This document summarizes a case presentation of a 27-year-old male patient who presented with clicking in his left ear and difficulty opening his mouth. His history and examination found restricted mouth opening, popping and pain in his left temporomandibular joint. Diagnostic tests showed a dislocated disc in the left TMJ. The proposed treatment is a stabilizing occlusal appliance to treat the disc dislocation. An orthodontic referral was also made. The case presentation demonstrates the history, examination, diagnosis and proposed treatment plan for this patient's temporomandibular disorder.

1. CHAIRPERSON
DR. MD. MAHBUBUR RAHMAN
BDS, DDS, PhD
CHAIRMAN
DEPERTMENT OF PROSTHODONTICS
BSMMU

2. PRESENETR
Dr. MD.MAHBUB –UL-
ALAM
RESIDENT PHASE- B
DEPERTMENT OF
PROSTHODONTICS
BSMMU
MODERATOR
DR. MD. AMZAD HOSSAIN
BDS, MSc, MS, FCPS
ASSOCIATE PROFESSOR
DEPERTMENT OF
PROSTHODONTICS
BSMMU

4. A 27-year-old male,
Mohammed Mamun reported
to Department of
Prosthodontics, BSMMU with
the complaints of
 Clicking sound infront of
left ear.
 Difficulty in mouth
opening.

5. HISTORY OF PRESENTING ILLNESS:
According to the statement of the patient, he was
relatively all right two years back, then he developed
locked jaw frequently. In this situation he went to a
local doctor who prescribed some medicine.
Therefore he gradually developed restricted mouth
opening.
The condition worsened at early morning and
slightly improved at day time.
For that reason he comes to our department for better
management.

6. SCREENING HISTORY OF TEMPOROMANDIBULAR
DISORDER
The patient state a positive history of
 Difficulty in mouth opening.
 The jaw got “stuck or locked”.
 Difficulty in jaw function like chewing and talking.
 Noises noticed in left jaw joint
 Regular feeling of stiff, tight or tiredness.
 Mild pain in around the ear and neck.

7. Past Medical History: Nothing contributory.
Past Dental History: History of lock jaw two years back.

8. CLINICAL EXAMINATION
 Central Nerve examination: Normal functioning of all the
cranial nerves.
 Eye examination: Normal.
 Ear examination: No pain on palpation, normal in
function.
 Cervical examination: no cervicospinal pain or
dysfunction was found.

9. CLINICAL EXAMINATION
Muscle examination:
 Muscles of Mastication palpation:
Masseter: Normal functioning and no pain on
palpation.
Temporalis: Normal functioning and no pain on
palpation.
Lateral and Medial pterygoid: Normal and no pain
on functional manipulation.
 The Sternocleidomastoid muscles: Normal if function and
no pain on palpation.
 The Posterior Cervical muscles: Normal in Function and
no pain on palpation.

10. CLINICAL EXAMINATION
 Maximal Interincisal
Distance:
 Maximum Comfortable
opening: 30 mm.
 Maximal opening: 30 mm.
 End fill test:
 Soft End fill: Absent
 Hard End fill: Present.
 Deviation (Return): Not
present.
 Deflection (Don’t return):
Present in the left (Ipsilateral
side.)

11. EXAMINATION OF THE TEMPOROMANDIBULAR
JOINT
Lateral Palpation:
Placing the fingertips on the lateral aspects (Condylar Point
)of the both joints simultaneously and patient was asked to
open and close few times. Once the position was verified
mild force was applied.
No pain.
Joint sound: “pop” was present.
Joint Restriction: Present.
Auscultation: Audible.

12. DENTAL EXAMINATION
Incisor relation:
Overbite: Increased (5 mm.)
Overjet: Normal
Canine relation: Angel’s class one relationship
Molar relation: Angels class one relationship
Teeth absent: Left lower first molar.
Mobility: Not Mobile.
Tooth wear: Not Present.
Abfractions: Not Present.

13. OCCLUSAL EXAMINATION
Centric relation contracts: Normal
Stability of Maximum Intercuspal
position: Stable and no habitual
posture.
Arch integrity: Loss of integrity of the
lower arch due to loss of left lower first
molar.
Vertical dimension of occlusion:
Reduced
Eccentric occlusal contracts:
Lateral – Normal
Medial – Normal
Protrusive- Normal

14. ADDITIONAL DIAGNOSTIC TESTS
Imaging:
 Panaromic radiographic test was done for screening purpose.

15. Diagnosis:
Disc dislocation with
reduction of the left TMJ.
Suggested Investigation:
Xray trans cranial view.

16. Referral note to Orthodontic Department of BSMMU

17. Treatment plan:
Occlusal Appliance Therapy by Stabilizing appliance.

20. Cast poured with type 3 stone.

21. Blocked out of deep fissure and undercuts by ordinary plaster

22. First layer of wax was adapted over the teeth surfaces
Marking the
outline of the
appliance.

23. Wax pattern of the
appliance

24. Articulation

25. Processing of the cast before
packing

26. FABRICATED
STABILIZING
APPLIENCE

27. Occlusion marks
with articulating
papers

28. Insertion of the
Stabilizing
Appliance