Page 44 - Open versus closed Mandibular condyle fractures

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Chapter 2.2 Closed
In the present technical note, an alternative non-surgical treatment modality for treating severe long-term post-traumatic malocclusion is presented describing placement of occlusal stops constructed from drops of dental composite.
CASES
In 2013 and 2014, four patients with a long-term post-traumatic malocclusion were treated using occlusal stops (table 1). The time between trauma and the presentation of malocclusion varied from 4 to 8 weeks in these cases. The occlusal stops were constructed from drops of dental composite (Transbond Plus, Light cure band adhesive; 3M Unitek, Monrovia, CA, USA) and bonded to the occlusal plane of the teeth. Occlusal stops were placed between the molars and/or premolars of the fracture site. In all cases, the occlusal stops were 3 to 4 mm thick and patients were able to maintain sufficient jaw extension (open configuration) with the adapted occlusion in exact horizontal orientation. If necessary, additional brackets on the premolars and molars were placed with guiding elastics to adjust the bite.
Orofacial physiotherapy was initiated, which focused on guiding a symmetrical mouth opening and loosening of the fibrous scar tissue around the fractured bone. After 4 to 6 weeks, the occlusal stops were removed and physiotherapy was intensified.
During this period, the physiotherapist trained the patients to achieve symmetrical mouth opening, appropriate function (among other things translation and maximum mouth opening), and a restored occlusion (non-elastic guided closure). Because of the retrospective nature associated with this report, approval by the medical ethics review board was not necessary.