Temporomandibular disorders with skeletal open bite treated with stabilization splint and zygomatic miniplate anchorage: a case report

Clinical decision of centric relation

Centric relation (CR) was used in the complete dentures for edentulous jaws firstly. Then, CR was gradually applied in the clinical diagnosis and treatment of dentate jaws. Regarding the application of CR in dentate jaws, there are many doubts about its rationality. For instance, should CR be the core of diagnosis and treatment of temporomandibular disorders? Should CR be used as the jaw position of establishing occlusion in occlusal reconstruction? Should CR serve as the target jaw position in orthodontic treatment? Meanwhile, varieties of CR clinical applications are objective. According to the existing evidence, this paper summarizes the applicable conditions of several main clinical situations with little controversy. We preliminarily put forward the decision tree for the clinical application of CR, which can be used as a reference in clinical practice.

Computer-aided surgical workflow in a surgery - First orthognathic approach to correct anterior open bite in a young adult with temporomandibular disorders

An 18-year-old female patient with temporomandibular disorders (TMD) history sought medical care in orthodontic-orthognathic interdisciplinary department with chief complaint of anterior open bite. After splint therapy to seat the condylar into the musculo-skeletally stable position, a surgery-first approach was formulated assisted by 3D virtual planning and transferred to the surgery by computer-aided manufacturing splint. No TMD symptom reoccurrence was reported or noted. Stable occlusion and satisfactory facial aesthetics were achieved. In the 18-month follow-up, no clinically significant open bite relapse occurred. This case report describes the remarkable role that computer-assisted surgical simulation could play throughout the surgical-orthodontic procedure to correct the skeletal open bite deformity.

Diagnostic and treatment protocol for a patient with temporomandibular disorder using a stabilization splint and temporary anchorage devices

Treatment of orthodontic patients with temporomandibular disorder (TMD) is challenging for orthodontists because of the TMD signs and symptoms and unstable mandible position, which may lead to improper diagnosis and treatment design. This case report presents a 22-year-old woman with proclined maxillary incisors and TMD. First, stabilization splint therapy was implemented to eliminate temporomandibular joint pain and to obtain the stable adapted centric posture. Subsequently, orthodontic treatment was initiated on the basis of a definitive diagnosis made from the postsplint records. Temporary anchorage devices were used to intrude maxillary molars and distalize the maxillary dental arch. Favorable soft tissue, skeletal, and dental relationship were accomplished after 12 months of comprehensive orthodontic treatment. Functional occlusion was established with teeth as well as vacuum-formed retainers. Excellent posttreatment stability was maintained after a 20-month retention.

[Treatment goals in FACE philosophy]

INTRODUCTION

The FACE philosophy is characterized by clearly defined treatment goals: facial esthetics, dental esthetics, periodontal health, functional occlusion, neuromuscular mechanism and joint function. The purpose is to establish ideal occlusion with good facial esthetics and an orthopedic stable joint position.

MATERIALS AND METHODS

The authors present all the concepts of FACE philosophy and illustrate them through one case report.

RESULTS

Taking into account all the FACE philosophy concepts increases diagnostic ability and improves the quality and stability of treatment outcomes.

DISCUSSION

The goal of this philosophy is to harmonize the facial profile, tooth alignment, periodontium, functional occlusion, neuromuscular mechanism and joint function. The evaluation and treatment approach to vertical problems are unique to the philosophy.

Effectiveness of two different splints to treat temporomandibular disorders

Nearly 5% of the the world's population has temporomandibular disorder (TMD) severe enough to make them seek treatment. A third of the total population has at least one TMD symptom. There are different types of splints to treat TMD. In our study, we compared the success of two different appliances [stabilization splint (ss), nociceptive trigeminal inhibition splint (NTI)] by using Fonseca's questionnaire, the OHQoL-UK and visual analog scale (VAS). A total of 40 patients suffering from TMD were included in this study and answered questionnaires twice, at the beginning of the treatment and 3 months later. Regarding TMD alone, 39 patients (97.5%) had some degree of the disorder, 7 of of these cases being mild (17.5%), 15 moderate (37.5%), and 17 severe (42.5%). We analyzed posttreatment changes compared to baseline. Pain complaints decreased in both groups, and the OHQoL-UK revealed better quality of life after treatment. Based on the posttreatment Fonseca's questionnaires, significant changes in the patients' complaints in the group SS (p < 0.01) were observed. The group NTI also displayed changes but these were not statistically significant after treatment (p > 0.05). Patients in both groups had fewer TMD complaints after TMJ treatment. According to the Fonseca's questionnaire, the patients' major TMD complaint was clenching-grinding, followed by pain in the craniomandibular joint, or earache.