Stomatognathic function and image evaluation for Angle ClassII Division 2 case with marked condylar remodeling

This case report describes orthodontic treatment, stomatognathic function and image evaluation for Angle ClassII Division 2 case with marked condylar remodeling after orthodontic treatment. The chief complaints of this patient, a woman aged 18 years 8 months, were lingual inclination of the maxillary incisors, temporomandibular arthralgia and disturbance of mouth opening. Her TMJ showed bilateral reciprocal clicking with intermittent locking, arthralgia and tenderness. Bilateral TMJ articular discs displayed anterior displacement without reduction in the right side and with reduction in the left side. Bilateral mandibular condyles showed deformity and retruded position. This case was diagnosed as skeletal maxillary protrusion with lingual inclination of the maxillary incisors, mandibular undergrowth and temporomandibular joint disorders (TMD), typeIII and IV. The maxillary dentition was stabilized with a bite raising splint. After maxillary incisors were inclined labially, mandibular dentition was leveled with a maxillary splint. High pull headgear, palatal bar and intermaxillary elastics were used to correct the lower shift of the condyles and the right shift of the mandibular midline. The bilateral mandibulary third molars were extracted. After treatment, severe lingual inclination of the maxillary incisors, retropositioned mandible and deepbite were improved, and a good profile was achieved. The distance of the mouth opening was increased, freeway space was decreased and the chewing pattern was improved. Arthralgia and masticatory muscles tenderness were also improved. No improvement was noted in TMJ tenderness and bilateral clicking. Disorders of occlusal functions were improved. The positions of discs and condyles were also improved. Double contours appeared on the condyles, which emphasized the condyle remodeling in progress. Patients with skeletal maxillary protrusion and unphysiologic retruded mandibles could be improved in terms of TMD and maxillary protrusion by orthodontic treatment that maintains the mandibular position downward and forward.