Abstract
Recently it has been shown that most internal derangements of the TMJ can be relieved by conservative therapy, whether the displaced disk is successfully repositioned or not. If the displaced disk returns to its normal position by use of appliance therapy or other therapy, the mandible is frequently repositioned anteriorly and inferiorly, which requires following occlusal reconstruction. However, it is still not apparent whether the management of occlusion is necessary or not if a patient acquires his normal oral function again through adaptative change of the TMJ structure without disk recapturing.
This report concerns two cases with closed lock in which we failed to reposition the displaced disk by use of Farrar's manipulation technique. We performed the following appliance therapy, and symptoms such as pain and limitation of jaw opening that had been observed before treatment completely disappeared. Although the disks were still displaced without reduction, the mandibles were nevertheless repositioned anteriorly and inferiorly. Therefore, occlusal reconstruction was made to obtain occlusal stability at the jaw position. It was confirmed by TMJ tomography that deviation of condyles in the fossae was corrected by the reconstruction.Surprisingly, a few months later we observed that the disk displacement without reduction had improved to displacement with reduction in both patients. These results suggest that changing the mandibular, i. e. condylar, position through occlusal reconstruction provides an opportunity to reposition displaced disks.
