A 32-year-old Japanese female patient consulted the authors' dental clinic with a 4.5-year history of rheumatoid arthritis (RA). She complained of pain during mouth opening and difficulty in eating due to masticatory dysfunction caused by an anterior open bite. Imaging showed severe erosion and flattening of both condyles. RA stabilized after pharmacological therapy and became inactive during the orthodontic therapy aimed at reconstructing an optimal occlusion capable of promoting functional repositioning of the mandible. At present, 4 years and 2 months postretention, the reconstructed occlusion remains stable, and both condyles continue to be remodeled. The distance from reference position to intercuspal position has gradually decreased throughout the 4-year posttreatment and postretention periods. Orthodontic therapy that comprehensively reconstructs occlusion and enhances the functioning of the mandible can induce remodeling of eroded condyles, even those with a history of rheumatoid arthritis.
This article is to review our approach to disc displacement with reduction case by using combination therapy of modified functional appliance (mFA) and multibracket appliance (MBA). This patient was a 17-year-old Japanese female who was complaining of right-side temporomandibular joint (TMJ) clicking, pain during mouth opening, and limitation of condylar movement at initial medical examination. We assumed that the clicking during mouth closing occurred in the mandibular position in which the displaced disc returned to normal position on the condyle, as we called therapeutic reference position (TRP), and performed mFA therapy, by which disappearance of clicking and subjective symptoms were obtained. We stabilized the occlusion by mFA and MBA setting at TRP and reconstructed occlusion was obtained with disappearance of all the clinical symptoms passed about 4 years of postretention. Therefore, it is possible that the combination therapy of mFA and MBA of occlusal reconstruction seems to be an effective treatment for the disc displacement with reduction cases.
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