MANAGEMENT OF TEMPORO MANDIBULAR DISORDER (TMD) IN PATIENT WITH LOW VERTICAL DIMENSION AND DEEP ANTERIOR BITE

Henni Koesmaningati,Laura Susanti Himawan

doi:10.14693/jdi.v13i2.301

Abstract

The cases of TMD are complex and multifactorial, therefore the management should be done by several disciplines. In this report, a 27-year-old man came to the teaching hospital of the University of Indonesia Faculty of Dentistry’s Prosthodontic Department complaining about clicking sound and pain around his right joint. He received orthodontic treatment 9 years ago with removable appliance at a private practice and had 4 premolar extractions. The patient’s face looked asymmetric, with a low vertical dimension, a Class II occlusion, and an anterior deep bite. Besides that, he clenched his teeth during emotional stress. Lateral transcranial photo showed that the position of the left condyle was relatively normal or slightly anterior, and the right condyle was in the superoposterior position in the fossa with an abnormal shape. To solve this problem, the patient was referred to the Orthodontic Department to get a correct vertical dimension and normal anterior overbite. After 6 years, the patient was again referred to the Prosthodontic Department, but the result was not successful. In order to get the right vertical dimension, an occlusal splint was fabricated to achieve a comfort jaw relation. In this position, the overbite was 2 mm, but the space between the upper and lower posterior teeth was 5 mm. In this situation, full veneer crowns were not impossible to fabricate. Finally, to maintain this comfort position, the patient was suggested to wear the occlusal splint and come regularly for control every 6 months.

Highlights

thereforethe managementshould be done by sev-eradl isciplines
pain aroundhis right joint He receivedorthodontictreatment[9] yearsago with removableapp-liancear a privare practiceandhad[4] premolarextraction
T€rjadinya gangguan sendi Unrukmengataski eadaanini ditetapkan merujuk pasien guna mendapatkan 4

Summary

Introduction

The calses of TMD are complex and multifactorial, thereforethe managementshould be done by sev-eradl isciplines. ln this report, a 27-yeat-oldman cameto the teachinghospital of the University of IndonesiaFaculty of Dentistry's ProsthodonticDepartmentcomplaining ibout clicking sound and pain aroundhis right joint He receivedorthodontictreatment[9] yearsago with removableapp-liancear a privare practiceandhad[4] premolarextraction.The patient,sfacelookedasymmetric,with a low vertical dim;nsion, a class II occlusion,and an anteriordeepbite. Proses pengunyahanyang baik dipengaruhi oleh hubungangigi geiigi rahangatas dan rahang bawah,sendi temporomandibulaj,aringan otot dan persaiafannya.Bila hubungan fungsional s€mua sistem ini berlangsung baik rnaka secara keselwhan setiapkomponenmaupunslstemakan bertungsidenganbaik. Bila terjadi gangguanpada sendi temporomandibulam, akaranda-tandyaangadaantamlain ra5anleri padapembaansekitarsendi.rerjadibunli sendipadasaarmembukadan atau menutupmurul ket€gangandenganatautanparasanyeri padaotototot pengunyahanyang dapat menjalar sampaike otot-otot kepala dan leher, sehinggamsnyebabkan keteftatasan pergemkan rahang bawah, ketidaknyamanan, bahkandapatjugaditandaidenganmuka yangasimetri. Setelahnyerihilangdirujukke Departem€n dengan seksama,untuk enghilangkankeluhan l:iodonsia.untuksedapant ungkin menanggulangi utamam, akaperawatadnimulaidenganpemasangan :rmensivertikalyang rendahdan gigitananlerior splinsatusetengathahunyanglaludanmengajarkan .ig dalam denganmengusahakaenksrusi gigi latihan otot yangdilakukanduakali seharsi elama :.ligi posterior,serta memperbaikiposisi gigi kuranglebihsepuluhmenitdengantujuanagarotot grliginya agar didapatgigitan yang stabil pada lebih cepat b€radaptasi.Pada saat pasien datang limensi ve$ikal sesuaisplin yang ada.Perawatan kontrol[2] bulankemudiank,eluhanmulaiberkurang, dilal'ukan denganpemakaianalat ortodontik cekat kemudiandatang kembali 1 minggu kenudian .elamakim-kira 6 tahun yaitu pada tahun 1997 dengankeluhanyangrelatifsudah iinggalsedikir.

Results

Conclusion