Treating Malocclusion After TMJ Surgery for Internal Derangement

Abstract

Statement of the Problem: TMJ internal derangement includes an aberrant relationship between the articular disc and the condyle that when symptomatic and unresponsive to conservative therapy can be corrected surgically. Arthrocentesis, arthoscopy or disc repositioning open procedures are some of the surgical techniques advocated to treat this condition; however, one of the disadvantages of TMJ disc repositioning is postoperative malocclusion. The aim of this study is to utilize class III guiding elastic postoperatively to treat malocclusion seen after disc repositioning surgery and to discuss the different options and rationale for success. Materials and Methods: This study included 42 paients (72 joints) who presented with a Wilkes class III or V internal derangement that had failed conservative herapy and were proposed surgical correction. All paients underwent the same surgical technique for repoitioning of the TMJ disc using a Mitek mini anchor. All urgeries were performed by the same surgeon. Thirtyve patients were placed in class III guiding elastic mmediately postoperatively for 2 weeks. Seven patients id not receive class III guiding elastics. The patient’s cclusion was recorded before and after surgery. All atients completed a preand post-operative visual anaogue scale assessing their symptoms and occlusion. ostoperative MRIs in a small subset of these patients ere also obtained to corroborate surgical success and isc position. Results of Investigation: All 35 patients who received lass III guiding elastic did not experience any maloccluion postoperatively. All 7 patients that did not receive uiding elastics experienced malocclusion. Four of hose patients’ malocclusion did not resolve over time and re currently awaiting corrective jaw surgery. Three of the even patients who did not receive the guiding elastic had alocclusion that resolved after 3 to 4 months of heavy hysical therapy. All patients had improvement of their ain and resolution of their chief TMJ complaint at longest ollow up. Conclusion: The use of class III guiding elastic is a imple and noninvasive technique to treat malocclusion fter TMJ disc repositioning surgery.