Orthopedic/orthodontic therapy for anterior disk displacement: unexpected treatment findings

Craniomandibular pain dysfunction (CMPD) is of increasing clinical concern to all fields of dentistry, especially orthodontics. One of the more common manifestations of CMPD is anterior disk displacement. Orthodontic/orthopedic treatment for anterior disk displacement using anterior repositioning of the mandible has been suggested by several clinicians as the treatment of choice. Returning the mandible back toward the original occlusion or habit centric has also been suggested by several reports. Functional jaw orthopedic (FJO) appliances would appear to be ideally suited for the treatment of anterior disk displacement due to the anterior repositioning nature of these appliances. In growing individuals, among other changes, the condyle is supposed to grow back into the fossa (which would serve as the walkback procedure). This article presents three young patients who had anterior disk displacement and posterior condylar displacement before treatment. Each patient was treated using a functional appliance and each patient ended treatment still having a posterior condylar displacement and anterior disk displacement. These findings were unexpected and no explanation is offered. This occurrence is rare in the author's practice (approximately 2-3%), but this is a real concern and the patients should be made aware of this possibility before starting treatment, so that their expectations are realistic. These enigmatic findings also emphasize the complexity of TMJ as well as FJO treatment and indicate the need for further research and study.