A case report of maxillary protrusion with TMD

Abstract

The patient was a 24-year-old female who consulted our hospital, complaining of protrusion of her upper anterior teeth and jaw discomfort. During the first visit, examination of the frontal face revealed mandibular deviation to the left side, and intraoral findings revealed Angle Class II maxillary protrusion with functional crossbite at the left molar section. TMJ examination showed bilateral tenderness and TMJ clicking on the right side. Tooth Contacting Habit (TCH) was recognized from the questionnaire on TMJ conditions. MRI examination showed bilateral anterior and lateral disc displacement without reduction on the left side and with reduction on the right side, and erosion was observed at the right condylar head. The patient was diagnosed as having maxillary protrusion with functional mandibular deviation to the left side, and temporomandibular joint disc derangement (type III) and osteoarthrosis of the temporomandibular joint (type IV). Primary TMD management was applied for TCH before orthodontic treatment. After confirming the stability of TMD symptoms, orthodontic treatment was started with four premolar extractions to improve maxillary protrusion with functional mandibular deviation. After the treatment, the Angle Class II molar relationship and severe maxillary protrusion with functional mandibular deviation to the left side were improved, and a good profile and occlusion with anterior guidance were achieved. The distance of mouth opening was increased and bilateral tenderness was improved. MRI examination showed marginal proliferation at the left condylar head. No improvement was noted in TMJ clicking on the right side. The patient is currently in the retention period, and TMD symptoms have not been observed at one year after orthodontic treatment.