In TMD cases with severe occlusal disharmony, occlusal correction is carried out to obtain improvement and stability of the occlusion after splint therapy. If occlusal treatment such as occlusal adjustment or occlusal reconstruction by prosthetic procedures is not effective, an alternative treatment including orthodontic treatment can be used. However careful attention must be given to the side effects caused by these orthodontic mechanics on the masticatory muscles and TMJs. This clinical report presents two cases of occlusions which were reconstructed by orthodontic treatment following splint therapy and Myo-functional therapy executed together with orthodontic treatment to avoid uncomfortable signs.

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The patient was a 28 years old female with a chief complaint of limited mandibular opening. Though her maximum range of jaw opening was limited less than 36mm, she was able to open more widely with pressing her left condyle by her own thumb. Her joint condition was diagnosed as intermittent closed lock with anterior disc displacement. Since she had a clenching habit at the lateral occlusal position, an anterior repositioning splint with lateral ramp was applied for four months. This splint produced an effect on the treatment and almost all complaints disappeared, however, on left premolars and molars region, a little space was observed between upper and lower dental arch when she occluded on the habitual closing position. Occlusal reconstruction was performed by using hard resin caps on the occlusal surface of left premolars and molars. This case suggests that type of splint should be carefully selected according to the condition of patient, including parafunctional habits.

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Double contrast arthrotomogram by Scanora^® was performed to the superior joint space for the patients with temporomandibular joint disorders, excluding type I and V, which were clinically diagnosed by the classification of Japanese Society of the Temporomandibular Joint. Twenty patients were involved in this study, including five males and fifteen females. The average of age was 35. The arthrotomogram showed well differentiated images of the temporal bone, the articular disc, and the condyle as well as the morphological and functional changes of the disc. As a result, seven cases involved anterior disc displacement, in which 4 cases were accompanied with reduction and 3 without reduction. Six cases involved fibrous adhesion in the superior joint space, likewise three closed lock, one reciprocal click and six normal. Classification revealed thirteen cases of type III which included 4 IIIa and 3 IIIb, and seven type II. It took approximately 20 minutes to finalize the series of radiological examinations for each patient. Then it was suggested that double contrast arthrotomogram by Scanora^® was a simple and useful imaging method for the patients with temporomandibular joint disorders.

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The purpose of this study was to assess the feasibility of pivot splint therapy in improving persistent limitation of mouth opening in patients with unilateral closed lock. Twenty-three clinically diagnosed unilateral closed lock patients who had limitation of mouth opening after relief of maxillofacial pain received the treatment with a pivot appliance and were assessed clinically and radiographically. Eighteen patients (78.3%) were found to have had successful recovery of mouth opening range. They all recovered within 12 weeks of the treatment. The patients who did not successfully recover showed condylar bone change and/or were older in age. The results of this study suggested the possibility that the twelve week-use of pivot appliance might be effective in managing limited mouth opening without joint pain. They also suggest that pivot appliance is less effective in the advanced stages of internal derangement where radiographic change of condylar bone is observed.

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There have been very few reports about secondary amyloidosis of the temporomandibular joint affected by rheumatoid arthritis. We presented a case of secondary amyloidosis of temporomandibular joint of a 68-year-old man with severe rheumatoid arthritis. Total TMJ replacement was performed bilaterally and TMJ specimens were harvested for examination. Deposition of amyloid was detected histologically in TMJ with Congo-red stain. Immunohistochemical observation also revealed CD68 positive cells in bone marrow. It was suggested that macrophage related to secondary amyloidosis in rheumatoid artritis of TMJ. Furthermore investigations were required to clear the mechanisum of temporomandibular joint rheumatoid arthritis.

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We have done the arthrography using the X-ray fluoroscope and tomography on the temporomandibular joint (TMJ) diseased patient with a trismus. However, the placeable penetration of middle cranial fossa injury was a problem at the time of the superior joint space cannulation with needle. Recently a report on surgery treatment by image assistance is reported in the medical area. However, it is rare in the dentistry area. Limited cone beam CT (Ortho-CT) for dental use that we developed in this department using dual examination with the X-ray fluoroscope and X-ray CT are possible. This small X-ray CT is effective in the examination of a small range of the maxillofacial area. We report on the Ortho-CT arthrography technique because it proved to be fine. With this examination technique, injection into the superior joint space on the basis of the expectation of the needle position was done and we were able to measure the safety angle and safety distance. Furthermore we did the arthrography with consideration to safety and with reference to 3 dimensional images too. The object is the diagnosis of TMJ disease case with a trismus.
Results showed that Ortho-CT arthrography technique is safe. Also the arthrography of the Ortho-CT showed the same view as MRI.
In conclusion that Ortho-CT arthrography technique is effective in the TMJ arthrography.

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We report clinical findings and magnetic resonance images (MRI) of TMJ in patients with jaw deformity before and after intraoral vertical ramus osteotomy (IVRO). IVRO was performed in 13 sites of 11 patients with jaw deformity. Clinical findings and MR images of the 13 TMJs before and after IVRO were compared.
Preoperative clinical examination revealed that 9 joints had noise and 2 joints had pain during jaw movement. At postoperative examination, the joint noise disappeared in 4 joints and pain disappeared in 2 joints. The average maximum incisal opening was 49.5mm before surgery and 43.5mm after surgery. MRI findings showed that the condyle was temporally displaced anteroinferiorly in 6 joints after surgery. The disc position was normal in 2 joints before and after surgery. In 6 joints that were preoperatively diagnosed as anterior disc displacement (ADD) with reduction, the disc was reduced in the normal position in 2 joints, but it remained in ADD with reduction in 4 joints. In 5 joints that were diagnosed as ADD without reduction before surgery, the disc remained in ADD without reduction in 4 joint and it was improved to ADD with reduction in one joint after surgery.
Because IVRO has a good effect on TMJ symptoms and disc displacement, we recommend it as a method for the treatment of jaw deformity with TMJ disorders.

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To evaluate the effect of the lavage manipulation technique on mandibular function, the mandibular movement in 12 TMD patients before and after treatment were analyzed. All the subjects having trismus due to an articular disc displacement without reduction were treated in unilateral TMJ at which they feel pain and/or stuck on opening. The articular disc position was diagnosed by magnetic resonance imaging in 10 of 12 subjects. Mandibular movements including open-close, lateral excursion, and protrusive jaw movements were recorded with a six-degree of freedom jaw tracking device. In open-close jaw movement, initial translations of 29.65±5.15mm at an incisal point increased to 44.06±6.73mm after treatment (p<0.01; paired t-test). Condylar point translation also changed significantly from 7.30±2.41mm to 14.61±3.22mm in the treated side, and from 7.62±.33mm to 15.24±2.86mm in the non-treated side (p<0.01; paired t-test). The rest of the parameters were revealed to increase range of translation significantly after the lavage manipulation technique than before.
Although the lavage manipulation technique was utilized unilaterally, the range of the contralateral condylar movement was also expanded along with the trated side. These results would contribute to make clear for mandibular function based on the complex joint system of TMJ.

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