Abstract 2: Non-surgical management of TMD by neuromuscular approach

This case report discusses the diagnosis and non-surgical management of a 32-year-old patient presenting with TMJ clicking and difficulty chewing. The TMJ noise, occurring during mandibular movements such as opening, closing, eating, and speaking, had persisted for six years without associated pain. Clinical and radiographic assessments revealed impacted wisdom teeth and variations in occlusal planes, with no periodontal or restorative issues. The treatment plan aimed to reduce TMJ noise, restore functional mandibular movements, and stabilize occlusion. A multidisciplinary approach was employed, including (1) dynamic digital analysis to evaluate mandibular positioning leading to mandibular deprogramming using an appliance and, (2) correction of mandibular alignment combined with sequential wisdom tooth extractions, and (3) functional orthodontic planning for long-term occlusal stability. CBCT imaging, kinesiography, electromyography and joint sonography were integrated to assess mandibular dynamics and occlusal contacts. The use of a rebalancing orthotic device provided immediate functional improvement, allowing the patient to chew without difficulty and eliminating TMJ noise. The patient reported significant symptom relief and satisfaction. This case underscores the value of a comprehensive neuromuscular approach using advanced imaging and functional analysis in the non-surgical management of TMD. Follow-up orthodontic treatment will further enhance occlusal stability and ensure sustained results.

Learning Objectives :

Understand the role of neuromuscular approaches in non-surgical TMD management.

Recognize the importance of advanced diagnostic tools (CBCT, kinesiography, electromyography, joints sonography) in evaluating mandibular function.

Develop a stepwise treatment protocol combining deprogramming, occlusal correction, and orthodontics for TMJ disorders.