Joint Decompression in a Neuromuscular Physiological Mandibular Rest Position Promotes a Positive Remodeling in a Degenerative Process of a Teenager Temporomandibular Joint

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Pathology of the temporomandibular joints has been more frequently detected with the arrival of new diagnostic tools and is a growing concern among health care professionals. Pain and decreased range of mandibular opening may be the only evidence of chronic infections.

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An eighteen year-old female patient with sharp pain in both TMJ was referred by her dentist who was treating her with different modalities including bite plates that did not alleviate the symptoms.

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Panoramic radiograph can show in many cases degenerative processes of the TMJ. But is not a good tool to diagnosis TMJ pathologies. In this case it doesn´t show relevant information of both mandibular heads.

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Her teeth photographs showed an inferior wear, many of the professionals commented that her pain was because of bruxism, but the miorelaxing plates didn´t alleviate her symptoms.They told her that the pain was only because stress, but really nothing was investigated.

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Psychosocial factors or lack of diagnosis?

7  A laminography solicited in the first consultation revealed the disease in both mandibular heads, more in the right side , which showed an important loss of substance.8

A CT revealed a vast resorption of the right mandibular head and subcondral cysts of the left mandible head.  Her clinical history revealed a traumatism in her infancy and repetitive ear infections.

9    A CT revealed a vast resorption of the right mandibular head and subcondral cysts of the left mandible head.  Her clinical history revealed a traumatism in her infancy and repetitive ear infections.10

The  MRI revealed the destruction of the disc and ligaments of the right mandibular head and the irreducible dislocation of the disk on the left side.

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CT Sagital slice and MRI comparison . Both images show the lack of cortical

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Even if the patient didn´t present clinic symptomatology of inflammatory disease. We send her to a rheumatologist for investigation.

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We can´t trust in pathologic structures as a reference for any intra oral device confection.

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Her masticatory muscles were electronically deprogrammed with TENS (Transcutaneal Electronic Neural Stimula­tion). A jaw tracker then registered a neurophysiologic position from which an intraoral appliance was constructed and tested with SEMG (Surface Electromyography.)

17    For this record we use the neurophysiologic technique.18

19The jaw tracker record shows the limitation in opening 31,8 mm and the poor velocity.

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No machine can deliver a diagnosis, it is an important tool, but always the decision on where we take the record is the professional choice that depends on the differential diagnosis of each patient.

22      With this data we can construct an intraoral appliance, tested electromiographically and magnetographically, to support that neurophysiologic position.

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Comparative records: on the right initial record with opening limitation and bad velocity. On the left with the DIO intra oral device, excellent opening and translation and a good velocity.

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After one year o treatment, a new CT clearly showed an almost complete good positive remodeling of the mandibular head of the right side and a healing process in the left side.

25   After one year o treatment, a new CT clearly showed an almost complete good positive remodeling of the mandibular head of the right side and a healing process in the left side.
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  After one year o treatment, a new CT clearly showed an almost complete good positive remodeling of the mandibular head of the right side and a healing process in the left side.
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Initial records and after 6 years control comparison.

Sem Título-1MRI sagital slice right closed TMJ before and after treatment. We can observe the new cortical absent in the first MRI28

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Degenerative process recuperation comparative images

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1 thought on “Joint Decompression in a Neuromuscular Physiological Mandibular Rest Position Promotes a Positive Remodeling in a Degenerative Process of a Teenager Temporomandibular Joint

  1. Pingback: TMJ Study and Investigation Page. One year of publication | Page of Studies and Investigation – TMJ

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