Some patients suffer sufficient damage to their jaw joints that the tissues just cannot recover and heal. When this occurs there are only two choices:
- Leave the disc dislocated
- Surgically repair/replace the joint
In this instance the quality of life was so compromised that joint replacement was the treatment of choice.
Total joint replacement was the viable treatment for this patient’s joints. TMJ / Concepts joints were fabricated in accordance with the CT – scan images of the damaged joint structures. These joint structures were replaced surgically.Inheritant problems exist with this type of treatment. Ideal joint structures are not being replaced, but damaged structures are evaluated and used as a template for the new joints. When the joints are being replaced the patient is rendered unconscious, muscle paralysis medications are utilized and the mandible “falls” from the glenoid fossa. Therefore, when the joints are replaced the structures are not aligned as they would be if the muscles were functioning in a normal manner. The resultant surgical position is only as accurate as the pre-surgical template and the post-surgical position.
The functional bite association is determined immediately after surgery with a post-surgical orthotic. This orthotic position is modified over the next three to four months as healing occurs and a better functional position is determined.
A class III position was discovered to be the best functional orthopedic relationship following the joint replacement surgery, post-surgical physical therapy and post-surgical orthotic wear. Treatments now had to be implemented to maintain this functional position and approximate the dentition.
The functional mandibular / maxillary position is maintained with the diagnostic /treatment orthotic as the maxillary arch is further developed with fixed and functional appliances. After the maxillary arch is developed the tooth alignment using TMJ – Orthodontic techniques is initiated.
The anterior and posterior teeth were approximated in the initial phase of the TMJ-Orthodontic corrections. The functional position of the mandible would therefore be maintained by these approximated teeth and the functional guidance was transferred from the treatment orthotic to the Universal Lingual Wire System (ULAW). This allowed the maintenance of the joint position when the treatment orthotic was removed so the remaining teeth could be approximated to maintain the determined best functional mandibular / maxillary position.
The remaining dentition is approximate to the best functional mandibular / maxillary association that was initially determined in the post-surgical healing phase and which has been maintained throughout the TMJ-Orthodontic procedure.
These treatment results have now been stable for 9 years as they were rendered to the best functional mandibular / maxillary position determined and maintained after the joint replacement surgery.