Orthodontic finalization strategies in dysfunctional adult patients

Although orthodontic treatment for the finalization of temporomandibular dy sfunction (TMD) patients is often advocated, it represents a risk of failur e. Furthermore, in the literature there are few articles that illustrate ap propriate orthodontic strategies for the finalization of these patients. In this article the authors suggest a step-by-step clinical procedure in orde r to: 1. verify the rationale for orthodontic finalization in TMD patients; 2. illustrate the guidelines for correct orthodontic treatment; and 3. sug gest a strategy to stabilize the mandible during orthodontic treatment and to retain that stabilization after treatment. If splint therapy is successf ul in relieving the TMD symptoms, a fixed posterior bilateral stop is used for occlusal stability. After one or two months during which the bilateral stop is shown to be adequate in maintaining TMJ health without a splint, or thodontic finalization can be performed with minimal risk of failure. The e ssential sequences of Class I, Class II, and Class III treatment for the fi nalization of TMD patients are also presented. The difficult goal of a long term stability in cases that have been orthodontically finalized is reache d by the conversion of the posterior bilateral stops (crown buildups) into permanent vertical stops.