Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders: A case report and review of literature

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.