How is the orthodontic therapy can be used to treat TMJ dysfunction?
Again, as you will see throughout all my articles, diagnosis plays the most important part in any treatment process, and in many case, it may take several appointments before the diagnosis can be confirmed.
First, we must determine from the medical record and the comprehensive examination that the TMJ signs and symptoms are indeed orofacial in origin. We must rule out migrain, stress or tension headache, or consequence from head and neck trauma. In many case, patient may be sufferred from fibromyalgia or even psychological problems. Again, this is where we cross over to different area of health fields.
Second, we must determine that the TMJ dysfunction is of the dental, skeletal, muscular, or combination in origin. Moreoften in the TMJ treatment, the ultimate relief is the movement of condyle downward and forward, thus releasing the pressure upon the posterior tissue of the joint complex, and allowed inflammation to subside. Orthodontic treatment can widen the intercanine width of the upper arch and allow the mandible to move forward. It also allows better intercuspation in centric and eliminates pathological interference upon excursion, mastication, and most important of all, swallowing. It allows better force distribution in the posterior teeth upon functioning, and also eliminates clenching, grinding, and other oral habit which introduced imbalance of joint-teeth-muscle complex. With orthodontic therapy, we can supraerupted the posterior teeth to increase the vertical dimension, altered the plane of occlusion, thus moving the mandible downward and forward.
The next step is the splint construction. There is nothing more frustrating than when we finish the orthodontic therapy 2-3 years later and find out that patient still have same signs or symptom, or get even worse. The idea is that the splint will help us to determine the amount of downward and forward movement required to relieve the signs and symptoms. In TMJ patient the splint construction is to restore the joint-occlusion-muscles complex to the normal physiologic function. It helps to stabilized the joint while promoting healing, decompresses the TMJ tissue and reduces inflammation, balances and stretches the forshortened muscle, decrease neuromuscular activity in the muscles, decreases the proprioceptive impulse from the dentition and helps to deprogram and guide the mandible to the physiologically favorable position. However, in mild case with short symptomatic period with no joint derrangement and in young patient, we can proceed to orthodontic therapy without constructing the splint. And this will come with experiences in treating TMJ patient. (Please select TMJ/Splint Therapy in the services menu)
The next step is to determine the need for the arch expansion and the eruption of posterior molars. In most of the TMJ case that is dentally related, we found that the maxillary intercanine width is insufficient due to narrow premaxilla. Most often, rapid palatal expansion is used to effectively expand the maxilla width by achieving separation at the intermaxillary suture and also by tipping of the posterior teeth. Eruption of posteriors may be achieve by using splint to raise sectional the vertical dimension, or the use of selectively crowing of teeth, or place temporary filling in selective posterior teeth while we erupting the others.
Finally, we proceed to the orthodontic treatment. At every appointment, we need to determine if there is any severe interference occur with the movement of the teeth and whether or not it can be relieved by slight grinding of selected location. Step bend and rotating bend can be made to arch wire to accomplish the same result. Erupting posterior teeth many times is necessary to increase the vertical dimension. This is the very reason why we do not believe in using the invisallign for our orthodontic/TMJ treatment. There is more to straighten out the teeth in Orthodontics. In many cases, we will expect to find that the TMJ symptom comes and goes after each appointment. This further confirm the dental origin of the signs and symptom of TMJ dysfunction.
These are the protocols of which Dr. Bui, D.D.S., M.S., follows in his treatment modality. It is not necessary the same or equivalent with other operator. Our method may be different, but the final result should be toward eliminating or relieving the TMJ dysfunction. I would like to extend my gratitude to Dr. John E. Scott, D.D.S., M.S. and Dr. Brendan C. Stack, D.D.S., M.S. for all my training and education.