Female patient 54 years old consults in the clinic with complaints of many years of head ache, ache in the temples and in the back of the head. Shoulder ache, blocked ears sensation, popping in both temporomandibular joints. She presented limitation of mouth opening and difficult for mastication. She used pain killers and anti inflammatory that did not alleviated her symptoms.
Postural frontal images show de misalignment of the patient shoulders and the forward head position.
The patient had a complete superior prosthesis, she related that many professionals constructed different removable inferior prosthesis, but they increased her symptomatology.
Occlusal view show the wear of the anterior lower teeth.
Patient panoramic radiograph.
General alveolar horizontal resorption.
Asymmetrical condilar heads and suggestion of osteophytes in both mandibular heads.
Stylomandibular ligament calcification.
Periapical lesion in the endodontically treated element.
TMJ laminography before treatment. Important retro position of the mandibular condyles. Arrows in the zone of compression.
Surface electromyography of the patient in habitual occlusion.
Anterior right and left temporalis.
Right and left masseter.
Right and left digastrics.
Right and left superior trapezius.
Important asymmetry between the masseter muscles.
Activation of the digastrics in closure, these muscles only must be activated in opening movement.
MRI: sagittal slice of the right TMJ closed mouth, before treatment
Articular disk dislocation and retro position of the mandibular condyle.
MRI: sagittal slice of the left TMJ open mouth before treatment.
Favorable case for disks repositioning in a neurophysiological position promoting disk recapture
We consider not only the jaw tracker information after the electronic deprogramming but fundamentally the information of the MRI for the decision of the bite record for the tridimensional construction of the intraoral device.
The patient presents a pathological free way space of 10 mm and a mandibular retro position of 6 mm.
The device is electromiographically controlled to check the improvement of the muscular function.
The comparative laminography, demonstrate the decompression of the retrodiscal zone.
It is important to know that any laminography cannot demonstrate the recapture of the articular disc. This is only possible with the MRI
MRI: sagittal slice of the right TMJ closed mouth before and after treatment demonstrates the articular disc recapture and the repositioning of the mandibular condyle.
MRI: sagittal slice of the right TMJ open mouth before and after treatment. The MRI after treatment demonstrates the right TMJ optimal translation without the limitation of the initial MRI
MRI: sagittal slice of the left TMJ closed mouth before and after treatment. The MRI after treatment demonstrates the left TMJ articular disc recapture and the repositioning of the mandibular condyle.
MRI: sagittal slice of the left TMJ open mouth. The MRI after treatment demonstrates the left TMJ optimal translation.
Head position improvement, comparison with the forward head posture of the image before treatment
The lip has no more the inclination, of the initial image before the treatment.
Improvement of the aesthetic facial plane
Finishing the TMJ pathology treatment I recommended the patient to the colleague that carried the neurophysiological rehabilitation, maintaining the tridimentional position.
The implants more than five years after insertion.
I felt a lot of pain, during many years. Ear ache, pain behind the eyes, strong head ache that got stronger after chewing. I changed to eat only soft food and stop eating meat and raw vegetables. This food when I chewed provoked and increased my ear pain and head ache. I felt ashamed when I chewed because of the noises that came from my TMJ.
When I complained from the pain in the neck and shoulder pain, they told me that was because of my work, I am a seamstress. Today I continue with my job but I don´t feel more pain, neither in the shoulders, nor in the neck or behind my eyes.
I don´t feel the noises I had when I chewed before the treatment
I feel that I also, rejuvenate, looking to my pictures before and after the treatment, I see my mouth is not twisted like it was before.