In an article published in the ODF Review in 1987, we described the static relationships existing between and among the different components of the temporomandibular joint. This new article completes that work by supplying a dynamic vision of the range of movement, as well as recent anatomical and electromyographic data concerning the lateral pterygoid muscle.

The diagnosis of functional temporo-mandibular and cervical problems depends to a great extent on subjective information provided by patients. As a result, it is difficult to arrive at a substantiated assessment of the prevalence of these disorders. Based on the data reported from large-scale epidemiological studies, it appears that nearly 50 % of the populations of developed countries have symptoms of musculo-skeletal problems. The over-abundance of diagnostic tests suggested for assessing this problem adds confusion to this murky area. The purpose of this article is to precisely evaluate the pertinence of the various tests used to establish a clinical diagnosis.

The masticatory apparatus, which serves numerous functions in the life of humans, is constantly active and, as a result, can be the victim of a variety of malfunctions, even trauma. which occurs suddenly, often brutally enough to provoke patients to seek a consultation with a specialist in the masticatory apparatus, that is, an orthodontist.

What attitude should we adopt when examining a patient with myalgia, a subluxated or ‘‘locked’’ mandible, or sudden onset of arthralgia, pain in the temperomandibular joint? Finesse in clinical diagnosis and a profound knowledge of disorders of the masticatory apparatus are essentials in dealing with emergency visits from patients who have suffered a traumatic incident. We should devise prompt, prudent, and appropriate treatment to help them.

Current evidence based data found in the scientific literature recommend that the therapeutic management of patients suffering from temporomandibular disorders (TMD) should be based initially on simple, conservative and reversible procedures including exercise therapy. The integration of this message into oral health instructions for patients makes it easy for them to keep informed about TMD and aware of the steps they can take to deal with their symptoms. The integration of exercise therapy into structured patient education programs provides patients with information about TMD and suggests methods to deal with it. This medical approach is similar to those used to treat other joints in the musculoskeletal system.

Easy to set up, this exercise therapy helps patients suffering from temporomandibular disorders to become partners in the conduct of their treatment plan of reducing pain and restoring functional comfort.

Many hypotheses concerning the relationships that might exist between the disorders of masticatory system or temperomandibular disorders (TMD) and malocclusions have been advanced. But, in terms of evidence-based medicine, can we say that any of them have scientific merit?

The objective of our project was to analyze the existing international literature of the years 2000 to 2009 on the relationship between malocclusion and malfunction of the masticatory system.

Materials and method: we used MEDLINE to find all papers written in French or English that had an abstract referring to “Malocclusion” and “Temperomandibular joint disorders.” We subjected them to a critical analysis using a reading record program that sorted the papers into types of study, descriptive or analytical, and the intensity of their methodology. Two of our authors calibrated this analysis and we compared their results.

Results: We examined 17 studies out of a panel of 171 articles. Nine out of the seventeen were transverse studies, six were longitudinal studies, one evaluated cases and a control group, and one was a cohort study. An ethical committee had approved of 9 of the studies and 9 out of the group had been randomized. From all seventeen we collected calibrations from observers and made statistical analyses of the data.

Our conclusion was that there is a relationship between malocclusion and TMD but that it is a weak one.

The results of the different studies varied considerably as a factor of the type of malocclusion incriminated and the type of temperomandibular disorder reported. Our work indicated that a relationship between TMD and malocclusion cannot be established and the studies we reviewed had little scientific value primarily because of the heterogeneity of the samples and of the lack of clearly established definitions of the terms “malocclusion” and “disorder” of the masticatory system.

The last stage of orthodontic treatment is occlusal finishing. This complex and subtle treatment period demands careful reflection by orthodontists in order for them to achieve an optimal occlusion.

Elastodontic concept is a straightforward therapeutic tactic, whose essence is a considered and individualised approach to treatment within a well-structured plan.

Elastodontic concept enables orthodontists to construct of a functional occlusion which satisfies the three fundamental criteria of function of the masticatory apparatus: effectiveness, harmony, and economy.

An illustrated case study will give the reader an understanding of the design and unique action of this type of appliance.