Complex Treatment of Internal TMJ Disorders in Patients with Different Bit Types

Abstract

Objective: To assess the impact of physiological and pathological types of occlusion on the effectiveness of the treatment of patients with internal disorders of the TMJ. Material and Methods: A comprehensive examination and treatment of 139 patients with internal TMJ disorders with subluxation and chronic dislocation of the articular disc was carried out. The patients were divided into three groups. All groups included patients with both physiological and pathological occlusion. The first group included 28 (20.1%) patients who were treated only with occlusal splint therapy; the second group included 95 (68.3%) patients who were treated with a combination of occlusal splint therapy and the use of arthrocentesis; in the third group (16 people (11.5%), along with splint therapy and arthrocentesis, TMJ arthroscopy was performed. The examination included a survey and examination of patients, a study of diagnostic models of the jaws to determine the types of occlusion and occlusal contacts, magnetic resonance imaging (MRI) and ultrasound examination (ultrasound) of the TMJ. Patients underwent a phased treatment, including occlusive splint therapy (stage I); with insufficient effectiveness - occlusive splint therapy and arthrocentesis (stage II); occlusive splint therapy and arthrocentesis in combination with arthroscopy (stage III of treatment). Results: As a result of the study, it turned out that the groups of patients differed significantly in the complexity and duration of the treatment. Thus, in patients with internal TMJ disorders and pathological type of occlusion, in 82.6% of cases, additional use of arthrocentesis was required and in 34.8% - arthroscopy (95 patients out of 139), while patients with physiological types of occlusion (orthognathic, progenic, biprogenic and direct) needed these treatments in 80.2% and 7.8% of cases, respectively In the groups of patients, the duration of therapy, as well as the number of arthrocentesis performed in patients at the second and third stages of treatment, significantly differed. In the first group, the duration of treatment was 6.2 months for patients with normal occlusion and 8.7 (p<0.01) months for patients with pathological occlusion; additional methods of treatment (arthrocentesis and arthroscopy) were not used. In the second and third groups of patients, the duration of treatment for patients with occlusion pathology was also longer: in the second group 4.9 and 6.8 (p<0.01) months for patients with physiological and pathological types of occlusion, respectively, in the third group with the use of splint therapy, arthrocentesis and arthroscopy in patients with normal occlusion was 13.1 (p<0.05) months, and in patients with occlusion pathology 14.5 months Conclusion: Patients with internal TMJ disorders need a comprehensive examination for the timely detection of occlusion pathologies. The relationship between internal TMJ disorders and the type of occlusion must always be taken into account in the choice of further treatment tactics and therapy planning in order to achieve the best result.