Rehabilitation of a Completely Edentulous Patient with Nonreducible Bilateral Anterior Dislocation of the Temporomandibular Joint: A Prosthodontic Challenge—Clinical Report

Abstract

Nonreduced bilateral anterior dislocation of the temporomandibular joint (TMJ) is an extremely rare condition, and its prosthodontic rehabilitation is a clinical challenge, especially in patients who refuse to or cannot undergo surgery. There are no previous clinical reports of successful or standardized prosthetic rehabilitation approaches for patients with this condition. This clinical report describes the successful prosthodontic management of an edentulous patient with nonreduced bilateral anterior dislocation of the TMJ.

The Treatment of Temporomandibular Joint Dislocation

“…Patients without acute facial trauma who for the first time experience a temporomandibular joint dislocation can be diagnosed based on medical history (8,10,16,19). Especially in older patients with multimorbidity, temporomandibular joint dislocation may initially be overlooked as symptoms are milder and the ability to communicate is often limited (5).…”

“…The goal is here to limit maximum opening of the jaws; rigid fixation should be avoided. In case of complicating further problems, such as malocclusion (for example, anterior open bite due to persistent dislocation refractory to treatment), an individualized approach based on the range of functional surgical procedures for temporomandibular joints as well as reconstructive and orthognathic surgery may be required (GoR 0; LoE IIIa-V) (3,5,20).…”

“…Besides neurological and neuromuscular diseases (3), advanced tooth loss with resulting lack of posterior support is regarded a predisposition for temporomandibular joint dislocation (4,5). In an aging population, it is reasonable to expect a future rise in incidence (6).…”

“…Especially in older patients with multimorbidity, symptoms tend to be less pronounced. Combined with a reduced ability to communicate their complaints, delayed diagnosis of dislocation is common, further complicating the management of patients in this group (5). Physicians not specialized in treating temporomandibular joint dislocation see only few patients with this dislocation.…”

Temporomandibular joint dysfunction and physiotherapy: direction through a case report

“…[3][4][5] TMJ dislocation impacts the quality of life of those affected with the condition. 2 Management of TMJ dislocations is primarily manual reduction but mostly surgical in nature. However, in recent times individuals are looking for alternative conservative ways to manage TMJ dislocations.…”