Occlusal Splint as a Part of the Therapy of TMJ Anterior Disc Displacement
Asst. Prof. Lenka Vavrickova1, Asst. Prof. Martin Kapitan1, Asst. Prof. Jindrich Charvat Jr.2, Assoc. Prof. Hana Hubalkova3, Assoc. Prof. Marie Bartoňova4, Asst. Prof. Jindrich Charvat, Sr.2
1 Department of Dentistry, Charles University, Faculty of Medicine in Hradec Kralove, and University Hospital Hradec Kralove,
2 Department of Dentistry, Charles University, First Faculty of Medicine, and General University Hospital in Prague, and Private Dental Office, Statenice,
3 Department of Dentistry, Charles University, First Faculty of Medicine, and General University Hospital in Prague,
4 DMD Private Dental Office, Prague
Introduction
The temporomandibular joint (TMJ) anterior disc displacement (ADD) is a specific temporomandibular disorder with different clinical signs. ADD with reduction (DDWR), sometimes called clicking joint, is typical for joint noises during opening and closing movements. Contrary, ADD without reduction (DDwoR), known as „locked joint“, more likely presents with visible limited jaw opening
Case Description
30-year-old woman in the 1st trimestr of pregnancy came with the complaint of pain in the right TMJ. She suffered from type 1 diabetes mellitus treated with insulin pump. She described very limited and painful opening attack (1 finger) with strong yawning pain followed with joint rigidity a month ago. Clinical examination proved chronic pain in the right TMJ, with active opening range 35 mm (passive opening range 53 mm with pain), silent click at 12 mm on closing. During protrusive moment the click is lost. Palpation of the chewing muscles was not painful. The diagnose was assessed as DDwoR and TMJ two-way chronic synovitis. The conservative treatment included caring mode, local heat and anterior repositioning appliance (ARA). NSAID were contraindicated due to pregnancy. Conventional ARA without any individualized data was fabricated and delivered in the same day. The intraoral scanner and digital facebow was used to prepare more comfortable and precise ARA using digital workflow in one week. Within 3 weeks patient described pain and limited opening regress.
Discussion
The conservative treatment of DDwoR is prefered. The imaging methods as well the farmacotherapy were limited due the pregnancy in this case. Individualized ARA brought the comfort and loss of pain for the ADD patient.