Orthodontic diagnostics and treatment planning in adults with temporomandibular disorders a case report.

Abstract

Temporomandibular disorders are not an uncommon finding in adult patients undergoing orthodontic treatment. In a 25-year-old female patient with neutroclusion, bialveolar protrusion with anterior crowding, and mesial tipping of tooth 27 due to early loss of tooth 26, a unilateral clicking in the right temporomandibular joint was recorded as a secondary finding. Clinical and instrumental functional analysis revealed right-sided anterior disc displacement with reduction, which had been induced by forced guidance of the mandible to posterior. Space was to be gained by extracting tooth 41, by closing the residual gap at tooth 26, and by interproximal reduction of the dental enamel in the right upper buccal region. In addition, occlusal adjustment was to be undertaken subsequently to eliminate the forced guidance and to achieve a slightly overcorrected Class I relationship. Treatment wit a complete fixed appliance fulfilled the treatment objectives, with normal functioning of the temporomandibular joint being achieved. This case of a patient with a temporomandibular disorder is used to illustrate steps in diagnosis and functional analysis. Steps which ensure not only a successful orthodontic outcome but also a beneficial orthopedic effect on the temporomandibular joint.