Diagnostics:
A comprehensive diagnostic assessment was conducted to evaluate the condition of the TMJs and occlusal relationships, including:
- CT scan of the head – to assess bony structures,
- MRI – to visualize the joint discs and soft tissues,
- Functional analysis – to evaluate the biomechanics of the mandible,
- Condylography – to determine the therapeutic position of the mandible.
The diagnostic findings revealed:
- Left TMJ: complete ventral disc displacement with reduction upon mouth opening (explaining the clicking sound).
- Right TMJ: complete disc displacement without reduction upon mouth opening.
Treatment:
Based on the diagnostic findings, the therapeutic mandibular position was determined, ensuring the most stable function of the TMJs. To maintain this position, a custom splint was fabricated for the lower jaw to provide proper joint positioning.
After initiating splint therapy, significant improvements were observed:
- The clicking sound in the left TMJ disappeared.
- A follow-up MRI during splint therapy confirmed disc repositioning in the left TMJ.
Further Treatment Plan:
- Fabrication of temporary overlays on the posterior teeth in the therapeutic position.
- Repeat orthodontic treatment to stabilize the achieved result and restore functional and aesthetic occlusion.
- Ongoing monitoring and therapy adjustments as needed.
Thus, a thorough diagnostic approach and comprehensive treatment plan not only eliminated the patient’s symptoms but also created conditions for the long-term stabilization of the TMJs.
