Lu T, Mei L, Li BC, Huang ZW, Li H. Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders: A case report and review of literature. World J Clin Cases 2024; 12(2): 431-442 [PMID: 38313641 DOI: 10.12998/wjcc.v12.i2.431]
Corresponding Author of This Article
Huang Li, PhD, Professor, Department of Orthodontics, Nanjing Stomatological Hospital, The Affiliated Hospital of Medical School, Nanjing University, No. 30 Central Road, Nanjing 210008, Jiangsu Province, China. lihuang76@nju.edu.cn
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 16, 2024; 12(2): 431-442 Published online Jan 16, 2024. doi: 10.12998/wjcc.v12.i2.431
Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders: A case report and review of literature
Tong Lu, Li Mei, Bao-Chao Li, Zi-Wei Huang, Huang Li
Tong Lu, Bao-Chao Li, Zi-Wei Huang, Huang Li, Department of Orthodontics, Nanjing Stomatological Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Li Mei, Discipline of Orthodontics, Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin 9016, New Zealand
Author contributions: Lu T performed the orthodontic treatments under the supervision of Li H, and made contributions to collecting data and drafting the paper; Mei L made contributions to collecting data and drafting the paper; Li BC made contributions to lateral cephalometric radiographs and cone-beam computed tomography 3D superimposition; Huang ZW contributed to revising and editing the manuscript; Li H contributed to the conception and design of the paper, and clinical supervision of the treatments. All authors gave final approval and agree to be accountable for all aspects of the work.
Supported byNatural Science Foundation of Jiangsu Province, No. SBK2021021787; the Major Project of the Health Commission of Jiangsu Province, No. ZD2022025; and the Key Project of the Nanjing Health Commission, No. ZKX20048.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huang Li, PhD, Professor, Department of Orthodontics, Nanjing Stomatological Hospital, The Affiliated Hospital of Medical School, Nanjing University, No. 30 Central Road, Nanjing 210008, Jiangsu Province, China. lihuang76@nju.edu.cn
Received: November 6, 2023 Peer-review started: November 6, 2023 First decision: December 5, 2023 Revised: December 11, 2023 Accepted: December 27, 2023 Article in press: December 27, 2023 Published online: January 16, 2024 Processing time: 65 Days and 16.8 Hours
Abstract
BACKGROUND
The relation between orthodontic treatment and temporomandibular disorders (TMDs) is under debate; the management of TMD during orthodontic treatment has always been a challenge. If TMD symptoms occur during orthodontic treatment, an immediate pause of orthodontic adjustments is recommended; the treatment can resume when the symptoms are managed and stabilized.
CASE SUMMARY
This case report presents a patient (26-year-old, female) with angle class I, skeletal class II and TMDs. The treatment was a hybrid of clear aligners, fixed appliances and temporary anchorage devices (TADs). After 3 mo resting and treatment on her TMD, the patient’s TMD symptom alleviated, but her anterior occlusion displayed deep overbite. Therefore, the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves. After the levelling, the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion. After careful examination of temporomandibular joints (TMJ) position, the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion. Eventually, the improved facial appearance and relatively stable occlusion were achieved. The 1-year follow-up records showed there was no obvious change in TMJ morphology, and her occlusion was stable.
CONCLUSION
TMD screening and monitoring is of great clinical importance in the TMD susceptible patients. Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.
Core Tip: This article is about the treatment of an adult female patient with skeletal class II and temporomandibular disorders (TMDs). The treatment was a hybrid of clear aligners, fixed appliances and temporary aids devices (TADs). This case report suggested that TMD screening and monitoring is of great clinical importance in the TMD susceptible patients. For these cases, hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.