Three approaches or a combination thereof, may be recommended as initial therapy:
1. Occlusal correction, equilibration or coronoplasty (reshaping teeth to remove interferences that cause abnormal jaw displacement) are various approaches that the dental profession offers among those clinicians who have been trained in these techniques. The terms occlusal correction, equilibration and coronoplasty are carefully chosen terms that refer to differing occlusal philosophies and clinical beliefs as to what method and protocols are to be implemented.
Caution to the consumer patient: Be vary careful and to have any dentist adjust or grind on your teeth, especially a complete arch, because it can induce irreversible jaw positioning problems, specifically for those patient who may have underlying condyle/disc problems, joint derrangement problems and or masticatory pain problems. Equilibrating or adjusting one’s bite is a big deal and the teeth must be adjusted to a physiologic position, if not, symptoms as mentioned in this site will occur!
2. Construct an orthotic to orthopedically align the lower jaw to the cranium in three dimensions providing there is a bite over closure. If symptoms subside after wearing the appliance for three months pain free and off medications, crowns may be recommended to maintain the orthopedic position established by the orthotic. Orthodontia may be recommended to avoid crowns. Possibly a combination of orthodontia and crowns will be recommended if needed. When posterior (back) teeth are missing, dentures and /or partials may be recommended.
This is the most conservative and proven method to establish joint, muscle and postural stability. It is reversible and the standard of care, especially for any patient experiencing TMJ/TMD problems.
The orthopedic orthotic is not designed for long term use. If the symptoms reoccur after the orthotic is removed, a second phase of treatment may be necessary to complete the treatments with one of the following methods at the orthopedic position:
- Crown and/or bridge restorations
- Combination of crown and/ or bridge restorations and orthodontia
- A semi-permanent orthotic
When the most posterior teeth (back molars) are missing or all teeth are missing removable partial dentures, provisional flipper(s) or implant surgery to place missing teeth (bicuspids/molars) maybe required to assist in jaw stabilization.
3. Surgery is the last and least recommended when irreversible damage has occurred in the joints and is beyond natures healing capacity. Vary rare is temporomandibular joint surgery recommended or even indicated. Complete joint replacement is rarely indicated and should be avoided unless previous failing condyle and fossa replacements have previous failed. Do not take joint surgery lightly!
Establishing an optimal physiologic mandibular position first with a removable appliance/orthotic, using sound neuromuscular principles without manipulation is recommended, especially when all methods and TMJ approaches have failed.
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