Considerations on clear aligner therapy in patients with temporomandibular disorders and/or Bruxism

Bruxism and temporomandibular disorders (TMD) are highly prevalent conditions that sometimes coexist. TMD is a multifactorial disorder now understood through a model that incorporates biological, psychological, and social factors. Bruxism is considered a behavior rather than a distinct dental disorder. With clear aligner therapy increasingly widespread, many orthodontic patients might present with bruxism and/or TMD. There are no absolute contraindications to treating bruxers with aligners, although they do not stop bruxism or cure TMD. Biomechanically, bruxism introduces heavy occlusal forces that could challenge aligner tracking, but careful treatment planning (e.g. slowed tooth movement velocities and smaller increments) mitigates these risks, and auxiliary measures like composite attachments on worn teeth can improve aligner retention. Aligner insertion may transiently change masticatory muscle activity due to altered occlusion, but this effect abates as patients adapt, with muscle activity returning to baseline over time. Active TMD pain should be managed prior to orthodontic treatment, and patients should be educated about potential transient bite changes or muscle tenderness with aligners. Adopting a comprehensive, biopsychosocial approach allows successful clear aligner therapy in bruxism/TMD patients without compromising orthodontic outcomes.