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Corrective TMJ threapy

Corrective TMJ therapy was properly postulated over 60 years ago. In 1951, Dr Ireland (1) wrote that clicking joints can be treated by making a bite splint that prevents the mandible from closing more than 2 mm beyond the rest position. Ireland used ARA therapy to reduce displaced disks and reduce dysfunction of patients in 1951. Most of the concepts that he postulated continue to be valid Temporomandibular joint disorders can be categorized into two types, definitive treatment and supportive treatment. Definitive treatment refers to those methods which control or eliminate the biologic factor that causes the disorder. Definitive treatment for an anterior displacement of the articular disk would reestablish the proper condyle-disk relationship. Okeson believed the best treatment for a displaced disk is to recapture the disk.

The only method by which this can be accomplished nonsurgically is by ARA therapy. Data now supports Hall (3) that a normal disk position:

1) assists in alleviating pain
2) prevents gross degeneration of the condyler head
3) promotes growth of the mandible

Using this data, he feels there is a strong argument for including disk recapture as and important goal of treatment of the painful joint with displaced disk that reduces G. Boering's (4) thirty-year study of the course of degeneration of the TMJ, Nicherson (5) states that reestablishing normal disk position protects the joint from degeneration disease. Lundh and Westesson (6) found that recapturing a a displaced disk effectively eliminates pain and dysfunction in patterns in whom a normal disk-condyle relationship can be established.

ARA therapy was found superior to both flat plane therapy and no-treatments. Shockingly, many of my colleagues deny these researcheres and instead expose anecdotal eveidence that their treatment is superior. Many of them dispute that it is possible to recapture a displaced disk.

Using the Bimler cephalometric analysis in conjunction with 3 dimensional imaging of the condylar position in the glenoid fossae, our office is capable of developing and repositioning the maxillae to its proper relation to the anterior cranial base. We then reposture the mandible down and forward to its proper relation in the glenoid fossae, ideally recapturing the disk, minimally improving its position to the gelb 4/7 in the glenoid fossae.

Once we have established the mandible to its correct relationship to the maxillae, it is important to stabilize this newly established relation. There are two accepted modalities of stabilization 1) Orthodontic eruption of the posteriors segment, or 2) prosthetic rehabilitation via crown or bridges or prostatic overlays.

Using evidence based research our office can effectively treat TMJ disorders with consistent long lasting results.

Bibliography

1) Ireland. The problem of the clicking jaw preceding of the Royal Society of Medicine Jan 22, 1951: 27
2) Okerson JP. Management of Temporomandibular disorders and occlusion Ted Masky 1998
3) Hall HD. Intra – articular disk displacement part II: Its significant role in temporomandibular joint pathology, Journal of Oral Maxillofacial surgery 1995, 53: 1073-1079
4) Boering G. Temporomandibular joint arthrosis A clinical and radiographic investigation. Groningen. The Netherlands, Van Dendersen, 1994
5) Nickerson JW. Oral and Maxillofacial Surgery Clinics or North American May 1994:285 6) Lundh H, Westesson PL. Disk repositioning analysis in the treatment of TMJ disk displacement comparison with flat occlused splint and with no treatment. Oral surgery Oral medicine Oral pathology 1998, 66: 155-162

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