Occlusal Rehabilitation In TMJ Degenerative Disease: A Case Report

Severe tooth wear in early adulthood can cause disc displacement and degenerative joint disease in temporomandibular joint (TMJ). Occlusal rehabilitation is challenging under such conditions. A 35-year-old female presented with severe tooth wear due to amelogenesis imperfecta and chronic TMJ pain. Diagnosis of disc displacement without reduction, and degenerative joint disease was made in the left TMJ. Dental examination also revealed missing teeth (#26, #27, #17), deep caries (#27, #37), and chronic periapical periodontitis (#16, #46, #24). A stepwise two-phase approach was adopted. First, a stabilization splint was applied for six months to identify a therapeutic mandibular position. Then, prosthodontic rehabilitation was performed on the position that was tested and modified through two-stage provisionals. At 1-year follow-up the patient showed satisfactory aesthetics and function, and left TMJ bone remodelling was observed. Amelogenesis imperfecta can result in severe tooth wear at an early age, predisposing several issues: early tooth loss, misalignment, dental pulpitis, periapical periodontitis, and the displaced disc and degenerative joint disease in TMJs. The therapeutic position is crucial for its occlusal rehabilitation. In this case, initial position was acquired by muscle deprogramming guided by TMJ imaging and functional analysis, then the therapeutic position was tested and modified through stabilisation splint to provisionals. This stepwise two-phase approach with multiple steps to confirm the therapeutic position can effectively manage both severe tooth wear and degenerative joint disease.