Orthodontics for Orthognathic Surgery

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  • Topic: Temporomandibular joint disorder, Temporomandibular joint, Mandible
  • Pages : 32 (9355 words )
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  • Published : February 13, 2012
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COMMON TMJ DISORDERS: ORTHODONTIC AND SURGICAL MANAGEMENT
Larry M. Wolford, Daniel S. Cassano, João Roberto Goncalves

ABSTRACT
The temporomandibular joints (TMJs) are the foundation and support for jaw position, function, occlusion, and facial balance necessary for quality treatment outcomes in dentistry, orthodontics, and orthognathic surgery. If the TMJs are not stable and healthy (non-pathological), treatment outcomes in these dental disciplines may be unsatisfactory relative to function, esthetics, occlusal and skeletal stability, and pain. There are many temporomandibular joint disorders that can affect the TMJ adversely. The most common of these conditions include: 1. 2. 3. 4. 5. 6. Articular disc dislocation; Reactive arthritis; Adolescent internal condylar resorption; Condylar hyperplasia; Osteochondroma or osteoma; and End-stage TMJ pathology.

These conditions often are associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, sleep apnea, etc. Patients with these conditions may benefit from corrective surgical intervention. This chapter will discuss the most common TMJ pathologies and present the orthodontic and surgical management considerations to correct the specific TMJ conditions and associated jaw deformities to obtain predictable outcomes. Improvements in TMJ diagnostics and surgical procedures have contributed to improved treatment and rehabilitation of the pathological, dysfunctional and painful TMJ disorders. Research has demonstrated that TMJ and orthognathic surgery can be performed safely and predictably at the same operation, but it does necessitate the correct diagnosis and treatment plan, as well as requires the surgeon to have expertise in both TMJ and orthognathic surgery.

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Common TMJ Disorders There are many temporomandibular joint (TMJ) conditions that can cause pain, TMJ and jaw dysfunction and disability. The most common of these conditions include: 1. 2. 3. 4. 5. 6. Articular disc dislocation; Reactive arthritis; Adolescent internal condylar resorption (AICR); Condylar hyperplasia; Osteochondroma or osteoma; and End-stage TMJ pathology (e.g., connective tissue/ autoimmune diseases, advanced reactive arthritis and osteoarthritis, multiply operated joints, failed alloplastic TMJ implants, absence of the joint, traumatic injuries and ankylosis).

These conditions often are associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms and sleep apnea. Patients with these conditions may benefit from corrective surgical intervention. The difficulty for many clinicians may lie in identifying the presence of a TMJ condition, diagnosing the specific TMJ pathology and selecting the proper treatment for that condition. This chapter will discuss the most common TMJ pathologies and present the orthodontic and surgical management considerations to correct the specific TMJ conditions and associated jaw deformities.

WHY CONSIDER TMJ SURGERY?
The TMJs are the foundation and support for jaw position, function, occlusion and facial balance necessary for quality treatment outcomes in dentistry, orthodontics and orthognathic surgery. If the TMJs are not stable and healthy (non-pathological), treatment outcomes for patients may be unsatisfactory relative to function, esthetics, occlusal and skeletal stability, and pain. Contrary to popular belief, orthognathic surgery to correct a malocclusion and jaw deformity will not “fix” or eliminate co-existing TMJ pathology and symptoms. Our studies (Fuselier et al., 1998; Wolford et al., 2003; Goncalves et al., 2008) and other studies (Arnett and Tamborello, 1990; Kerstens et al., 1990; Moore et al., 1991; Crawford et al., 1994; DeClercq et al., 1994) demonstrate that performing only orthognathic surgery on patients with co-existing TMJ pathology can result in unsatisfactory treatment...
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