Acute Occlusal Change Following Acute Anterior Disc Displacement without Reduction: A Case Report

급성 비정복성 관절원판 변위에 따른 급성 교합변화의 증례

  • Jung, Jae-Kwang (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Hur, Yun-Kyung (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Choi, Jae-Kap (Department of Oral Medicine, School of Dentistry, Kyungpook National University)
  • 정재광 (경북대학교 치의학전문대학원 구강내과학교실) ;
  • 허윤경 (경북대학교 치의학전문대학원 구강내과학교실) ;
  • 최재갑 (경북대학교 치의학전문대학원 구강내과학교실)
  • Received : 2012.09.25
  • Accepted : 2012.11.26
  • Published : 2012.12.30


A 35 year-old female presented with the complaint of sudden occurrence of bite change and concurrent opening limitation, as well as pain in the right temporomandibular joint (TMJ) during mouth opening. From her history it was revealed that she had simple clicking of right TMJ for several years before onset of these symptoms, and that the clicking sound subsided recently after development of opening limitation. On clinical examination, anterior open bite, midline shift of the mandible to right, and premature contacts on left posterior teeth were observed. Maximum mouth opening and lateral movement to left were also restricted. On magnetic resonance images, the right TMJ showed anterior disc displacement without reduction and the posterior joint space is greatly collapsed by retrusion of the condyle. It was thought that the sudden occurrence of occlusal change would be resulted from abrupt displacement of the mandible associated with development of the anterior disc displacement without reduction. The stabilization appliance traction therapy was performed initially for first 3 months along with physical and pharmacologic therapy. However, the anterior open bite and opening limitation didn't resolve and the position of mandible still remained altered. So the stabilization appliance was changed to intermaxillary traction device. Then the mandible returned progressively to normal position and the occlusion became more stable and comfortable. After 5 months of intermaxillary traction therapy, the anterior open bite was dissolved completely and the occlusion became stabilized satisfactorily along with recovery of normal mouth opening range. On post-treatment magnetic resonance image, remodeling of condylar head was observed.


Acute occlusal change;Anterior disc displacement;Intermaxillary traction therapy;Magnetic resonance image


Supported by : Kyungpook National University


  1. Dworkin SF, Huggins KH, LeResche L, Von Korff M, Howard J, Truelove E, et al. Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc 1990;120:273-81.
  2. Rutkiewicz T, Kononen M, Suominen-Taipale L, Nordblad A, Alanen P. Occurrence of clinical signs of temporomandibular disorders in adult Finns. J Orofac Pain 2006;20:208-17.
  3. Okeson JP. Management of temporomandibular disorders and occlusion. 6th edition., St Louis, 2008 Mosby Co., pp 253.
  4. Kurita H, Ohtsuka A, Kobayashi H, Kurashina K. A study of the relationship between the position of the condylar head and displacement of the temporomandibular joint disk. Dentomaxillofac Radiol. 2001 May;30(3):162-5.
  5. Rheu SS, Kim SH, Kee WC. A case report on the treatment of an TMJ osteoarthritis patient with anterior open bite using an intermaxillary traction device. Korean J Oral Med, 1998;23(4):379-382.
  6. Choi JM, Ahn HJ, Choi JK. The effectiveness of TMJ distraction therapy for anterior open bite as a consequence of degenerative joint disease. Korean J Oral Med, 2002;27(3):363-370.
  7. Okeson JP. Management of temporomandibular disorders and occlusion. 6th edition., St Louis, 2008 Mosby Co., pp 488-491.)
  8. Ngan P, Wilson S, Florman M, Wei SH. Treatment of Class II open bite in the mixed dentition with a removable functional appliance and headgear. Quintessence Int 1992; 23: 323-333.
  9. Ngan P, Fields HW. Open bite: a review of etiology and management. Pediatr Dent. 1997 Mar- Apr;19(2): 91-8. Review.
  10. Arnett GW. Progressive mandibular retrusionidiopathic condylar resorption. Part II. Am J Orthod Dentofac Orthoped 1996; 110 (2):117-27.
  11. Tanaka E, Detamore MS, Mercuri LG. Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment. J Dent Res. 2008 Apr;87(4):296-307. Review.
  12. Cholasueksa P, Warita H, Soma K. Alterations of the rat temporomandibular joint in functional posterior displacement of the mandible. Angle Orthod. 2004 Oct;74(5):677-83.