LASER THERAPY FOR TMJ DISPLACMENTCASE PRESENTATION

DR.ASHRAF ELMESSERY2nd Laser fellowship MUST-Genova

CLINICAL EXAMINATION

Occlusion-attrition(bruxism)

LOWER-BILATERAL BRIDGES

CONCLUSION

Age:34 yrs. Gender: Female. Mouth opening:32mm(normal 48-52) TMJ sounds: audible clicking Mandible pathway: no deviation Articular pain: severe Muscular trigger points:4 points Habits:bruxsism at night Psychic state: stressed

RADIOGRAPHSPanorama Anatomy

THE PANORAMA IS TAKEN BEFORE INSERTION OF THE BRIDGES.

RADIOGRAPHS MRI-LEFT SIDE-OPEN AND CLOSED

NOTE: REDUCIBLE MEANS THE ARTICULAR DISC RETURN TO ITS NORMAL LOCATION IN CLOSING THE MOUTH.

Classification of displacement according to location

1-anterior-very common-84% of TMJ disorders.

2-anteromedial 3-antetiodistal 4-lateral 5-medial 6-posterior-rare(open lock)

Classification according to function

1-reducible which may be: A-partial or B-complete Non reducible which may be: A-acute or B-chronic

DIAGNOSIS

Reducible anterior displacement of the left articular disc

TREATMENT PLANE

1-patient awareness. 2-Laser therapy:6 visits. 3-Medecine:anti-inflamatory-analgesic-ms.relaxant-topical

gel(NSAID). 4-Pysiotherapy:steam hot pack-jaw exerecise-masseage. 5-occlusal splint: flat occlusal splint(aqua splint) for 4wks/full day. 6-phsycic relaxation aids: music-holy Quran-hopes-week end journey. 7-correction of sleep and sitting behavior.

REMEMBER : Reducible displacement and Acute non reducible are Treated by conservative approach And the occlusal splint must be(stabilizing

joint splint-or anterior bite plane-or resilient) (for acute pain relief)

But chronic reducible sometimes needs surgery and the splint must be posterior bite plane splint(conservative approach)

NON reducible displacement

LASER THERAPY

CLINCAL FINDINGS IMPROVEMENT

1 VISIT 2 VISIT 3 VISIT 4 VISIT 5 VISIT 6VISIT

Mouth opening

28 mm 39mm 40mm 40.5 mm 39mm 41.5mm

pain 9 7 7 3 1 1Functions Severe

disturbedMild disturbed

fair good good normal

clicking +++++ +++++ +++++ ++++ ++ ++

Severe pain=7-10Moderate=3-6Minimum=1-3

APPLICATION FEILDS

1-TEMPORALIS MS. 2-MASSETER MS. 3-MEDIL –LATERAL PTERGOID MS.

(INTRAORAL). 4-STYLO-SPHENO MANDIBULAR

LIGAMENTS. 4-CIRCULAR APPLICATION ZONE AROUND

TMJ.

PARAMETERS 0.7-0.8WT/CM. 50 SEC. AND 10 SEC.REST. 5-8 mm away from skin.(45

sec./3-4/cm for analgesia). 970nm- energy 0.3j/sec.

Bio stimulation tip. Average power:0.7wt. Peak Power:0.7wt. Fiber Thickness:320um

1-PBM(LLLT):IS THE USE OF LASER WITH LOW POWER AND ENERGY(0.1-0.8 WT) CAN CAUSE PHOTOSTIMULATION WITH CHEMICAL ,PHYSICAL AND BIOLOGICAL EFFECTS ON THE TARGET TISSUE.

2-THERE ARE SPECIAL TIPS WITH EVERY LASER MANIFUCTURES.

FOLLOW UP 1-weekly follow up- very slight myofascial pain-good functions. 2-occlusal splint: night time only 3-MRI:after 3Ms.

This presentation was presented in final exam of 2nd laser fellowship (MUST-EGYPT AND GENOVA UNIVERESITY-ITALY)18-12-2015

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