Case Reports

These cases were presented at international meetings and are posted below by courtesy of the patients.

This is a 17 years and 4 months old Japanese lady and a skeletal open bite case with severe root resorption of four maxillary incisors and a periapical lesion of the maxillary right first premolar. CT images of the temporomandibular joints (TMJs) revealed flattening and downward displacement of both condyles. Condylar seating and stabilization of mandibular position were achieved with splint therapy. Following presurgical orthodontic treatment, three-piece Le Fort I osteotomy of the maxilla and SSRO of the mandible were performed to obtain a functional occlusion and a pleasing facial profile.

A surgical case with DJD

Masako Komatsu

The patient has a history of trauma to the face around the age of 5 years. She fell off a jungle gym, slammed her face on the ground. Someone then stepped on the back of her head. When she was in high school, she heard clicking sounds on wide opening. She does not remember which side was making noise. She presently experiences joint pain and sounds on yawning. She also has a history of headache, stiff shoulder and other unidentified complaints.

Both condyles were grossly deformed, and an open bite was observed intraorally. The case was treated with a combination of orthodontics and orthognathic surgery because of an increased severity of the open bite after splint therapy and the need for 5 mm of vertical control in the posterior area.

The patient presented with the chief complaint of difficulty closing the lips. She had a TMJ symptom of reciprocal clicking in the left joint. MRI revealed anterior disc displacement (DD) without reduction in the right joint and anterior DD with reduction in the left joint. Slight flattening of the right condyle was observed on CT images. Splint therapy to identify her mandibular position resulted in an open bite. Treatment was performed based on the diagnosis and treatment plan made in the stabilized mandibular position to obtain a pleasing facial profile and a functional occlusion.

We perform stabilization splint therapy to seat the condyles into the fossae for stability of the temporomandibular joints and predictable treatment in our practice. We reported results of three-dimensional joint space analysis with CBCT at the last RSCI meeting. This study was conducted to examine the status of the joints in different stages of disc displacement (DD) following preoperative splint therapy and bilateral sagittal split ramus osteotomy (BSSRO) using CBCT and MRI images.

The patient presented with maxillary protrusion, sever occlusal wear, CO-CR discrepancies, dolicofacial pattern and crowding. Because of the occlusal wear and CO-CR discrepancies, splint therapy was carried out for stabilization of mandibular position, which led to the development of an open bite and uncovering of dental and skeletal problems in the vertical dimension. Implant anchors were utilized to correct the dental and skeletal vertical problems. Careful attention was paid to the temporomandibular joint status, facial profile, occlusion and periodontal health throughout the treatment period.

The patient presented with skeletal mandibular protrusion and mandibular deviation to the left side. Intraorally, the anterior teeth were in crossbite. The jaw was difficult to manipulate during bite registration, and radiographs revealed condylar displacement. Orthognathic surgery was planned. Splint therapy was carried out to identify the true discrepancy and stabilize mandibular position. This led to the surgical decisions to intrude and move to the right the posterior maxilla, to set back and horizontally rotate the mandible, and to add genioplasty. A presurgical splint was used to accurately assess the amount of surgical movement. A functional occlusion, healthy periodontal tissues and a pleasing facial profile were obtained through repeated steps to ensure stability of mandibular position.

This patient presented with severe class Ⅱ malocclusion and TMD. Splint therapy stabilized the patient's jaw position and improved her symptoms, however, it resulted in a severe skeletal class Ⅱ malocclusion. She was a great candidate for jaw surgery but sometimes jaw surgery is not an option. Here was how I treated a 10mm over-jet while I was still a student according to Roth philosophy that I was learning in the two year course. The treatment plan included extraction of her upper first premolars and second molars, and use of a temporary anchorage device (TAD) for intruding upper molars. This plan was designed to reduce her over-jet and lower face height using counter clockwise rotation instead of jaw surgery.

The patient had bimaxillary protrusion, dental midline deviation to the right, history of TMJ pain, subjective symptom of clicking and CO-CR discrepancies. Splint therapy was instituted because the muscles were resistant during manipulation of the jaw into CR. Following stabilization of mandibular position, orthodontic treatment was initiated with a plan to extract four first bicuspids. Implant anchors were utilized to maximize anchorage for both arches. Retraction of the upper and lower anterior teeth led to profile improvement and establishment of functional occlusion.

A patient presented with osteoarthritis of the temporomandibular joints, skeletal open bite and micrognathia. She had pain, joint sounds, trismus and condylar deformity in both joints. A stabilization splint was used to stabilize jaw position. Trismus, joint sounds and pain were improved with splint therapy. The anterior open bite increased as a result of changes in jaw position. Splint therapy was followed by orthognathic surgery for skeletal and occlusal improvements.Orthognathic surgery comprised of Le Fort I osteotomy, sagittal split ramus osteotomy (SSRO) and genioplasty. It has been two years since the start of retention. A stable functional occlusion and a pleasing facial profile have been maintained without recurrence of pain or trismus.

Age at initial examination: 21y6m
Sex: Female
Chief complaints: Inability to incise food, difficulty of mouth opening
Medical history: Chronic sinusitis in junior high school
Family history: Both parents and elder brother had straight teeth.

The patient presented with crowding. Examination of the temporomandibular joints revealed joint sounds in the right joint and a reduced size of the right condyle. The mandible shifted to the right with splint therapy, resulting in a severe open bite. Orthognathic surgery was proposed but not accepted by the patient. The treatment plan included upper first and lower second bicuspid extraction , use of micro-implants for reinforcement of anchorage and upper molar intrusion.

Age at initial examination: 20y7m
Sex: Female
Chief complaint: Crowding
Medical history: Allergic rhinitis
Family history: N/A

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