laser therapy for tmj displacmentcase presentation
TRANSCRIPT
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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