Orthodontic treatment of TMJ disc displacement with pain: an 18 year follow-up.

To assess the effects of mandibular repositioning-stabilization splints concluded by occlusal orthodontic therapy in patients affected with TMJ internal derangement (with and without disc reduction), all suffering from severe pain, with a follow-up of 18 years from treatment.A group of 68 patients, (58 women and 10 men, average age 22, range 14 to 55 years) was considered. The evaluated parameters were: a) mandibular dynamics, b) subjective symptoms (intensity of facial pain perceived through VAS), c) articular noises, d) condylar position via radiography. These were determined before treatment, immediately after completion and 5, 10 and 18 years after treatment.At the end of treatment there was a significant improvement of the manibular function (p < 0.001), a significant reduction of spontaneous pain (8 patients vs all patients, p < 0.001) and disappearance of joint noises in all cases. In the course of the 18-year period subsequent to the treatment only minor relapse of symptoms/signs was noted; spontaneous pain was present in 13 patients, with a pain intensity at TMJ level significantly lower than at baseline (p < 0.001). Clicking was present systematically in 3 patients and only occasionally in 19 patients (p < 0.001). A relapse of condylar dislocation was found only in 11 cases at the X-ray examination.It is suggested that a permanent occlusal orthodontic treatment be used in subjects suffering from disc displacement with pain, particularly if patients need that for malocclusion and if orthopaedic joint instability is present after a change in the mandibular positioning with a stabilization splint.