Prosthodontics and Temporomandibular Disorders.
This paper will outline the the conceptual and historical development of teporomandibular
disorders TMDs through the years and how this impacts the foundations of fixed prosthodontic rehabilitation. For the last decades, prosthodontics had been intimately associated with the function and dysfunction of the masticatory system. Reconstruction of the dentition was closley linked and governed by the prevailing explanation and concept of disorders of the TMJs and the neuromuculature. From the 1930s to as far as the 1990s occlusion was considered to be one of the principal causative elements of TMDs relating to the occlusal vertical dimension, posterior support, occlusal interferences and excursive guidance. Treating and avoiding TMDs was governed by paradigms, dogmas and so called “philosophies”. Multple association studies from the 1970s and onwards started to refute this influence of occlusion and specific occlusal discrepancies on TMDs relegating them from a directly causative role to that of subsiduary risk factors. This too has been rigorously contested with many maintaing there to be no ground to further hypothesize a role for dental occlusion in the pathophysiology of TMDs 2000-2015.
Concepts continued to change with the advent of the “bio- psychosocial” multifactorial model in 1992 replaceing the former psycho-physiologic theory. Following multicenter validation the new diagnostic classifications of the DC/TMD also appearing in the 2010s. Further changes were provided by the OPPERA orofacial pain prospective cohort study 2013 , distinguishing between subclinical, transient and persistent intractabele painful TMD condidtions. This emphasized the nature of persistant painful TMD conditions with potential comorbidities to other persistent chronic pain conditions. Interacting phenotypes with genetic regulation combined with environmental contributions describe contibution to persistent, chronic, intractable painful TMDs now Orofacial Pain. Orofacial pain remains a prevalent and debilitating condition with significant social and economic impacts. This high impact pain group is characterized as a chronic pain disorder and is involved with high levels of suffering.

The publication of the 2020 consensus on TMD by the Nationl Academy of Science consensus report emphasizes the positioning of painful TMDs firmly in the Domain of Orofacial Pain placing a dominant emphasis on the bio pychosocial and multifactorial model with the traditional dental domain of TMDs significantly de-emphasized and marginalized.

In light of these major changes this paper will evaluate how prosthodontics and the “dental
domain” should be adapting its traditionsal paradigms to the new conceptual realities.