Clinical characteristics associated with occlusal disharmony and traumatic occlusion: a qualitative systematic review of case reports and series

Abstract

Introduction: Occlusal disharmony and traumatic occlusion pose diagnostic challenges due to the lack of consensus regarding their clinical diagnostic criteria.  Objective: To identify and organize into dimensions the clinically relevant characteristics for the diagnosis of occlusal disharmony and traumatic occlusion. Materials and Methods: A qualitative systematic review of case reports and case series was conducted following the PRISMA 2020 guidelines. A literature search was performed in Scopus, PubMed/MEDLINE, SciELO, EMBASE, Virtual Health Library (VHL) and Google Scholar, including studies published between 1965 and October 31, 2025. A total of 18,883 records were identified; for the screening process, the 2,383 records retrieved from the electronic databases and the first 300 Google Scholar results were screened. After applying the eligibility criteria, 46 studies were included. Compliance with the CARE reporting guidelines was assessed and risk of bias was evaluated using the Pierson methodology. One study with a high risk of bias was excluded from the narrative synthesis (n=45). Results: Five dimensions were identified for occlusal disharmony and six for traumatic occlusion. The inclusion of periodontal tissue involvement in traumatic occlusion suggests differences in the distribution of clinical characteristics between the two conditions. Conclusions: Organizing clinical characteristics into dimensions provides a preliminary framework for structuring and interpreting the clinical findings reported in the literature. This framework may contribute to the clinical assessment of both conditions; however, it requires validation through observational studies and diagnostic accuracy studies.