Click-Disappearing Position Of Anterior Repositioning Therapy In Temporomandibular Disorders

This case report shows that clicks-eliminating position was chosen to fabricatie anterior repositioning splints(ARS), guided temporomandibular joint(TMJ)into therapeutic anterior position to re-establish a physiological sagittal disc-condyle-ossa relationship. 42-year-old female presented with a 6-year history of bilateral TMJ pain, reciprocal joint clicking, and reduced masticatory efficiency on the left side. Occlusal analysis revealed anterior guidance was lacking in left lateral movement, and there were balancing interferences, open bite exist on left side. MRI confirmed bilateral anterior disc displacement with posterior condylar positioning. CBCT showed degenerative changes at posterosuperior region of left condyle. Clicks- eliminating position was used to fabricatie the splint. Clinical signs and symptoms of TMD were removed and the condyle was centered topographically by the anterior repositioning. With insertion of the ARS in clicks-eliminating position, the TMJ was guided into a therapeutic anterior position. Post-treatment MRI and CBCT demonstrated that condyle moved anteriorly and inferiorly, meantime, disk moved posteriorly and self-recaptured, we successfully re-establish a physiological sagittal disc-condyle relationship and remove clinical signs and symptoms. Pain eliminating might be related to the reduction in TMJ loading, which is associated with considerable increase in the posterosuperior space, improvement in occlusion, and a balanced distribution of muscle force. And further follow-up observation is needed to evaluate the new bone regeneration in this case. Clicks-eliminating position could be used as herapeutic anterior position to reduce TMD symptoms and re-establish a normal disc-condylar relationship.