Mandibular Forward Repositioning And Tooth Extraction On Temporomandibular Disorder Patients

For patients with mandibular retrusion accompanied by mandibular deviation, a series of symptoms such as pain and head position deviation caused by condylar compression may occur. In such cases, it is necessary to adjust the mandibular position first, and then start orthodontic treatment. This case report describes an orthodontic treatment of a 13-year-old girl with skeletal Class II, dental Class I malocclusion, right mandibular deviation of 2mm and temporomandibular disorders (TMD). Repositioning the mandible and aligning the midline is necessary to reduce the pressure on the bilaminar zone of temporomandibular. Since the new position induced in Class III malocclusion, we designed a method of extracting four second premolars, with a low anchorage for the maxilla and high for the mandible. This approach aimed at distalizing the mandibular premolars, enabled the anterior teeth to achieve sufficient overjet, and meanwhile created space for mandibular protraction and established a Class I relationship of the posterior teeth. When patients present with joint symptoms, mandibular forward repositioning is required to relieve the pressure in the bilaminar zone. Retaining the special anatomical structure of the first premolar-the transverse ridge-will also make the occlusal relationship more stable after orthodontic treatment. After fifteen months of treatment, the midline alignment and Class I occlusion was achieved, resulting in improved facial profile. It can be seen on the CBCT that the posterior joint space after treatment is significantly widened. Following 1-year retention, stable Class I occlusion was maintained with concurrent improvement in temporomandibular joint symptoms.