Arthrogeneous origin of TMJ pain, Asymmetry, Centric relation, condylar asymmetry recognition, Dentistry, Myogeneous origin of TMJ pain, Retruded Position of the Mandible, Temporomandibular joint, Temporomandibular Joint Clicking, Temporomandibular joint diagnostics, Temporomandibular Joint Disk Displacement, Temporomandibular joint pain, Temporomandibular Joint Sounds
TMJ clicking sound has been reported, discussed, investigated and even visualized in thousands of articles during the past thirty and more years with a peak of interest in 1980-s. Common knowledge is that the sound is either due to deviations in form of the articulating surfaces of the condyle and / or the temporal component ( increase of cartilage in specifically overloaded areas of the articulating surface ) or to a displacement of the disk. Disk displacement often comes and goes and it is therefore not a surprise that it is more common among patients with a mainly myogeneous origin of pain. Since the result of comprehensive epidemiological studies in the 1970-s it is also common knowledge that the phenomena occurs in about 40% of the adult population.
Hopefully in not contributing to the too often clinically existing confusion of how to handle the sound I would rather suggest the following: Check the panoramic x-ray i.e. check specifically the temporomandibular joint condylar heights before you take any further steps in your attempt to help your patient!
Most probably you will find a shorter condyle of the joint with the registered clicking sound. Try to guide a mandibular rotation movement around the higher condyle and most likely the clicking sound disappears or at least gets a reduced magnitude, when it is due to a latent disk displacement. If there is no discomfort or pain to be registered there is no real indication for intervention. However, if discomfort or a mainly myogeneous origin of pain is reported by the patient there is a need for an initially reversible treatment in form of a stabilization splint that compensates for the difference in vertical dimensions between the two condyles. The splint is to be worn part time . The patient is supposed to find a seemingly fast relief. When the clicking sound is found in combination with a mainly arthrogeneous origin of pain the splint needs to be worn as much as possible for at least 6 months before additional permanent treatment is considered.
In addition , even if the clicking sound is due to a deviation in form ( of the condyle and / or of the temporal component ) the clicking sound may over time get reduced as a smoothening out of the articulating surfaces can be expected at a consequent long term wearing of the correctly designed splint. Therefore I once again would suggest the use of the Maaxloc instrument in producing the index which will be used in mounting the models into the articulator before the construction of the stabilization splint. The splint absolutely must compensate for the registered difference in vertical condylar height between the two joints in providing a symmetrical oral stability in order to eliminate the painful and bothersome tmj clicking.