Temporomandibular joint arthritis: Clinical, orthodontic, orthopaedic and surgical approaches

Rheumatic diseases (RD) of the temporomandibular joints (TMJs) are increasingly frequent affections and unfortunately often confused with “classic” manducatory dysfunctions (disk dislocation, myofascial pain syndroms). Their diagnosis is mandatory, given the major subsequent craniofacial disorders, which may occur (mandibular condylar hypoplasia, facial hyperdivergence, remodelling of the condylar unit, ankylosis), although the clinical implementation remains unspecific. The delayed diagnosis may be explained by the embryologic, anatomical and physiological characteristics of this joint. Magnetic resonance imaging (MRI), scans and more recently cone-beam computed tomography (CBCT) allow to diagnose its early signs (alteration of the disc-ligament complex, intra-articular effusion, osteochondral lesions). The treatment of TMJ rheumatic diseases (RD) is not consensual, and often includes a non surgical phase (hygiene and dietary rules, non-steroid anti-inflammatory drugs (NSAI), occlusal splints, and/or a surgical phase for the advanced stages (joint washing, orthognathic surgery, or joint surgery), and non responding patients to the medical treatment of inflammatory rheumatism. Orthodontics will be useful to correct dento-alveolar compensations, while monitoring, however, the impact on joint function.