Mandibular Repositioning Via Orthodontic Treatment On Adult With Temporomandibular Disorders

Patients with deep overbite and excessively uprighting maxillary anterior teeth often have retruded mandibles, which is called “fencing effect”. It may cause occlusal trauma, tooth attrition, or temporomandibular disorders (TMD) such as disc displacement, pain or clicking. Correcting excessive uprighting maxillary anterior teeth is important for improving jaw function in the long term. It's necessary to reposition the retruded mandible and establish posterior support during orthodontic treatment when early symptoms of TMD appear. A 21-year-old female patient was concerned with joint sound and frequent tooth cracking. Clinical examination showed reciprocal joint clicking on both sides and moderate attrition of mandibular anterior teeth. First, treatment reference position was established based on condylar tracing graph and articulator mounting. After the bite registration of TRP transferred to patient’s mouth, the reciprocal joint clicking was found to disappear. Then, clear aligners were designed to extrude premolars and molars in TRP to establish posterior support, while root-lingual torque was imposed on maxillary anterior teeth. Mandibular repositioning is effective in addressing reciprocal clicking and, in some cases, may help reposition the TMJ intrusion of the mandibular anterior teeth is a traditional maneuver in patients with deep overbite. However, in this case, we preferred posterior extrusion to establish vertical support in the posterior region and to reduce excessive pressure in TMJ. Uprighting of maxillary anterior teeth provides a “fencing” effect on mandible, potentially triggering jaw dysfunction and tooth attrition. Mandibular repositioning, followed by establishment of posterior support is recommended in these cases.