Comprehensive Dental Treatment In Angle’s Class Ⅱ Division Ⅱ Patients With Joint Derangement ～ A Combined Procedures Of Occlusal Equlibration And Orthodontics

Objective:Angle class Ⅱ division 2 malocclusion complaint about limited opening and joint pain in adult female patients is not uncommon.Comprehensive diagnosis,occlusal equlibration with occlusal level adjusting splint are imperative procedures for these patients in Department of Prosthodontics.After temporomandibular disorders symptoms are managed,onlay restorations canine area to validate occlusal relationship then progressing to orthodontic treatment to establish occlusal relationship by vertical elastics.Labial tilting of upper anterior teeth to eliminate the interference during lateral excursion,equalibrate occlusion and enhance facial beauty.Three adult female patients of Angle classⅡ division 2 malocclusion with temporomandibular disorders were discussed and analyzed,then the treatment experience was documented.Materials and methods:Three cases were treated by the author during the period of graduate school in Department of Orthodontics.Case 1: A 20 year-old female patient complaint about limited opening after one month of orthodontic treatment in another clinic.After thorough examination in our OPD final diagnosis was made as Angle’s class Ⅱ division2 malocclusion with a low angle mandible,upper and lower anterior teeth of the interior,Ⅲ°deep overbite and right anterior disc displacement(ADD)and left anterior disc displacement without reduction(ADDwo R),Then she was treated with occlusal equlibration protocol including: occlusal level adjusting splint to protrude the mandibular,adjust the position of the condyle to keep a physiologic position in the articular fossa for releasing the pressure in articular cavity and relieving joint pain.After a more stabler mandibular position were obtained and the masticatory muscles could work smoothly without pain,onlay restorations were be done over the molar and canine area to validate a occlusal relationship.Then orthodontic treatment was to establish occlusion by vertical elastics,labial tilting upper anterior teeth and correcting the midline were followed.A harmonious mandibular movement and enhanced facial beauty were achieved in the long run.Case 2: A 21year-old female patient complaint about bilateral TM joint pain and limited opening for four months,who was diagnosed as skeletal classⅡ,Angle class Ⅱdivision 2 malocclusion and upper anterior teeth of the interior and Ⅲ°deep overbite and bilateral ADDwo R and bilateral temporomandibular joint osteoarthrosis(TMJOA).She was treated with occlusal equlibration protocol,including:occlusal level adjusting splint to protrude the mandibular,adjust the position of the condyle in the articular fossa for releasing the pressure in the articular cavity and relieving the pain.After the more stabler mandibular position and a balanced,pain-free masticatory muscle function were obtained,onlay restorations over the molar area were to validate occlusal relationship.Then orthodontic treatment was to establish occlusion by vertical elastics,processed with using microimplants to push the maxillary molars toward distal and to level upper anterior teeth.After Angle’s class 1 occlusion was obtained,labial tilting of upper anterior teeth and correcting the midline as planned.Case 3 :A 25 year-old female patient complaint about limited mouth opening in the morning 2 months ago and been treated with occlusal splint in another hospital since then.Without any improvement she came to our hospital for further treatment.She was diagnosed as skeletal class Ⅰ,Angle ’ s class Ⅱdivision 2 malocclusion with upper anterior teeth of the interior and Ⅲ°deep overbite and bilateral ADDwo R and TMJOA.Then she was treated with occlusal equlibration protocol including:occlusal level adjusting splint to adjust the position of the condyle in the articular fossa.After the more stabler mandibular position and a balanced,pain-free masticatory muscle function were obtained.Onlay restorations to support new vertical dimension of occlusion over molar area then orthodontic treatment including :establishing occlusal relationship,labial tilting upper anterior teeth and correcting the midline.Eventually harmonic mandibular movement and better facial beauty was obtained.Result:After the treatment,temporomandibular disorders symptoms were managed and molar occlusion overbite of interior teeth were improved in these three patients.Conclusion:Treatment procedure of Angle’s Class Ⅱ Division 2 patients with temporomandibular disorders:1.Occlusal level adjusting splint can be effective in deep overbite patients who need to increase the intermaxillary distance for occlusal equlibration to pave way for protruding the mandibular,releasing the pressure in the articular cavity and relieving the pain and other temporomandibular disorder symptoms.2.Onlay restorations over molar and canine area can support a new vertical dimension of occlusion for proceeding orthodontic treatment by vertical elastics.3.Upper anterior teeth of patients with Angle’s Class Ⅱ Class 2 malocclusion should be tilted labially to eliminate the interference of mandibular movement and facilitate condyle growth.