Interdisciplinary approach to temporomandibular disorder: a case report (Part 1: the initial therapy)
A 26-year-old female patient presented with a high-grade limitation of her mouth opening. After initial clinical examination and evaluation of medical and dental history, a detailed sequential treatment plan was developed. Primarily, the patient was referred to the physiotherapist. The goal of this treatment phase was to enhance the mouth opening, to enable further examinations including alginate impressions of the upper and lower jaw. Based on the results of the clinical and instrumental analysis, a myo-relaxation splint was fabricated. Equilibration was performed consequently. The mandibular mobility and the subjective symptoms could be positively influenced within this treatment phase. The treatment outcomes were evaluated and recorded by occlusal index and palpation of muscle and joints. The results of an interims analysis, including a second condylography, were used to refine the initial therapy. Special manipulation techniques have been applied during the condylographic recording, to achieve more information on particular situation of the jaw joints. The splint was readjusted to a particular therapeutically position, which has been determined after the second condylography. A lateral mandibular shift was introduced by the new splint. The mouth opening could be increased further with this joint position to a sufficient amount. The patient is pain free, the movement of the jaw is adequate and without severe limitations. The condyle-disk relation is reestablished. The therapeutically achieved jaw positions are now the basis for set up and wax up procedure, to establish the orthodontic treatment plan. Based on this individual case report, the authors want to emphasize, that even in severe cases with involvement of jaw joint structures, a consequent and systematic interdisciplinary treatment sequence is essential to obtain the treatment goals. Consequently, a physiologic relation of condyle and disk should be established, if possible. The jaw mobility should not be the result of stretched ligaments or burden to joint structures such as disk and bilaminar zone. The reported effect of such kinds of treatments is the consequence of interdisciplinary treatment, based on clinical and instrumental findings and the willingness of the team to readjust the treatment if indicated.