A case of severe temporomandibular joint osteoarthritis associated with loss of occlusal function

Abstract

The patient was a 68-year-old female who had been diagnosed with autonomic dysfunction and had been attending a chiropractic clinic twice a week for 10 years for treatment of neck discomfort. She had experienced a loss of occlusal function in the right molar region starting 4-5 years before the first visit. In 2013, her right mandibular molar was temporarily restored at a dental clinic to improve her occlusion on the right side. This was not successful and her right-side occlusal function was not restored. The dental clinic referred her to Tokushima University Hospital in 2015 for right-side molar open bite. She presented with crepitus in the left TMJ, but did not exhibit significant symptoms such as pain or difficulty in mouth opening. Panoramic radiography revealed resorption of the mandibular head and shortened mandibular ramus on both sides. CT images exhibited severe deformation of the left TMJ. No rheumatoid factors were found in the physician's examination, and a diagnosis of slight cervical spondylosis of the neck was made by the orthopedist of the University Hospital. We diagnosed her symptoms as bilateral osteoarthritis of the TMJ. A stabilization splint was fitted to restore occlusal function. This was followed by a step-by-step approach for prosthodontic treatment of the final molar restorations.