トップへ » Considering Dentures? » Dentures and TMJ Arthrosis » The process of treating TMJ arthrosis (an actual case)

The process of treating TMJ arthrosis (an actual case)

During the initial exam we found that the patient could not open her mouth and that she experienced pain when she tried to do so. Her right jaw made a snapping noise. She shared with us that she was constantly worried about the area in front of her right ear and that it was effecting her work.

The process of treating TMJ arthrosisAt first glance, it seemed that there were no obvious problems with the inside of her mouth. To the right is an X-ray image of the inside of her mouth. The many crowns and fillings in her molars stand out, but there was no problem with the shape of her jaw.
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The process of treating TMJ arthrosisWe examined the joints of her jaw using a Doppler stethoscope. We listened to find out whether the snapping noise occurred when she opened her jaw or when she closed it. In this patient's case, a snapping sound occurred in the joints on the right side when she opened her jaw. She was also unable to open her jaw straight.
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The process of treating TMJ arthrosis
The second time she came to the clinic we took a mold and examined it. This is after we added plaster to the mold of her upper and lower jaw and neatly trimmed it.
The process of treating TMJ arthrosis
The process of treating TMJ arthrosisWe then attached the mold to a device called an actuator, which can accurately reproduce jaw movements. The angle of jaw movement is different in each person. The jaw movement is always quite complex when people grind their teeth. The jaw rotates and moves back and forth and to the left and right. It is necessary in TMJ arthrosis patients to undergo this detailed examination.
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The process of treating TMJ arthrosisThis is a face-bow transfer. It is a device used to attach the upper jaw mold to the actuator. We can use it to examine whether or not the bite alignment plane is vertically aligned with the midpoint of the body. It is important to use the face-bow transfer even when making just a single crown or filling.
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The process of treating TMJ arthrosisThis is how we transfer the recorded data to the actuator. The relationship between the midpoint of the body (midpoint of the actuator) and the bite alignment is transferred accurately.
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The process of treating TMJ arthrosisIt is not enough that the upper and lower bite alignment meet at only a particular location when biting. We record the central position (the original position where the jaw is most relaxed) and then attach the upper and lower teeth.
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Then we check to see if there are any changes between the position of the jaw when relaxed and the position when biting. In this patient's case, the reconstructed (fixed) fillings and crowns turned out to be the cause of her symptoms. This mold examination is extremely important and teaches us a lot about the condition. A high level of skill is required to master this examination technique.(IPSG
The process of treating TMJ arthrosis
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The process of treating TMJ arthrosisThere are many grooves hidden inside of the shape of teeth. These are not random imperfections, but they actually follow rules.
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The process of treating TMJ arthrosisThe third time the patient visited the clinic we record the movements of her jaw in 3-D and examined her jaw function. We record how her jaw movement has changed after treatment compared to before treatment.
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The process of treating TMJ arthrosisIt varies per case, but usually during the fourth visit we administer sprint therapy or instruct the patient on how to perform home therapy. In this patient's case, since the cause of her symptoms was unbalanced bite alignment due to fillings and crowns, we carried out occlusal adjustment.

Occlusal adjustment needs to be monitored and is usually complete after being carried out 1 to 3 times.
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The process of treating TMJ arthrosis
After adjustment, the patient was cured of the snapping noise in her right jaw joints. She also regained the ability to open her mouth straight. You can see from the image to the left that her jaw was barely moving at all. The image to the right shows that she was able to move and open her jaw widely after adjustment.

The patient was very pleased. She told us that she initially thought the pain was a result of being tired from work, but after treatment she was able to happily return to work in good health.

*TMJ arthrosis treatment is not covered by national health insurance and we charge 10,000 yen (tax not included) for the first examination.


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