Ufuk Demir 8.9.20
Hello everyone my name is Ufuk Demir and i am an orthodontist from Istanbul,Turkey
I would like to present a case that we have treated with stabilization splint and orthograthic surgery.
When she first visited our office she was already in pain for 4 years. In the past she used various type of splints (hard, soft, upper, lower) and also several kinds of medications(antidepressants, glucosamin chondroidin, naproxyn). She was treated by 4 different doctors and i was the 5th one. One of the doctors was a very famous TMD specialist in Istanbul and he said that some cases are untreatable and she is one of them.
She had asymmetry on her face with increased lower facial height, also she had a negative smile line. Intraorally she has CL1 occlusion with anterior open bite and a mild amount of crowding. When we mount the case in centric relation she didn’t have a large Co/Cr difference. She was in pain and her mandible was hard to manipulate and because of that we cannot trust the first mounting. In her cbct there was no active remodeling in the condyle but the condyle was functioning on the posterior. Because of her chronic pain, we started with full coverage stabilization splint full time. The splint was too thick and she was not the perfect patient. Even she was not perfect, her pain was started to lessen gradually. After several months of adjustment, the splint gets too thin in the posterior that it was perforated and from that point we moved into a 3 piece splint. Total splint time was more than 1 year. After the splint she had no pain but a much larger open bite.
While we were discussing the treatment alternatives we agreed on orthodontics followed by orthognathic surgery because of her asymmetry and retruded profile. Brackets and centric bite blocks were prepared indirectly and we started leveling. After leveling she was ready for surgery. In order to achieve a good occlusion and a good profile we planned a double jaw surgery starting from mandible followed by a multi piece maxillary Lefort1 with counterclockwise rotation of both jaws. Maxilla moved 4mm mandible moved 7,5mm forward. 7 months after surgery the treatment was finished and we achieved a good result both esthetic and functionally. The last video was taken 1 year after her treatment she still has no pain and no functional limitation.
Best regards to all of you from Turkey.
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