J Korean Acad Prosthodont.  2016 Oct;54(4):431-437. 10.4047/jkap.2016.54.4.431.

Re-restoration of temporomandibular joint disorder acquired after implant prosthetic restoration using T-Scan: A case report

• Joo SJ
• Kang DW
• Lee HS
• Jin SY
• Lee GJ

• KMID: 2388223
• DOI: http://doi.org/10.4047/jkap.2016.54.4.431

Abstract

In cases of extensive prosthetic restoration, correction of occlusal contact is often needed, as it is the essential component for a successful restoration. If occlusal contact is given incorrectly, various symptoms of occlusal trauma can occur of which temporomandibular joint disorder (TMD) is one of them. As one of the common symptoms of TMD, patients may suffer with masticatory muscle disorder and temporomandibular joint pain. This case presents satisfactory results for the improvement of masticatory muscles and temporomandibular joint pain of a TMD patient, caused by incorrect occlusal contact of the restoration, by replacing the prosthesis after occlusion correction.

Keyword

Occlusion; Trauma from occlusion; Temporomandibular joint disorders; T-Scan

MeSH Terms

Humans
Masticatory Muscles
Prostheses and Implants
Temporomandibular Joint Disorders*
Temporomandibular Joint*

Figure

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  Fig. 1. Intraoral photographs before treatment. There are restorations on maxillary and mandibular posterior teeth. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 2. (A) Panoramic radiograph before treatment, (B, C) Transcranial projection. The left TMJ is anteriorly displaced compared to the right TMJ as the reduction of the anterior disc space was observed.

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  Fig. 3. T-Scan examination at MIP before treatment. (A) Severe imbalance of occlusal force of right side was observed and the center of force (COF) was biased to the right, (B) About 75% of total occlusal force was biased to the right side (red line), whereas the left side (green line) accounted for about 25% of total occlusal force.

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  Fig. 4. Occlusal stabilization splint (UCLA type) fabrication and try-in. (A) Frontal view, (B) Mandibular occlusal view, Occlusal contacts were only in the posterior teeth area, (C) Right lateral view, (D) Left lateral view.

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  Fig. 5. Provisional restoration. (A) Frontal view, (B) Maxillary occlusal view, (C) Left lateral view. After removing the previous prosthesis, a temporary crown was fabricated for a uniform occlusal contact at the left premolars and molars. After 5 months of follow-up, pain reduction of the masticatory muscles and TMJ was observed.

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  Fig. 6. T-Scan examination at MIP after provisional restoration. (A) Occlusal contact was evenly distributed, and the COF was formed close to the center of the arch. (B) The graph showed 50:50 force distribution in left (green line) and right side (red line).

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  Fig. 7. Final restoration. (A) Frontal view, (B) Maxillary occlusal view, (C) Right lateral view, (D) Left lateral view. Excluding deflective occlusal contact, after installing the new prosthesis with an evenly distributed occlusal contact, pain on the masticatory muscles and TMJ was gone.

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  Fig. 8. (A) Panoramic radiograph after treatment, (B, C) Transcranial projection. The anterior-posterior disc space of the left TMJ was recovered and the condyle is positioned in the center of articular fovea.

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  Fig. 9. T-Scan examination at MIP after setting a new prosthesis (A) occlusal contact was evenly distributed and the COF was formed close to the center of the arch. (B) The ratio of left and right forces was balanced. Green and red line overlapped each other at center of graph.

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  Fig. 10. Transcranial projection after 1-year examination. (A, B) The anterior-posterior disc space of the left TMJ was evenly spaced and the condyle is positioned in the center of the articular fovea.

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