Orthotown May 2024 - 15
drrmiller2
Post: 4 of 8
4/1/2021
Every intraoral photo has her tongue prominent behind the front teeth, and the posterior teeth appear on plane
with each other. It's only in the anterior that the bite opens. Are you certain there's no tongue thrust? All the more
reason not to treat! n
dhmjdds
Posts: 5 and 6 of 8
4/1/2021
Oh, good lord. Did her rheumatologist not already explain to them that in such a severe case of TMJ IRA, surgical
correction after the condition has burned itself out is always necessary? She is only 12, she probably hasn't even hit
true puberty yet, and the IRA always worsens during puberty. Methotrexate isn't a cure-and it's going to cause
other problems.
I have a similar case in my office, except the family is fully aware that surgical correction will be necessary when
she is in her 20s. We are discussing doing some limited, maxillary arch-only braces to improve her alignment in the
meantime. I'd rather do nothing for now, but her twin sister (no IRA) got through orthodontic treatment and has a
great smile now, so I can see that the twin with IRA would like something done. We'll see on that situation. So, you
could offer a similar, very limited, treatment option. If they say, " No, that's not what we are wanting, " then you're off
the hook.
And who did that terrible endo? n
justinudm
Post: 7 of 8
4/2/2021
I believe this is a clear situation where the tongue is adapting to the
severe skeletal open bite.
I wouldn't give any credence to the tongue thrusting in this case. It's
simply an adaptive response. Proffit put the tongue-thrust debate to bed,
man, decades ago. n
SylvainChamberland
Post: 8 of 8
4/4/2021
There is no viable treatment option other than surgery and likely total
joint replacement. BTW, extraction will be needed to decompensate. n
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