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. 2018 Mar;17(1):52-58.
doi: 10.1007/s12663-017-1018-7. Epub 2017 May 15.

Clinical and MRI Evaluation of Orthodontic Mini-Screws for Disc Repositioning in Internal Derangement of TMJ: A Prospective Study

K Rajkumar  1 , S K Roy Chowdhury  1 , Ramen Sinha  2
Affiliations

Clinical and MRI Evaluation of Orthodontic Mini-Screws for Disc Repositioning in Internal Derangement of TMJ: A Prospective Study

K Rajkumar et al. J Maxillofac Oral Surg. 2018 Mar.

Abstract

Purpose: The purpose of this study was to assess the efficacy of orthodontic mini-screws as a modified suture anchor for disc repositioning in cases of internal derangement of the temporomandibular joint.

Patients and methods: A prospective evaluation of ten patients was undertaken for a period of 6 months using this modified approach from Jan 2014 to Jun 2016. Symptomatic patients with clinical and MRI features suggestive of internal derangement of TMJ and willing to undergo surgical repositioning of articular disc to alleviate symptoms of temporomandibular dysfunction were taken up for the study. Post-operatively, functional outcomes were assessed in terms of reduction in pain, joint movement and absence of joint noise and clicking sounds. Post-operative MRI was used to assess the disc position and morphological changes in the disc and arthritic changes in the condyle.

Results: All patients underwent a surgical repositioning of the anteriorly displaced disc by the modified orthodontic suture anchor. Patients were post-surgically followed up at intervals of 1, 3 and 6 months. Immediate complications in terms of pain, restriction of functional motion and transient facial nerve palsy were noted. Late complications include temporal nerve palsy in one case. All patients experienced significant improvement with good functional outcomes and stable repositioning of disc was noticed at the end of 6 months.

Conclusion: The modified disc repositioning using an orthodontic screw via a mini preauricular approach provided a good functional outcome in all patients as assessed over a period of 6 months. However, the long-term functional sequel of the procedure and changes in the articular disc needs to be assessed.

Keywords: Disc repositioning; Orthodontic mini-screws; TMJ internal derangement.

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Conflict of interest statement

Compliance with Ethical StandardsAuthors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Mini-preauricular incision to expose the superficial temporal fascia
Fig. 2
Fig. 2
Superior joint space exposed
Fig. 3
Fig. 3
Orthodontic mini-screw fixed on the posterior surface of the condyle
Fig. 4
Fig. 4
Disc plication was achieved by 2-0 nylon sutures
Fig. 5
Fig. 5
Disc anchored to the orthodontic screw on the posterior surface of the condyle
Fig. 6
Fig. 6
Normal post-operative mouth opening at 6 months
Fig. 7
Fig. 7
Laterotrusive movements towards opposite side at 6 months
Fig. 8
Fig. 8
Pre-operative MRI showing anterior displacement of disc in closed mouth position
Fig. 9
Fig. 9
Six-month post-operative MRI showing stable position of disc over the surface of the condyle
See this image and copyright information in PMC

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