顎関節症状を伴う上顎前突症の1例  [in Japanese] A case report of maxillary protrusion with TMD  [in Japanese]

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<p>24歳1か月の女性。上顎前歯の前突と顎関節の違和感を主訴に来院した。初診時の正貌所見では下顎が左側に偏位しており,口腔内所見では上顎前歯部の突出を呈し,左側臼歯部に機能性交叉咬合を認めた。両側顎関節の圧痛および右側にclickを認めた。問診より歯列接触癖を認めた。MRIによる画像所見では,左側に非復位性円板前方外側転位,右側に復位性円板前方外側転位を認め,右側下顎頭ではerosionを認めたことより,機能性下顎左方偏位および上顎前突を伴う顎関節円板障害(Ⅲ型)および変形性顎関節症(Ⅳ型)の重複症例と診断された。顎関節症の初期マネージメントとして可逆的治療を中心とした初期治療を行った。症状の安定を確認後,機能性下顎左方偏位および上顎前突を改善するために両側上下顎小臼歯の抜歯を伴う歯科矯正治療を開始した。歯の移動によりAngleⅡ級の臼歯関係,重度な上顎前突および機能性下顎左方偏位が改善された結果,良好なアンテリアガイダンスを伴う咬合関係および側貌が得られた。顎関節の開口量は増加し,咀嚼時痛および圧痛は消失した。右側のclickは残存した。MRI所見では左側下顎頭にmarginal proliferationを認めた。治療後および動的治療終了後1年時の顎関節症状は安定していた。現在は保定治療および顎関節の経過観察を定期的に行っている。</p>

<p>The patient was a 24-year-old female who consulted our hospital, complaining of protrusion of her upper anterior teeth and jaw discomfort. During the first visit, examination of the frontal face revealed mandibular deviation to the left side, and intraoral findings revealed Angle Class II maxillary protrusion with functional crossbite at the left molar section. TMJ examination showed bilateral tenderness and TMJ clicking on the right side. Tooth Contacting Habit (TCH) was recognized from the questionnaire on TMJ conditions. MRI examination showed bilateral anterior and lateral disc displacement without reduction on the left side and with reduction on the right side, and erosion was observed at the right condylar head. The patient was diagnosed as having maxillary protrusion with functional mandibular deviation to the left side, and temporomandibular joint disc derangement (type III) and osteoarthrosis of the temporomandibular joint (type IV). Primary TMD management was applied for TCH before orthodontic treatment. After confirming the stability of TMD symptoms, orthodontic treatment was started with four premolar extractions to improve maxillary protrusion with functional mandibular deviation. After the treatment, the Angle Class II molar relationship and severe maxillary protrusion with functional mandibular deviation to the left side were improved, and a good profile and occlusion with anterior guidance were achieved. The distance of mouth opening was increased and bilateral tenderness was improved. MRI examination showed marginal proliferation at the left condylar head. No improvement was noted in TMJ clicking on the right side. The patient is currently in the retention period, and TMD symptoms have not been observed at one year after orthodontic treatment.</p>

Journal

  • Journal of the Japanese Society for the Temporomandibular Joint

    Journal of the Japanese Society for the Temporomandibular Joint 29(2), 108-114, 2017

    The Japanese Society for Temporomandibular Joint

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