Management of temporomandibular joint dysfunction after orthodontic relapse using stabilization splints and clear...

Temporomandibular joint dysfunction (TMD) is a common clinical condition characterized by discomfort in the masticatory muscles and temporomandibular joint, limitations in mandibular movements, and clicking or crepitating sounds during jaw motion. To our knowledge, few reports have described the management of TMD associated with orthodontic relapse and skeletal open bite using a staged approach involving stabilization splint therapy followed by miniscrew-assisted clear aligner treatment. Therefore, this case report provides clinically relevant information on the management of TMD associated with orthodontic relapse.

This case report presents a 26-year-old female patient with TMD and relapse in alignment after seven years of initial treatment. Clinical and radiographic evaluation revealed a skeletal open bite, Angle Class II division 1 subdivision malocclusion, 1 mm mandibular midline deviation, mild crowding in the lower arch, condylar deformation, and degenerative changes within the TMJ. In the treatment, a maxillary stabilization splint was used full-time for seven months. After splint treatment, orthodontic correction was planned with clear aligners, incorporating maxillary molar intrusion and distalization supported by miniscrew anchorage. At the end of treatment, a stable Class I molar relationship, ideal overjet and overbite, and coincident midlines were achieved. Cephalometric analysis demonstrated mandibular anterior rotation and improved sagittal and vertical relationships. Post-treatment CBCT showed reduced bony contact and a more homogeneous joint space on the evaluated sections, suggesting adaptive changes in condylar position and joint relationship. At the one-year follow-up, the patient maintained stable occlusion with no signs of relapse.

This case report suggests that miniscrew-assisted clear aligner treatment following stabilization splint therapy may be a minimally invasive treatment option for patients with TMD and skeletal open bite. This treatment approach may also contribute to improvements in occlusal relationships and TMD-related symptoms.