The Occlusal Diagnosis and Management of Malocclusion with Osteoarthritis

Objectives:

The cause of jaw arthritis is negative to a bite factor. However, in osteoarthritic TMD patients changes in the accruing occlusal manifest suddenly.

In this study, we applied the extra-oral Gothic Arch to examine both the occlusion and the jaw function in osteoarthritic patients that had suddenly developed an open bite.

Methods:

The study involved 22 patients with both malocclusion and osteoarthritis. They were recruited from April 2004-March 2006. The diagnosis was based the results of the clinical examination, occlusal analysis, and an imaging study. The Pro-post gothic arch examination took the following points into consideration: 1. the relationship of the position between the apex point and the terminal points of the habitual opening-closing movements, 2. the included angle of the right and left lateral excursions, 3. the deviation and the convergence of the terminal points of the habitual opening-closing movements. Statistical analysis was performed via Wilcoxon's Signed Rank Sum Test.

The outcome of the occlusal treatment was divided into three categories, with full contact dentition deemed as “Successful,” pre and molar teeth contact deemed as “Effective,” and all other outcomes deemed as “Poor”.

Results:

The MR Imaging reports were as follows: bone surface changes were found in 10 cases, 5 cases were due to Osteophytes, and there were 7 cases of deformity. The Pro-post gothic arch examination results provided a significant difference in Pre- post Tapping point (p=0.006) and Pre-post distance between TP – AP(p=0.037).

As a result of occlusal adjustment, 12 cases were deemed as a success (55%), 9 cases (41%) were effective, and 1 cases (5%) were non-effective.

Conclusion:

In this present study, we introduced the clinical application of Gothic Arch for patients with malocclusion with Osteoarthritis. While this device provided insights to the examination of the mandibular position around the intercuspal position, it also made considerable contributions to improving the accuracy of diagnosis, the treatment approach, and the subsequent evaluation of the treatment.