Mandibular repositioning can be effective in treatment of reducing TMJ disk displacement. A long-term clinical and MR imaging follow-up.
In order to evaluate the long term clinical and morphologic results of recapture of a displaced TMJ disk, we recalled for follow-up MR imaging 75 patients who had been treated by attempted disk recapture based on pre-treatment MR imaging 1-6 years earlier. The treatment included a day appliance with inclines to guide the mandible into the therapeutic position and a telescopic night appliance which prevented retrusion of the mandible during sleep. Appliance treatment was followed by rebuilding or resurfacing the posterior teeth of one arch to permanently support the mandible in the therapeutic position. After treatment of 115 joints with displaced disks, 52% of the disks were normally positioned, 23% were improved in position, and 25% showed persistent disk displacement. Symptom relief was 92% in patients with normalized (recaptured) disks, 84% in patients with improved disk position, and 49% in patients with persistent disk displacement. Failure to improve disk position occurred in 7% of the joints with anterior disk displacement and in 44% of the joints with a transverse (sideways) component to the displacement. Forty-five percent of the recaptured-disks improved in contour. We concluded that anterior mandibular repositioning was effective in the treatment of patients with reducing displaced disks primarily when the disks were displaced only in an anterior direction. This treatment can be recommended in anterior disk displacements if the patient has failed more conservative treatment measures, permanent occlusal reconstruction can be justified, and the patient understands that long-term use of a night appliance may be necessary. Anterior mandibular repositioning appears much less effective in cases with a transverse component to the disk displacement.
Summer
J D
JD
Westesson
P L
PL
D000293:Adolescent; D000328:Adult; D003828:Denture, Overlay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008875:Middle Aged; D017090:Occlusal Splints; D019224:Temporomandibular Joint Disc / Q000473:pathology*; D013705:Temporomandibular Joint Disorders / Q000628:therapy*; D016896:Treatment Outcome