Sudden, Severe, Idiopathic Occlusal Relationship Change Coexisting with Pain-Related Temporomandibular Disorders: A Case Report

Autor: Iva Z. Alajbeg, Senka Meštrović, Marko Zlendić, Magda Trinajstić Zrinski, Ema Vrbanović
Rok vydání: 2022
Předmět:
Zdroj: Acta stomatologica Croatica : International journal of oral sciences and dental medicine
Volume 56
Issue 4
ISSN: 1846-0410
0001-7019
DOI: 10.15644/asc56/4/7
Popis: The article presents a case of a young female patient who sought help due to myofascial pain followed by a sudden occlusal change (anterior open bite (AOB)) that occurred shortly after the administration of a soft night guard that had been previously provided by a general dentist. Palpation of the masseter and temporal muscles elicited the presence of familiar pain. After magnetic resonance imaging of temporomandibular joints, which ruled out disc displacement, the final diagnosis was myalgia. Since the patient had myalgia and malocclusion, the therapy included treatment of both conditions. Temporomandibular disorders TMD management included a combination of pharmacotherapy, kinesiotherapy, and a stabilization splint. After TMD symptoms had resolved, the patient underwent an orthodontic evaluation. Cephalometric analysis revealed skeletal class II, retrognathic face, convex profile, and normal vertical growth pattern. Orthodontic treatment included a fixed appliance with vertical intermaxillary elastics. After 19 months of treatment, both sides achieved acceptable occlusion with Class I. Since the patient had myalgia and severe malocclusion, it was important to follow a systematic diagnostic and therapeutic workflow. Although it is impossible to establish a relationship between TMD symptoms and orthodontic therapy, patients who have TMD symptoms should have their pain resolved through a conservative treatment protocol before commencement of orthodontic treatment. The beginning of orthodontic therapy comes into consideration only when the TMD pain resolves.
Opisan je slučaj mlade pacijentice upućene u Kliniku za stomatologiju Kliničkoga bolničkoga centra Zagreb zbog boli u žvačnim mišićima i iznenadne promjene u okluziji (prednji otvoreni zagriz). Simptomi su se pojavili neposredno nakon što joj je u drugoj zdravstvenoj ustanovi izrađena mekana okluzijska udlaga. Palpacija maseteričnoga i temporalnoga mišića izazvala je pojavu poznate boli, a poslije uvida u nalaz magnetske rezonancije temporomandibularnih zglobova, koja je isključila pomak zglobne pločice, konačna dijagnoza bila je mijalgija. Budući da je pacijentica imala i mijalgiju i izraženu malokluziju bilo je potrebno liječiti oba stanja. Temporomandibularni bolovi tretirani su kombinacijom farmakoterapije i kineziterapije te stabilizacijskom udlagom. Nakon što su se simptomi smanjili pacijentica je upućena na ortodontski pregled. Rendgenskom kefalometrijskom analizom potvrđena je skeletna klasa II, uz konveksni profil i normalan vertikalni obrazac rasta. Za korekciju prednjega otvorenog zagriza korištena je fiksna ortodontska naprava s intermaksilarnim vertikalnim gumenim vlakom. Nakon 19 mjeseci ortodontske terapije okluzijski odnosi obostrano su bili u Angleovoj klasi I. Iako trenutačno nema dokaza o povezanosti TMP-a i ortodontske terapije, pacijentima koji imaju simptome TMP-a i potrebu za ortodontskim ispravljanjem zagriza potrebno je najprije ublažiti bolove slijedeći konzervativni protokol liječenja. Početak ortodontske terapije dolazi u obzir tek nakon što se bolovi smanje ili nestanu.
Databáze: OpenAIRE
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