We talked about this bilateral posterior open bite secondary to long term snore appliance wear in my last blog. The patient is having chronic muscle pain secondary to this anterior position. What do we do?
We started by using an aqualizer, a posterior cushioning appliance that takes the load off the front teeth and lessens the load in the joints. He experienced almost immediate relief of most of the muscle symptoms.
In his case, we might move into a full-coverage appliance without any expectation of his bite returning to normal. After several years, there is most likely tissue change that will prevent it from returning to its original position.
Assuming he regains muscle comfort and has a stable position in the joints, we can consider next steps. Prior to moving forward, though, my personal comfort zone requires an MRI and cone beam CT to fully understand all the hard and soft tissue conditions present.
Once I know where the disks are, the condition of the condyles and have muscle stability, I can consider restorative options. He will probably be restored in this forward position due to irreversible changes in the retrodiscal tissues. That may require ortho and a combination of restorations to gain adequate overjet and to close the posterior open bites.
to begin with, was this man retrognat before wearing an appliance?Any predispositions for retrodiscal problems?
Could the same thing happen with an occlusal splint, mouth guards,with younger persons?
Steve, this is interesting.
Since this case is generating so many comments I am going to go into greater detail on the joint changes, restorative and ortho options and post treatment splint/snore guard use. It may take a couple of weeks since I will get expert opinions from other leaders in the specialties.
Steve
I just saw a pt. who had this happen by wearing a splint 24/7. How long does it take for the retro tissue to become amorphous and no longer painful?
Wow, I have been learning a ton. Stay tuned
How about Bite Splint THerapy? You mentioned in your 3rd paragraph of full coverage appliance and yet not expect the bite to return to normal. Usually this will train the muscles to relax as long as there is the absence of any degenrative joint problems. And as the muscles relax, the joint will be properly seated. Of course, this will not help in the snoring problem.
I love all the comments. stay tuned