Systematic review of current approaches to comprehensive management of children with unilateral mandibular ramus hypoplasia or aplasia in congenital osseous disorders of the temporomandibular joint. Part II: Orthodontic management

Relevance. Orthodontic management of children with congenital osseous disorders of the temporomandibular joint (TMJ) spans the entire course of dentofacial growth and accompanies each surgical stage from early childhood through adolescence. Although a wide range of orthodontic appliances is available for this patient group, published data on their use remain limited and inconsistent. Evidence from Russian and international sources suggests that combining functional orthopedic treatment with distraction osteogenesis (DO) yields more durable, clinically stable outcomes. However, the sequence of appliance use and continuity of care remain poorly organized and insufficiently systematized, a gap compounded by the absence of a unified clinical algorithm and formal practice guidelines. Objective. To analyze existing orthodontic management methods for patients with mandibular ramus hypoplasia and/or aplasia across the stages of comprehensive rehabilitation and to synthesize the available evidence.

Materials and methods. The literature review was conducted in accordance with PRISMA guidelines for systematic reviews and meta-analyses. Searches were performed in PubMed, Medline, EMBASE, and eLibrary using the keywords “orthodontic management,” “mandibular ramus hypoplasia and aplasia,” “functional appliance,” and “stages of orthodontic treatment,” combined with the Boolean operator AND, in both English and Russian. Original publications reporting the use of removable orthodontic appliances in patients with congenital osseous TMJ disorders were analyzed. A total of 1,500 records were identified; 22 met the inclusion criteria and were included in the final review. In addition, a retrospective analysis was conducted of orthodontic outcomes in 40 patients treated at the Department of Orthodontics, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, from 2004 to 2024.

Results. Reports in the Russian-language literature describing specific functional orthodontic appliances for children with unilateral mandibular ramus hypoplasia and/or aplasia due to congenital osseous TMJ disorders are scarce. Most published cases involve the Vankevich appliance (maxilla-supported fracture splint) or a removable plate with a lingual pad (pelotte). To date, no standardized protocol for orthodontic management of these patients has been proposed.

Conclusion. In this patient population, criteria for evaluating the quality of orthodontic care across stages of dentofacial development are lacking, and the continuity of multidisciplinary collaboration within comprehensive dental rehabilitation is insufficiently characterized. A clear clinical strategy for orthodontic management has not been defined, and the biomechanical capabilities of orthodontic appliances in influencing both jaws both jaws are not fully delineated. The optimal integration of surgical and orthodontic stages into a unified, evidence-based treatment protocol also remains to be established.

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