Diagnosis and Treatment of Temporomandibular Arthrosis: a Clinical Case

Abstract

Background. Complexity of anatomical structure, diversity of clinical pattern, lack of a unified theory of etiology, pathogenesis and treatment of this pathology, individual aspects of the course of the disease complicate the diagnosis and choice of relevant treatment for patients with various nosological forms of the temporomandibular joint diseases.Clinical case description. Patient P., 32 years-old, went to the clinic of orthopaedic dentistry with complaints of noise phenomena in the temporomandibular joint (clicks in the joint area have been registered for five years, the noise increased six months ago), dental crowding, absence of tooth 3.5. The patient underwent clinical examination with creating diagnostic models, electromyography of the masticatory muscles, axiography, computed tomography and MRI of the temporomandibular joint. Through computed magnetic resonance imaging of the temporomandibular joint, electromyography and axiography the patient was accurately diagnosed with deforming arthrosis of the temporomandibular joint complicated by dislocation of the intra-articular disc. A therapeutic-diagnostic plastic milled splint on the mandible was implemented. Dynamic observation during treatment was carried out. The effect of the treatment was observed after three months. The control cone-beam computed tomography of the temporomandibular joint showed positive dynamics in the form of an even expansion of all regions of the joint cavity on both sides, centered position of the heads of mandible in the mandibular fossa, but the cortical bone destruction of the upper contour of the mandibular head on the left was still present. After six months of treatment, electromyograms showed a decrease in bioelectrical activity at rest and an increase in bioelectrical activity during chewing on all the masticatory muscles within normal limits. The re-examination after six months revealed smoother vertical movements of the lower jaw, an increase in the amplitude of laterotrusion and protrusion, their symmetry, no “blockage” of lower jaw movements.Conclusion. An integrated application of radiologic imaging, electromyography and axiography in the diagnosis of temporomandibular joint diseases is crucial for objective analysis of the results, assessment of the quantitative and qualitative characteristics of the masticatory muscles and lower jaw movements, which ultimately determines the optimal patient surveillance and controlled treatment outcomes.