Efficacy of combination treatment in a patient with temporomandibular joint dysfunction

Background: Muscle and joint dysfunction is a common complication, particularly in females over 40 years. It is strongly associated with age-related hormonal changes in the bones, as well as concomitant dentoalveolar deformities and tooth loss.

Case description: The efficacy of combination treatment of dentoalveolar abnormalities and deformities complicated by temporomandibular joint (TMJ) dysfunction was demonstrated. The efficacy of combination treatment in patients with missing teeth, as well as dentoalveolar abnormalities and deformities complicated by TMJ dysfunction, was confirmed. To ensure a representative before-and-after comparison, the restoration of masticatory efficiency following orthodontic and orthopedic rehabilitation was assessed.

A physical examination in patient M. revealed hypertonia of masticatory muscles, restricted mouth opening, jaw shifting to the left, partially absent dentition in distal sections, and prosthetic restoration failure. On MRI, there were signs of deforming arthrosis of both TMJs. The following observation methods were used to assess the efficacy of rehabilitation:

1. questioning to identify symptoms of TMJ pain; follow-up examination for joint clicking when opening the mouth;
2. palpation of the external pterygoid muscle, masticatory muscle, and internal pterygoid muscle;
3. X-ray examination (TMJ CT and MRI) following treatment;
4. masticatory efficiency assessment using a masticatory performance test (according to Trezubov) before and after treatment.

Diagnostic testing following combination orthodontic and orthopedic treatment revealed that the patient’s left TMJ no longer felt heavy, and she could open her mouth easily; moreover, jaw shifting resolved, and masticatory muscle rigidity decreased.

Conclusion: This clinical case demonstrates why orthopedic surgeons and orthodontists must collaborate in the diagnosis and treatment of TMJ dysfunction. The authors present a well-established approach to the treatment of patients with TMJ dysfunction that has been used successfully in clinical practice for several years.