Methods: The first patient was a female aged 19,referred to us for a bilateral pain of TMJ.The second patient was also a female aged 26,presenting a chronical pain and discomfort of the right TMJ and locking of the joint.A dental occlusal analysis was performed using a semi-adjustable arcon-articulator following a careful physical examination.The X-ray exam appeared normal in the first patient and showed a significant narrowing of the right joint cartilage in the second one.
Results: The physical examination and occlusal analysis showed a poor occlusion associated with neck pain extended into the shoulders and arms in both two patients. In the first patient,teeth#37 and 47 were linguoversion,responsible for a limited mandibular propulsion and retrusion.Maximal opening and jaw diduction were painful and accompanied by clicking and popping.In the second patient the occlusion defect was more severe related to multiple tooth positioning abnormalities which were responsible for dramatically reduced jaw mobility and severe permanent pain.
Conclusions: A two-step treatment plan was used for the management of these patients.At the first step a conventional therapy associating occlusal bite splint and physiotherapy was undertaken during 3 months.On demand NSAI drugs were also prescribed.Clinical signs were rapidly decreased one week after the beginning of the treatment.The second step aims to restore esthetic function and give the patients a long-lasting physiologic occlusion using dedicated methods such as implants,dental prothesis adapted to the individual needs of each patient.This treatment plan is currently ongoing in our clinics.