Temporomandibular joint osteoarthrosis and internal derangement. Part II: Additional treatment options.

In some cases of temporomandibular joint osteoarthrosis and internal derangement, the initial treatment needs to be supported by additional treatment modalities. In this paper, the basic principles of the most common additional modalities used are discussed. Orthopaedic appliances are used to either stabilize, or reposition the mandible. Consequently, there are two splint types: the stabilization splint and the repositioning splint. The major indication for applying the former is to decrease the load imposed on the joint. Secondary effects are stabilization of the occlusion and masticatory muscle relaxation. The repositioning splint may be used in some cases to reduce a displaced articular disc. Physical therapy is often used to mobilize the joint and to re-educate mandibular movement patterns. Based on the stages of temporomandibular joint osteoarthrosis and internal derangement, guidelines are given for the treatment strategy to be followed in the management of this common disorder.