Arthroscopic disc fixation to the condylar head uses resorbable pins for internal derangement of the temporomandibular joint (stage II–IV). Several attempts have been made in the literature to recapture the anterior disc displacement without reduction, such as mandibular manipulation to recapture the displaced disc by pulling the condyle of the affected side downward and forward. On the left side, inverted V elastics (from lower left canine to upper left canine to lower left first premolar) were used from the lower canine and premolar to the upper canine to stabilize the joint on this side. Once 0.017” × 0.025” stainless steel upper and lower archwires were reached, a pivot composite buildup on the lower right first molar and a class II elastic (1/4”, 4.5 oz) with vertical component was given to allow displacement of the right condyle inferiorly and anteriorly to recapture the disc. The patient was presented with two treatment options: The first was to recapture the disc via joint surgery using a Mitek screw (Mitek Anchor, Mitek Products Inc., Westwood, MA, USA) to stabilize the disc into the condylar head the second was to capture the disc using the fixed orthodontic appliance. MRI image for both right and left joints in an open and closed position (a) left joint in a closed position (b) left joint in an open position (c) right joint in a closed position and (d) right joint in an open position Alternative treatments may include auriculo-temporal nerve block to differentiate a primary diagnosis of joint pain from muscular pain. In chronic cases, the patient should be referred to an oral and maxillofacial surgeon to surgically recapture the disc, using a Mitek screw to stabilize the condylar disc complex. Conservative supportive therapies should include advising the patient to avoid activities that aggravate the condition, advising the patient to perform gentle jaw exercises that help regain opening, prescription of non-steroidal anti-inflammatory drugs (NSAIDs) for pain control and resolution of inflammation, and the fabrication of a stabilization occlusal appliance for nighttime use. If unsuccessful, a minimally invasive surgical procedure may be considered to return the disc to the normal functioning position. One stabilization is achieved, a stabilization appliance may be used only for nighttime. If successful, the patient is then advised to wear an anterior positioning appliance for the first 2–4 days, followed by nighttime use. Manual manipulation to regain normal disc-condyle relationship may be considered in acute cases. Treatment approaches depend on whether the case is acute or chronic. We believe that the cause of the jaw shift was due to the malocclusion however, the patient was going through difficult times, which led to stress and parafunctional habits, such as nocturnal clenching and bruxism, that resulted in the anterior disc displacement without reduction. His chief complaint was, “I do not like my smile.” Clinical examination revealed V-shaped upper and lower arches with bimaxillary crowding (5 mm maxilla and 9 mm mandible), lower midline shifted to the right by 2 mm, crossbite in relation to upper right lateral incisor and lower right canine, lower chin deviation to the right, and reciprocal right TMJ clicking during opening and closing. A 24-year-old male patient presented to the orthodontic clinic for routine orthodontic treatment. Less common conditions may include temporomandibular joint (TMJ) ankylosis, coronoid hyperplasia, capsular fibrosis, and synovial chondromatosis. Differential diagnosis may include masticatory myalgia, myositis, degenerative joint disease, and temporalis tendonitis. This case report aims to demonstrate a new way to achieve stable occlusion in a patient who sustained disc displacement.ĭiagnosis is based on the patient's history, clinical examination, and related tests. The disc was eventually recaptured, and the patient resumed normal jaw function and mouth opening. An attempt was then made to recapture the disc using occlusal pivots and elastics. A maxillary occlusal splint was fabricated to reduce the symptoms and attempt to recapture the disc however, this attempt failed. Due to a life crisis, the patient developed anterior disc displacement on the right joint. ![]() ![]() The case was treated with fixed orthodontic appliance with maxillary expansion and unilateral mandibular extraction to eliminate the mandibular crowding. The patient was a 24-year-old male who presented with class I right molar and canine relationship and class III left molar and canine relationship on a class I skeletal base, complaining of bimaxillary crowding. This article presents a novel idea for managing patients with anterior disc displacement without reduction that often develops in susceptible patients during routine orthodontic treatment.
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