1990 Volume 2 Issue 2 Pages 302-314
The prognosis for conservative treatment was investigated in 35 patients with persistent anterior displacement of the disc without reduction of the TMJ. Nonsurgical reduction of the displaced disc had been impossible in those patients. Conservative treatment with stabilization type splint was performed in all patients, and followed by some prosthetic treatment in 20 patients to reduce the loading force toward the joint after improvement of pain and the maximal interincisal distance. The duration of treatment ranged from 6 to 24 months (mean; 15.5 months). The results were as follows:
1) The mean of maximal interincisal distance was 27.6mm before treatment and 44.4mm after treatment. 34 patients improved into more than 40mm in the interincisal distance.
2) 30 patients had pain of the TMJ and 34 patients had pain in the masticatory muscles before treatment. After treatment, TMJ pain had disappeared or been Limited on maximal mouth opening in 27 patients, and muscular pain had disappeared or remarkably improved in 25 patients.
3) A half of the patients developed crepitus in the course of treatment.
4) The radiographic. findings showed various bone changes of the condylar head in 21 TMJs before treatment and 26 TMJs after treatment. Some erosive bone changes that were the most frequent findings have undergone the change into the flattening of the condyle. 27 TMJs showed good condylar translation that is beneath or anterior to the crest of the eminence on maximal mouth opening.
5) Although arthrograms showed morphologic changes of the disc such as perforation, fibrous adhesion or thickening in 20 of 31 TMJs before treatment, symptoms disappeared except for crepitus in the end of treatment.
6) Bilateral arthrographic examination showed that 9 TMJs with disc displacement without reduction were free of pain.
These results show that symptoms were satisfactory in the majority of patients after conservative treatment. The TMJ has the capacity of adaptive changes to the displaced disc. Conservative treatment should precede surgical treatment.
