The Management of Temporomandibular Disorders and Orthodontic Treatment for a Motor Vehicle Accident (MVA) Inducing Class II, Division 1 Acute Malocclusion with Bimaxillary Fracture and Mutilated Denti

Abstract

Acute malocclusion induced by motor vehicle accident (MVA) is complicated and difficult to treat, since it may associate with jaw bone fracture, mutilated dentition and TMD. Quite often the comprehensive treatment for trauma-induced acute malocclusion requires interdisciplinary approaches including surgical, dental, orthodontic and prosthodontic treatments. The patient presented in this report is a 39-years old female[0] with Class II, division 1 acute malocclusion. She was injured in a MVA and suffered from maxillary alveolar bone fracture, mandibular symphyseal fracture and right subcondylar comminuted fracture. After surgical and general dental treatment, she was referred to orthodontic clinical for further treatment to esthetically and functionally restore her dentition. Model set-up was applied so that comprehensive orthodontic-prosthodontic treatment plan could be proposed. Pain control and managing TMD problems were carried out before orthodontic therapy. Preadjusted fixed appliance was set up to align her mutilated dentition, to re-distribute the spaces, and to achieve normal overjet. After 30-month orthodontic therapy, patient presented with straight facial profile, a stable Class I occlusion, and reasonable space distribution for the definitive prosthesis. The treatment procedures were described, and the outcome assessed by comparing pretreatment PAR (Peer Assessment Rating) score with that of post-treatment demonstrated significant improvement. Nevertheless, the justification was also issued in terms of the degree of accuracy of applying PAR index to numerically evaluate the orthodontic outcome of treating mutilated dentition.