Initial TMJ disk recapture with anterior repositioning appliances and relation to dental history.
Fifty-eight consecutive patients in a referral based practice seeking treatment for complex chronic painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess the recapture of displaced disks by anterior repositioning appliances (ARA) and the improvement in disk position in those disks that did not fully recapture. After standard clinical workup, including assessment of pain, maxillary and mandibular ARAs were constructed which repositioned condyles to the Gelb 4/7 position as determined by cephalometrically-corrected linear tomograms. Multi-planar magnetic resonance imaging (MRI) was performed immediately before and after insertion of the mandibular ARA, showing three-dimensional recapture of disks in 85% and improved disk position in 6% of reducing displacements. Disk position was improved in 28% of nonreducing joints, but none were totally recaptured. Recapture or improvement was achieved in 91% of reducing, 28% of nonreducing, and 63% of all joints with internal derangements. Initial disk position, reduction on opening and recapture by ARA were statistically independent of patient age, number of teeth missing, number of third molars missing, malocclusion (Angle's class), overjet, overbite, prosthetic appliances, and previous orthodontic treatment. It was concluded that ARA therapy provided effective recapture of displaced TMJ disks that reduce upon mouth opening. In this population of patients with chronic TMJ pain, previous dental treatment had no statistically significant effect on the incidence of internal derangement or on disk recapture by ARA therapy. There was no evidence of adverse effect from orthodontics, prosthetics, or any other dental care.
Simmons
H C
HC
Department of Dentistry, Vanderbilt University School of Medicine, USA.
Gibbs
S J
SJ
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D017090:Occlusal Splints / Q000706:statistics & numerical data; D011446:Prospective Studies; D019224:Temporomandibular Joint Disc / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome