Indonesian Journal of Prosthodontics

Toward optimal prosthetic strategies: the biomechanical impact of design and material in posterior implant-supported fixed partial denture

2026-06-26T11:01:13+00:00

ABSTRACT

Implant-supported fixed partial dentures (iFPDs) are used for posterior rehabilitation. Biomechanical problems arise in the posterior due to complicated occlusal stresses and insufficient bone support. Prosthetic design and material stiffness affect stress distribution on peri-implant bone and components, affecting iFPD success. This systematic review examined the biomechanical performance of zirconia, PEKK, and PEEK two- and three-unit iFPDs with fixed-fixed and cantilever designs. FEA was used to evaluate stress distribution and clinical implications. PICO criteria and Boolean operators were used to search PubMed, Scopus, ScienceDirect, and MyEBSCO for 2020–2025 studies. Five of 158.353 documents met PRISMA 2020 criteria. Von Mises stress, prosthesis configurations, material stiffness, and stress concentration zones were extracted. Cantilever designs had the highest stress values, especially at the connector and prosthesis-abutment interface. Due to its stiffness, zirconia shielded the peri-implant bone, while PEKK and PEEK reduced prosthesis stress but transferred more stress to the bone. Connectors were the most biomechanically susceptible in all designs and materials. The synergistic interplay between prosthetic design, material mechanical properties, and loading direction determines the stress distribution pattern and long-term stability of implant-supported prosthetic structures.

Keywords: Stress distribution, zirconia, high-performance polymers, finite element analysis, implant-supported fixed partial denture

Occlusal scheme in complete denture for knife-edge ridge: What works best?

2026-06-26T11:01:13+00:00

Fabrication of complete dentures for atrophic and knife-edge mandibular ridges poses challenges due to uneven stress distribution, which affects support, stability, and comfort. The selection of an occlusal scheme plays an important role in optimizing load transmission to the denture-supporting tissues. This systematic review aims to evaluate stress and strain distribution as well as denture displacement across various occlusal schemes in patients with atrophic or knife-edge ridges. A structured literature search was conducted through PubMed, Scopus, ScienceDirect, SpringerLink, and Google Scholar for studies published between 2015 and 2025. Seven studies met the inclusion criteria, encompassing in vitro experiments, finite element analysis (FEA), photoelastic models, and clinical evaluations. From 407 screened articles, seven studies were analyzed. Lingualized occlusion (LO) demonstrated the most even stress distribution centered along the ridge crest, while bilateral balanced occlusion (BBO) improved stability under functional loading. Monoplane occlusion (MO) reduced vertical strain but exhibited higher localized stress under specific conditions. No single occlusal scheme was universally superior. LO and MO provided favorable biomechanical outcomes in specific conditions, whereas occlusal scheme selection should be adapted to ridge morphology and patient functional needs.

Keywords: complete denture, occlusal scheme, knife-edge ridge, atrophic ridge, stress distribution

The relationship between salivary flow rate and masticatory performance in hypertensive and nonhypertensive complete denture wearers

2026-06-26T11:01:14+00:00

Edentulism is the complete loss of natural teeth, leading patients to rely on complete dentures to restore masticatory function. The success of denture use is influenced by salivary flow rate, which affects retention and stability. Salivary flow may be altered by systemic conditions such as hypertension, potentially reducing masticatory performance. This study aimed to determine the mean salivary flow rate and masticatory performance, and to analyze their relationship in hypertensive and nonhypertensive complete denture wearers at the Dental and Oral Hospital of Universitas Sumatera Utara. This analytic cross-sectional study involved 20 subjects (10 hypertensive and 10 non-hypertensive). Salivary flow rate was measured using the spitting method with sugar-free chewing gum, while masticatory performance was assessed using color-changeable chewing gum and the Visual Analog Scale (VAS). Data were analyzed using Spearman’s correlation test (p<0.05). The mean salivary flow rate was 0.36±0.11 ml/min in hypertensive patients and 0.86±0.15 ml/min in nonhypertensive patients. The mean masticatory performance scores were 2.8±0.78 and 3.9±0.99, respectively. A significant correlation was found between salivary flow rate and masticatory performance in both hypertensive (p=0.0001) and nonhypertensive groups (p=0.001).
Keywords: complete denture, hypertensive, salivary flow rate, masticatory performance

Optimizing occlusal schemes to reduce masticatory stress in resorbed class III jaw relations edentulous ridges: A systematic literature review

2026-06-26T11:01:14+00:00

Background: An unfavorable jaw relationship, such as Class III, contributes to uneven masticatory stress distribution, accelerating alveolar bone resorption and potentially resulting in a flattened ridge morphology. This condition directly impacts denture stability and retention. Therefore, selecting an appropriate occlusal scheme is essential to guide and balance masticatory forces, enabling more even and physiological stress distribution. However, there is currently no clear consensus on the most effective occlusal scheme for Class III jaw relationships with flat ridges. Objective:
This systematic review aims to evaluate and synthesize current scientific evidence regarding the influence of different occlusal schemes on stress distribution in patients with Class III jaw relationships accompanied by flat alveolar ridges. Methods: Following the PRISMA guidelines. A comprehensive electronic search was conducted through PubMed, Cochrane, and ScienceDirect databases to identify relevant studies published between 2015 and 2025. The search strategy included keywords such as: (“alveolar ridge” AND “occlusal schemes”) AND (“stress distribution”), as well as (“alveolar ridge” OR “occlusal schemes”) AND (“stress distribution”). Results: Out of 1061 articles screened, five studies met the inclusion criteria. Lingualized and balanced occlusion demonstrated a more uniform stress distribution compared to monoplane occlusion, particularly in patients with Class III jaw relationships and flat ridges. Conclusions: Occlusal schemes play a crucial role in reducing masticatory stress, especially in patients with Class III jaw relationships and flattened alveolar ridges. Further research is recommended, particularly in vitro biomechanical studies using masticatory simulation models that better represent the clinical conditions of Class III patients with flat ridges.

Keywords: occlusal schemes, stress distribution, alveolar ridges, Class III.

Preventing black triangles around posterior maxillary implants using customized peek healing abutments: A case report

2026-06-26T11:01:14+00:00

Background: Posterior maxillary implant placement is often challenging due to low bone density, limited soft tissue support, and a higher risk of black triangle formation. Prefabricated healing abutments are manufactured in standard shapes and often fail to guide soft tissue maturation according to individual anatomy. In contrast, custom healing abutments allow precise shaping of the emergence profile and supporting better peri-implant tissue healing. Case: A 31-year-old female presented with a missing upper left second premolar and masticatory discomfort. Clinical and radiographic examinations confirmed adequate bone volume for implant placement. Management: An implant (Dentis Implant s-Clean SQ, 4.0 × 10 mm) was placed using a digitally designed and 3D-printed surgical guide. A custom Polyetheretherketone (PEEK) healing abutment was fabricated and adjusted using flowable composite to mimic the natural gingival contour. This approach minimized repeated abutment disconnection and facilitated soft tissue maturation. After three months, an open-tray impression was made, and a screw-retained zirconia crown was delivered. Conclusion: Custom PEEK healing abutments demonstrate superior adaptation to peri-implant soft tissues, preserve gingival architecture, and effectively prevent black triangle formation compared to prefabricated abutments. Their use is recommended in posterior maxillary implant restorations to enhance functional and biological outcomes.

Keywords: black triangle; customized healing abutment; dental implant; PEEK (polyetheretherketone)

Management of disc displacement with reduction with intermittent locking, myofascial pain, and TMD-Related headache

2026-06-26T11:01:14+00:00

Temporomandibular disorders (TMD) refer to a group of problems involving the temporomandibular joint (TMJ) and the masticatory muscles. The most common intra-articular diagnosis is disc displacement with reduction; however, cases with intermittent locking are relatively rare and can be characterized by fluctuating symptoms. This case report describes the conservative management of disc displacement with reduction with intermittent locking accompanied by myofascial pain with referral and headache attributed to TMD in a 23-year-old male patient. The patient came in with a one year history of left TMJ clicking, recurrent locking episodes, jaw pain, and sharp temporal headache. A clinical examination showed corrected deviation while opening the mouth, limited pain-free mouth opening, joint sounds, myofascial pain with referral, and headache reproduction when the muscles were palpated. The final diagnosis was disc displacement with reduction with intermittent locking complicated with myofascial pain with referral and headache attributed to TMD. Management was a combination of mandibular stabilization splint therapy, muscle conditioning exercises, and physical self regulation. Subsequent visits showed improvement in muscle pain, headaches, joint sounds and locking episodes. Conservative management with stabilization splint therapy supported by behavioral and muscle conditioning interventions can lead to successful symptom relief and functional improvement.

Keywords: Temporomandibular disorders, disc displacement with reduction, myofascial pain, headache attributed to TMD, stabilization splint

Management of temporomandibular disorders on violinists

2026-06-26T11:01:15+00:00

Temporomandibular Joint Disorders (TMD) is musculoskeletal group syndrome involving temporomandibular joint, masticatory muscles, and related tissues. Symptoms that often appear are pain in the joint area, limited mouth opening, and jaw that locks easily. TMD is generally experienced by many violinists. The tilt of the head to one side when playing violin for a long period cause muscle tension and pain in the face and neck region. This case report aims to describe the treatment of TMD on violinist using occlusal splint. A 26 year old female violinist came to prosthodontic clinic with the main complaint of pain in the jaw when opening the mouth too wide and frequent pain in the facial muscles. The patient has a bruxism habit and anxiety for a long time, and had unbearable pain when opening her mouth. Dental impressions are preformed and an immediate splint was made at the first visit, then at the second visit the immediate splint was replaced with a stabilization splint which was used for 3 months and is given physical self-regulation instructions until the pain finally disappears. Occlusal splint therapy accompanied with physical self regulation can overcame TMD in violinist patient.

Management of fully edentulous with flabby ridge using double spacer custom tray and modified impression techniques

2026-06-26T11:01:15+00:00

Background: A flabby ridge refers to an area of alveolar ridge with hypermobile and fibrous soft tissue that typically forms as a result of prolonged pressure or unstable occlusion, which posing difficulties in achieving proper denture retention, support, and stability. A precise impression is essential for ensuring the stability of complete dentures with flabby ridge. The fundamental principle for impressions of a flabby ridges is to apply minimal pressure on the flabby area to prevent distortion impression outcome. To achieve that, double spacer custom tray along with selective pressure impression techniques was employed. Objectives: This case report aims to gain impression with minimum pressure on flabby ridge to enhance retention, support, and stability of the complete denture. Case Report: A 70-year-old male patient came to the Policlinic Prosthodontics Oral dan Dental Hospital Universitas Padjadjaran complaining that his old 10-years-used denture felt loose and uncomfortable. Intraoral examination showed that both maxillary and mandibular arches were fully edentulous, with flabby ridges present. Following the assessment, it was decided to make a new complete denture using double spacer custom tray and selective pressure impression techniques. Conclusion: Double spacer custom tray and selective pressure impression techniques have been effective in minimizing pressure that could lead to tissue compression during impression procedures, resulting more comfortable dentures with greater retention and stability.

Keywords: Flabby Ridge, Complete Denture, Double Spacer Custom Tray, Selective Pressure Impression Technique

Prosthetic rehabilitation of a severely resorbed mandibular ridge using the effective suction method

2026-06-26T11:01:16+00:00

Background: Mandibular ridge resorption commonly occurs after tooth loss and progressively reduces ridge height and contour, often resulting in a flat ridge. Severe resorption in edentulous patients creates challenges in complete denture fabrication, particularly in achieving adequate retention and stability. The mandibular suction effective denture technique was developed to improve retention by establishing a complete border seal and negative pressure beneath the denture base. Objectives: This case report aims to describe prosthetic rehabilitation of a patient with a flat mandibular ridge using the effective suction impression technique. Case Report: A 67-year-old female with complete edentulism and a flat mandibular ridge complained of difficulty in mastication and speech due to a loose, fractured denture. Rehabilitation was performed using the effective suction impression technique with a frame cut-back (FCB) tray and a closed-mouth impression method. Procedures included final impression making, jaw relation recording, artificial teeth arrangement, and insertion of complete dentures for both arches. Post-insertion evaluation showed good retention and stability, with improved comfort and masticatory function. Conclusion: The effective suction technique can provide improved retention, stability, and patient comfort in patients with flat mandibular ridges. Further clinical studies are needed to confirm its long-term success.

Maxillofacial esthetic rehabilitation using bilateral custom ocular prosthesis in a case of anophthalmia and phthisis bulbi

2026-06-26T11:01:16+00:00

Bilateral loss of the eyeballs is a condition that not only causes visual impairment but also significantly impacts the patient’s aesthetic appearance and psychosocial well-being. Rehabilitation through the fabrication of custom ocular prostheses can help restore facial appearance and patient self-confidence. This case report aims to describe the fabrication process and clinical outcomes of bilateral custom-made acrylic ocular prostheses in a patient with right-sided anophthalmia and left-sided phthisis bulbi. A 54-year-old male patient presented to the Prosthodontics Department at RSGM UNPAD, Bandung, with complaints of loose and uncomfortable right and left ocular prostheses. The patient had undergone enucleation of the left eye and had been wearing prostheses for the past five years. A new pair of custom ocular prostheses was planned. The treatment procedure included socket impression using polyvinyl siloxane (PVS), fabrication of a positive model, wax pattern try-in followed by acrylic sclera construction, manual iris painting, and application of clear acrylic as the final layer. The prostheses were inserted following a comprehensive evaluation of adaptation, retention, symmetry, and the psychological response of the patient and family. Custom ocular prostheses provide an effective rehabilitative solution for bilateral ocular loss. With an individually tailored design, they restore facial symmetry, enhance self-esteem, and reduce psychological distress.

Digital copy reference denture: enhancing accuracy and comfort in edentulous geriatric patients: Case report

2026-06-26T11:01:16+00:00

Introduction: Prosthodontic rehabilitation in geriatric patients is often complicated by systemic frailty, reduced neuromuscular adaptability, and limited tolerance for prolonged dental procedures. Conventional denture fabrication frequently requires multiple clinical visits and extended chairside time, which may increase treatment burden and compromise patient comfort. Advances in digital dentistry have enabled streamlined workflows that improve efficiency and predictability. The digital copy reference denture technique allows replication of an existing prosthesis while enabling controlled modification of functional and esthetic parameters, thereby facilitating patient adaptation and reducing clinical complexity. Case Presentation: A 93-year-old woman presented with poor denture retention and instability, leading to impaired mastication. Clinical examination revealed a maxillary complete denture with a suction cup causing palatal mucosal trauma and a mandibular partial denture retained by wire clasps on extruded teeth 33 and 43. Treatment involved fabrication of a new maxillary complete denture using a digital copy denture workflow while re-establishing vertical dimension and centric relation with a leaf gauge. A mandibular overdenture with magnetic attachments was planned. The digital workflow comprising intraoral scanning, digital design, and 3D printing enabled delivery of the definitive prostheses at the second visit while preserving familiar denture contours to facilitate adaptation. Conclusion: A fully digital copy reference denture workflow represents a predictable and patient-centered treatment strategy for prosthodontic rehabilitation in elderly patients. By reducing clinical visits and improving prosthesis retention, stability, and comfort, this approach offers an effective alternative for managing complex geriatric cases.

Complete denture rehabilitation in a patient with flabby ridge using an open-Window impression technique and double-spacer custom tray: A case report

2026-06-26T11:01:16+00:00

ABSTRACT

Background: A flabby ridge is an area of mobile soft tissue found superficially, which affects both maxillary and mandibular alveolar ridges. It is a common finding in long term denture wearers, where the rate of bone resorption is very fast leading to development of hyperplastic soft tissue over the alveolar bone. These mobile, hyperplastic tissues compromise denture stability and retention, leading to patient discomfort and functional limitations. A precise impression is essential for ensuring the stability of complete dentures with flabby ridge. The fundamental principle for impressions of a flabby ridges is to apply minimal pressure on the flabby area to prevent distortion impression outcome. To achieve that, open-window technique and double spacer custom tray along with selective pressure impression techniques was employed. Objectives: This case report aims to gain impression with minimum pressure on flabby ridge to enhance retention, support, and stability of the complete denture. Case Report: A 63-year-old male patient came to the Department of Prosthodontics, Padjadjaran University, complaining that his old 10-years-used denture felt loose and uncomfortable. Intraoral examination showed that both maxillary and mandibular arches were fully edentulous, with flabby ridges present. Following the assessment, it was decided to make a new complete denture using double spacer custom tray and open-window impression techniques. Conclusion: Double spacer custom tray and open-window impression techniques helped in recording flabby tissue with minimal displacement and hence enhanced the stability, support, and retention of the denture.

Keywords: Flabby Ridge, Complete Denture, Impression Techniques, Double Spacer Custom Tray, Open-Window Technique

Management of disc displacement with reduction and local myalgia using the wax record technique with aluminum wax on stabilization splints and infrared therapy: A case report

2026-06-26T11:01:17+00:00

ABSTRACT

Background: Disc Displacement with Reduction (DDWR) is one of the most common temporomandibular disorders (TMD), characterized by anterior displacement of the articular disc during mouth opening, typically accompanied by clicking sounds and masticatory muscle pain. DDWR is frequently associated with local myalgia, often worsened by stress and parafunctional habits. Stabilization splints and infrared therapy have demonstrated effectiveness in reducing symptoms. The use of aluminum wax in bite registration helps achieve a stable centric relation, enhancing splint fabrication accuracy.

Objective: This case report aims to describe the management of DDWR with local myalgia and arthralgia through bite registration using aluminum wax to support centric relation during stabilization splint fabrication, complemented by infrared therapy.

Case Report: A 40-year-old male reported pain in the left cheek and ear, along with clicking during jaw movement for six months. DC/TMD Axis I assessment confirmed DDWR with local myalgia and arthralgia, Axis II revealed psychological stress. Treatment consisted of behavioral counseling, infrared therapy applied to the left masseter, and splint fabrication with bite registration using aluminum wax. Registration was performed using baseplate wax combined with aluminum wax on the occlusal surface to achieve centric relation during articulator mounting. After two weeks, the patient experienced increased mouth opening from 45 mm to 46 mm, reduced muscle tenderness, and improved muscle relaxation.

Conclusion: The combination of behavioral counseling, aluminum wax-assisted bite registration for splint fabrication, and infrared therapy proved effective in reducing symptoms and improving mandibular function in a patient with DDWR and local myalgia.

Keyword : Disc displacement with reduction; myalgia; arthralgia; aluminum wax; infra-red therapy

Multidisciplinary approach with botulinum toxin (BTX) and 3D printing stabilization splint in cases of temporomandibular joint osteoarthritis exacerbated by bruxism

2026-06-26T11:01:17+00:00

ABSTRACT:

Background: Temporomandibular joint disorder (TMD) is a multifactorial condition involving the masticatory muscles and temporomandibular joint. Temporomandibular joint osteoarthritis (TMJ OA), is a degenerative joint disorder marked by articular surface erosion, crepitus, and joint pain. Parafunctional habits such as bruxism can exacerbate OA by increasing biomechanical load on the TMJ, accelerating joint degeneration, and worsening symptoms. Conservative treatments such as stabilization splints are commonly used in TMD management. Recently, botulinum toxin (BTX) type A has gained attention as an adjunct therapy for reducing excessive masticatory muscle activity.

Objective: This report aims to describe the multidisciplinary management of a complex TMD case using 3D-printed stabilization splints combined with BTX type A injections.

Case Report: A 24-year-old female presented with jaw pain and crepitation sounds upon mouth opening. She reported a history of bruxism and unilateral mastication. Cone-beam computed tomography (CBCT) revealed condylar erosion, osteophyte formation, and flattening. Clinical and radiographic findings confirmed myofascial pain and arthralgia with TMJ OA exacerbated by bruxism. Treatment included a custom 3D-printed stabilization splint and BTX type A injection into the masseter muscle. After 1 week, mouth opening improved from 34 mm to 35 mm, and to 38 mm after 1 month. The patient reported decreased pain during mastication and waking, along with reduced bruxism frequency.

Conclusion: A multidisciplinary approach involving 3D-printed stabilization splints and BTX type A injections is effective in alleviating pain and improving function in complex TMD cases associated with bruxism.

Keywords: Temporomandibular disorder, botulinum toxin, digital splint, bruxism

Posterior mandibular tooth replacement using a porcelain-fused-to-metal adhesive bridge with sanitary and conical pontic designs: A case report

2026-06-26T11:01:18+00:00

Posterior mandibular tooth loss can significantly impair masticatory function, occlusal stability, and overall quality of life. Among available treatment options, adhesive bridges offer a minimally invasive alternative that preserves tooth structure while restoring function. This case report describes posterior mandibular tooth replacement using a porcelain-fused-to-metal (PFM) adhesive bridge incorporating two different pontic designs, namely sanitary and conical pontics. A 50-year-old female patient presented with missing posterior mandibular teeth and complaints of discomfort during mastication. Clinical examination revealed a Kennedy Class III modification 1 condition with favorable abutment support. A conservative treatment plan was developed using a resin-bonded fixed dental prosthesis. Tooth preparation was performed within enamel, followed by impression procedures and laboratory fabrication. The pontic design was selected based on anatomical and hygienic considerations, with a sanitary pontic applied in one region and a conical pontic in another. Following coping try-in and evaluation of marginal fit and occlusion, final cementation was performed using dual-cure resin cement. Post-insertion evaluation demonstrated satisfactory function, stability, and esthetics, with good periodontal response. This case highlights that appropriate pontic design selection plays a crucial role in achieving functional efficiency, hygiene maintenance, and long-term success in adhesive bridge restorations.

Fabrication of a complete denture using a modified custom tray with a closed-mouth impression on a fully edentulous compromised mandibular flat ridge

2026-06-26T11:01:18+00:00

Background: Severe mandibular alveolar ridge atrophy, common in geriatric patients, compromises the functional success of complete dentures due to a reduced denture-bearing area and the proximity of muscle attachments to the ridge crest. This condition increases denture displacement during function in both horizontal and vertical movements, leading to poor retention and stability of the denture. Accurate impression techniques are critical to overcoming these challenges. The closed-mouth functional impression technique allows for the recording of denture-bearing areas and peripheral seal under functional pressure, potentially enhancing retention.
Objective: This case report aims to describe the procedure for fabricating a complete denture using a modified custom tray with a closed-mouth impression on a fully edentulous, compromised mandibular flat ridge.
Case Report: A 52-year-old woman presented with a loose and poorly fitting lower denture. Clinical examination revealed complete edentulism with a severely resorbed mandibular ridge. A custom tray was fabricated with a detachable handle to support the closed-mouth impression technique without interfering with occlusion during border molding and impression-making. The closed-mouth approach allowed for better muscle molding, recording of functional borders, and a more accurate reflection of the patient’s oral dynamics. As a result, the final denture exhibited significantly improved retention and comfort during function. This case highlights the clinical advantage of the closed-mouth impression technique in managing challenging ridge conditions and emphasizes the practical benefit of modifying tray design to ease the procedure for both clinician and patient. Such adaptation is especially relevant in geriatric care, where functional and anatomical limitations are common.
Conclusion: The use of a modified custom tray with the closed-mouth functional impression technique proved effective in managing a severely resorbed mandibular ridge. It resulted in a stable, retentive, and comfortable complete denture, contributing to enhanced patient satisfaction.

Heat-Cured Acrylic Resin Plates on Surface Roughness in A 6.25% Siwak (Salvadora Persica) Effervescent Tablet Solution

2026-06-26T11:01:18+00:00

Background: Heat-cured acrylic resin is widely used as a denture base material due to its favorable aesthetic and biocompatible properties; however, denture hygiene must be maintained using cleaning agents that do not adversely affect surface characteristics. Siwak (Salvadora persica) contains antibacterial and antifungal compounds and has demonstrated inhibitory effects against Candida albicans at a concentration of 6.25%, indicating its potential as a natural denture cleanser. Objective: This study aimed to evaluate the effect of immersing heat-cured acrylic resin plates in a 6.25% siwak effervescent tablet solution on surface roughness. Methods: A true experimental study was conducted using 27 heat-cured acrylic resin plates (65 × 10 × 3.3 mm), divided into three groups: alkaline peroxide solution, 6.25% siwak effervescent tablet solution, and effervescent tablet solution without siwak. Immersion was performed for 15 minutes daily over an 8-day period at 37°C. Surface roughness was measured using a Surface Roughness Tester, and data were analyzed using Welch ANOVA. Results: All groups exhibited an increase in surface roughness after immersion. However, statistical analysis showed no significant difference among the three groups (p > 0.05). Conclusion: Immersion in a 6.25% siwak effervescent tablet solution did not significantly affect the surface roughness of heat-cured acrylic resin and can be considered safe for use as a denture cleaning agent.

Correlation between length of usage and temporomandibular disorder presence in complete denture patient

2026-06-26T11:01:18+00:00

The aim of this study was to see if there was a correlation between the length of usage and the presence of TMD in patients wearing CD at Dental Hospital of North Sumatra University. This study is analytic observational with a cross-sectional design and a sample size of 50 subjects. The samples were separated based on the length of use, which was 12, 18 and 24 months. The FAI was used in interviews, while the DI was used in clinical tests. Subjects were interviewed using the TMD Etiology Index questionnaire to determine the level risk. The findings revealed that the prevalence of TMD risk based on duration of use showed at 12 month group with low risk, followed by 18 months and 24 months who experienced high risk. The results also revealed that the prevalence of TMD status based on duration of use at 12 months without TMD, followed by 18 months and 24 months. The Chi-Square test yielded a value of p = 0.0001 (p<0.05) based on the results of statistical tests evaluating the correlation between duration of usage and TMD status, indicating that there is a correlation between duration of use and TMD status and the highest results were found at 24 months of use of 85.7%.