Abstract
Our goal is to show that temporomandibular disorder (TMD) patients with orthopaedic instability can be effectively treated by the combination of occlusal splint therapy and molar intrusion. Diagnostic records of 18 patients reporting previous TMD and treated with splint therapy were evaluated. Postsplint anterior open bite was treated by skeletally anchored molar intrusion. Changes in overjet (OJ), overbite (OB) were measured on articulator mounted models: initially in maximal intercuspidation (MI), centric “de jour”, postsplint centric relation (CR) and postintrusion CR. Changes in ANB (A point-Nasion-B point) angle, mandibular plane–palatal plane angle and facial axis angle were assessed on lateral cephalograms. Morphological changes of the condyle were detected on pre-and posttreatment CBCT images. When compared screening mountings to MI models, significant differences were found in OJ and OB. Following splint wear, there was a significant increase in lower facial height and significant decrease in facial axis angle, which in turn increased ANB angle. OB and OJ showed a significant change on the postsplint mountings when compared to MI. After intrusion, mandible exhibited counterclockwise rotation, which decreased lower facial height, increased OB and facial axis angle and decreased ANB and OJ. Posttreatment CBCTs confirmed improved condylar morphology.Occlusal splint therapy followed by orthodontic molar intrusion provides MI-CR harmony, therefore, it seems to be an effective method for treating TMD patients.
Highlights
Orthodontic treatment of patients with temporomandibular disorder (TMD) due to orthopaedic instability has always been challenging
The degree of centric relation (CR)-maximal intercuspidation (MI) discrepancy has been shown to strongly correlate with the severity of the symptoms and signs of temporomandibular disorder (TMD) and it was proposed to be a contributory factor to the development of TMD [3]
The aim of the present study is to present the results of a series of 18 consecutive cases with orthopaedic instability treated with occlusal splint therapy followed by skeletally anchored molar intrusion, and studied by pre and posttreatment articulator mounting, lateral cephs and CBCT
Summary
Orthodontic treatment of patients with temporomandibular disorder (TMD) due to orthopaedic instability has always been challenging. The degree of CR-MI discrepancy has been shown to strongly correlate with the severity of the symptoms and signs of temporomandibular disorder (TMD) and it was proposed to be a contributory factor to the development of TMD [3]. Dawson and Roth were the first to explain how CR-MI discrepancy may lead to the development of TMD [4,5,6]. They declared that if CR interference exist during jaw closure, the inferior lateral pterygoid muscle is non-physiologically contracted in order to achieve MI. The contraction of the muscle distracts the condyle out of CR position resulting in hyperactivation of the elevator muscles.
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