We successfully performed intermaxillary traction using an Indirect Bonded Splint (IBS) to correct an anterior open bite with bilateral condylar resorption.
The patient was a 42-year-old woman who had slight TMJ pain and noticed anterior open bite one year before the first examination. The anterior open bite gradually increased thereafter and the examination showed an overjet of +1.0 mm and overbite of -3.5 mm. Maximal mouth opening was 46 mm. CT showed that the surface of the condyle was flat on both sides, and that the condyle on the left side was erosive and sclerotic. We attached an IBS to the surface of all teeth and intermaxillary traction was performed with elastic bands. After traction for 8 months, the anterior open bite was improved. CT showed that the condylar heads were round with the formation of a cortical layer of the bone.
These results indicate that intermaxillary traction using IBS is a useful conservative treatment for open bite with condylar resorption.

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The long-term progress in the pathology of the temporomandibular joint (TMJ) was examined in a patient with malocclusion and deformity of TMJ. The patient was a 20-year 5-month-old female, with the complaint of open bite. The overjet and overbite were 7.0 mm and 0 mm, respectively. The molar relationship was Angle Class II, and ANB angle was 5.9°. She was diagnosed as open bite accompanied with deformity of bilateral TMJ. After 3-month observation of pathologic status of TMJ with a stabilization type splint, teeth alignment with multi-bracket appliances was initiated. After treatment for 2 years and 3 months, an acceptable occlusion was obtained, and retention was initiated. Although changes in the condition of the disk and condyle were observed, no temporomandibular disorder (TMD) symptoms appeared during the whole treatment period. After 5-year retention, stable occlusion was maintained without TMD symptoms. From this case report, it is suggested that long-term observation of the pathologic status of TMJ after orthodontic treatment is important for patients with malocclusion with deformity of TMJ as well as treatment planning based on a diagnosis of TMD before treatment.

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Recently, most of the geriatric patients with temporomandibular disorders seen in our department have been treated by providing guidance on diet and daily life and by drug therapy, the same as that for young and middle-aged patients. To assess the efficacy of our treatment of geriatric patients, we conducted a retrospective clinical study on 77 temporomandibular disorders at the age of 65 years of age or over (old group), in comparison with 82 young and middle-aged patients aged 39 years or under (young and middle-age group).
The results showed that in the old group, the treatment was effective in 53 joints (68.8%), and that in 60.4% of the cured patients the signs and symptoms had improved within a month. In the young and middle-age group, treatment was effective in 59 joints (72.0%), and in 67.8% of the cured patients the signs and symptoms had improved within a month.
According to the classification of the Japanese Society of TMJ, in the old group the improvement rate of the type I patients was highest (92.9%), followed by the type III-a patients (80.0%), and type II patients (72.2%). The lowest improvement rate was in the type III-b patients (45.0%). In the young and middle-age group, the improvement rate of the type I patients was highest (100.0%), followed by the type II patients (77.1%), and type III-a patients (76.9%). The lowest improvement rate was in the type III-b patients (43.6%). There were no significant differences between the old group and the young and middle-age group in the improvement rates of any of the TMD types.
Guidance on diet and daily life and the drug therapy were effective, and the period of treatment was relatively short, probably because there were comparatively more type II patients and fewer patients with deformity of the TMJ in the old group.
The results suggest that conservative treatment, mainly guidance on diet and daily life is effective in geriatric patients, the same as in young and middle-age patients.

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The guideline committee for the primary care of temporomandibular disorders (TMD) in the Japanese Society for the Temporomandibular Joint carried out a preliminary investigation with questionnaire to the participants of the 20th annual meeting held on July 14 and 15, 2007. The purpose was to collect clinical questions (CQ) from medical care providers. The questionnaire included questions on the position in the society and social stage, the engagement period for TMD treatment, the format for CQ and free opinions on the guideline.
It was thought necessary to conduct advertising for the next investigation because we were able to collect only 61 answers. Among the respondents, 54 were members of the society (89%) and 24 were authorized specialists (39%). There were 31 dentists (51%) who had been involved in TMD treatment for more than 11 years.
Regarding the symptoms described in CQ format, pain-related CQ was the most frequent, followed by joint noise and limited mouth opening. As for treatment, CQs regarding splint therapy were the most frequent, followed by mouth opening exercise and pharmacotherapy. Splint therapy for pain was the most common answer for CQ.
Several respondents did not seem to recognize the format for clinical questions. It is suggested that we need to consider more detailed tactics for collecting CQs.

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We encountered a rare case of severe trismus caused by bilateral coronoid hyperplasia, and were able to improve the symptoms by surgical coronoidectomy simulated using three-dimensional models.
The patient was a 43-year-old female who presented with a chief complaint of limited mouth opening. The patient had been aware of trismus since childhood. At 32 years old, she received routine therapy under a diagnosis of temporomandibular joint disease. However, her symptoms did not improve, and subsequently she consulted our faculty. Interincisal opening of the patient was limited to 13 mm. Panoramic radiography and three-dimensional computed tomography (3D-CT) demonstrated that both coronoid processes extended above the zygomatic arch, indicating a bilateral enlargement of the coronoid processes. Before surgical treatment we performed a simulation of the operation using models made from the 3D-CT data. Because of severe trismus, we simulated an operation using three-dimensional models from the 3D-CT data. Bilateral coronoidectomy was performed through an intraoral approach under general anesthesia. Following mouth-opening training, the patient has maintained an interincisal opening of 40 mm 1 year postoperatively.

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