Korean J Orthod.  2012 Jun;42(3):144-154. 10.4041/kjod.2012.42.3.144.

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

• Tanaka E
• Yamano E
• Inubushi T
• Kuroda S

• KMID: 2272263
• DOI: http://doi.org/10.4041/kjod.2012.42.3.144

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 clockwise-rotated mandible through molar intrusion using titanium miniscrews is effective for the management of TMJ-OA with jaw deformity.

Keyword

Orthodontic mini-implant; TMJ; Orthodontic treatment

MeSH Terms

Congenital Abnormalities
Female
Humans
Jaw
Lip
Magnetic Resonance Imaging
Malocclusion
Mandible
Maxilla
Middle Aged
Molar
Mouth
Open Bite
Osteoarthritis
Overbite
Recurrence
Retention (Psychology)
Retrognathia
Splints
Temporomandibular Joint
Titanium
Titanium

Figure

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  Figure 1 Pretreatment photographs (age, 46 years 9 months).

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  Figure 2 Pretreatment records. A, Panoramic radiograph; B, lateral cephalograph; C, poster-anterior cephalograph; D, lateral transcranial radiograph of the temporomandibular joint (age, 46 years 9 months). ICP, Intercuspal position.

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  Figure 3 Pretreatment cephalometric analysis. A, lateral cephalometric tracing (solid line) superimposed on the mean profilogram (dotted line); B, cephalometric measurements. SNA, Sella-Nasion-A point angle; SNB, Sella-Nasion-B point angle; ANB, A point-Nasion-B point angle; GoA, Gonial angle; FMA, Frankfort-mandibular angle; IMPA, Incisor-mandibular plane angle; FMIA, Frankfort-mandibular incisor angle; U1-FH, Axial inclination of the upper central incisor in relation to Frankfort plane; Y-axis, Angle between Frankfort plane and Sella-Gnathion line; Interincisal A, angle between the axial inclinations of the upper and lower central incisors; Ramus height, Length of the mandibular ramus (Articulare-Gonion); Me to palatal pl., Lower anterior facial height (Menton to palatal plane). SD, Standard deviation.

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  Figure 4 Intraoral photographs during treatment. A, 6 months after the start of treatment; B, 12 months after the start of treatment; C, 18 months after the start of treatment.

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  Figure 5 Posttreatment photographs (age, 49 years 4 months).

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  Figure 6 Posttreatment records. A, Panoramic radiograph; B, lateral cephalograph; C, poster-anterior cephalograph; D, lateral transcranial radiograph of the temporomandibular joint (TMJ) (age, 49 years 4 months). ICP, Intercuspal position.

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  Figure 7 Posttreatment and 2- year retention cephalometric analyses. Lateral cephalometric tracings at posttreatment (dotted line) and 2-year retention (double dotted line) superimposed on the pretreatment tracings (solid line) on the Sella-Nasion plane at Sella (A); on the palatal plane at Ptm' (B); and on the mandibular plane at Menton (C). Cephalometric measurements before treatment (solid line), after (dotted line) treatment, and at 2-year retention (double dotted line) (D). SNA, Sella-Nasion-A point angle; SNB, Sella-Nasion-B point angle; ANB, A point-Nasion-B point angle; GoA, Gonial angle; FMA, Frankfort-mandibular angle; IMPA, Incisor-mandibular plane angle; FMIA, Frankfort-mandibular incisor angle; U1-FH, Axial inclination of the upper central incisor in relation to Frankfort plane; Y-axis, Angle between Frankfort plane and Sella-Gnathion line; Interincisal A, angle between the axial inclinations of the upper and lower central incisors; Ramus height, Length of the mandibular ramus (Articulare-Gonion); Me to palatal pl., Lower anterior facial height (Menton to palatal plane). SD, Standard deviation.

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  Figure 8 Magnetic resonance imaging of the temporomandibular joint after active orthodontic treatment.

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  Figure 9 Two-year post retention photographs (age, 51 years 5 months).

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  Figure 10 Two-year post retention records. A, Panoramic radiograph; B, lateral cephalograph; C, poster-anterior cephalograph; D, lateral transcranial radiograph of the temporomandibular joint (TMJ) (age, 51 years 5 months). ICP, Intercuspal position.

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