Management of acquired open bite associated with temporomandibular joint osteoarthritis using miniscrew anchorage

Abstract

This article reports the orthodontic treatment of a patient with skeletal mandibular retrusion and an anterior open bite due to temporomandibular joint osteoarthritis (TMJ-OA) using miniscrew anchorage. A 46-year-old woman had a Class II malocclusion with a retropositioned mandible. Her overjet and overbite were 7.0 mm and -1.6 mm, respectively. She had limited mouth opening, TMJ sounds, and pain. Condylar resorption was observed in both TMJs. Her TMJ pain was reduced by splint therapy, and then orthodontic treatment was initiated. Titanium miniscrews were placed at the posterior maxilla to intrude the molars. After 2 years and 7 months of orthodontic treatment, an acceptable occlusion was achieved without any recurrence of TMJ symptoms. The retropositioned mandible was considerably improved, and the lips showed less tension upon lip closure. The maxillary molars were intruded by 1.5 mm, and the mandible was subsequently rotated counterclockwise. Magnetic resonance imaging of both condyles after treatment showed avascular necrosis-like structures. During a 2-year retention period, an acceptable occlusion was maintained without recurrence of the open bite. In conclusion, correction of open bite and clockwiserotated mandible through molar intrusion using titanium miniscrews is effective for the management of TMJ-OA with jaw deformity.

Association of malocclusion, self-reported bruxism and chewing-side preference with oral health-related quality of life in patients with temporomandibular joint osteoarthritis

“…Besides, on one hand, if the malocclusion was present before TMJ‐OA occurred, it means that the malocclusion was more likely to have been present for a long time and patients may already be used to the malocclusion in daily life and are not likely to report feel discomfort in eating in the preceding 1 month. On the other hand, if the malocclusion of the patients occurred secondary to TMJ‐OA, patients may have anterior open bite, which is called acquired open bite associated with TMJ‐OA. However, acquired open bite associated with TMJ‐OA is not very common and TMJ‐OA can only cause relatively minor open bite changes with slow progression.…”

Effect of temporomandibular joint articular disc repositioning on anterior open-bite malocclusion: An orthodontic-surgical approach

“…Findings suggest that the improvement of clockwise rotation of the mandible, reducing the overloading of the TMJs, can be indispensable for the treatment of acquired open bite associated with TMJ osteoarthritis. 36 Despite its unpredictable course, the ideal position of the condyle and a stable occlusion can attain a balanced biomechanical joint, inhibiting the progression of osteoarthritis and possibly causing functional and adaptive remodeling of the condyles. 37 The use of 3D models from CBCT allowed a better understanding of the morphologic bone remodeling of the condyles after the disc repositioning surgery.…”

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“…A 0.014 NiTi arch wire was inserted to achieve leveling and alignment (Figure 5). Relieving the crowding in an easy way we decide to extract upper and lower first premolars (14,24,34,44). After 4 months, a 0.016 NiTi wire was in both upper and lower arches for transverse arch development.…”