2021 Volume 33 Issue 2 Pages 51-57
We applied an occlusal appliance to a young patient with temporomandibular joint (TMJ) osteoarthritis and confirmed a good outcome based on long-term clinical and imaging diagnostic follow-up. Herein, we report a summary of the clinical course of the patient. A 14-year-old girl presented with the chief complaint of pain of the left TMJ area at mouth-opening. At the initial examination, tenderness of the temporal and masseter muscles was observed. In addition, we detected functional pain of the temporal and masseter muscles, and TMJ pain with crepitus resulted in the limitation of mouth opening. Computed tomography (CT) revealed abnormal thinning and roughening of the cortical bone on the bilateral condyles and hypoplastic-like change with flattening of the left condyle. On magnetic resonance (MR) images, a partial erosive change of the condyle and anterior disc displacement without reduction were observed in the left TMJ. In the right TMJ, anterior disc displacement with reduction was detected. Based on these findings, the patient was diagnosed with temporomandibular disorders (TMD) of types I, II, IIIa, IIIb, and IV, according to the decision tree of diagnostic criteria for temporomandibular disorders (DC/TMD). Serial treatments using a maxillary stabilization-type oral appliance, physical therapy and guidance on a daily basis were applied to reduce the overloading on the masticatory muscles and TMJ. These treatments allowed relaxation of the masticatory muscles and TMJ and stabilization of the occlusion. As a result, the preoperative TMD symptoms disappeared, and the range of mouth-opening reached the normal level after 4-months of treatment. Thereafter, the patient was followed up every 6 months and instructed to wear an oral appliance for sleep bruxism when necessary. Consequently, no recurrence of TMD symptoms was observed during 4-years of follow-up after the start of treatment. Moreover, on follow-up CT and MR images at that time, remodeling of the condyles and disappearance of the findings suggesting osteoarthritis were observed. Thus, the clinical course was considered to be comprehensively successful.