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |