Case 5535
A 21-year-old male attended the dental office with an initial chief complaint concerning temporo-mandibular dysfunction (TMD). History-taking revealed he had been treated for TMD for about 18 months by a different specialist, but little progress had been made with the symptoms. The patient was worried about the TMD as well as his prognathic facial profile. He had been advised about the possibility of orthognathic surgery and third molar extractions but was seeking a non-surgical alternative. After receiving informed consent, physical examination was undertaken as well as panoral radiography (Fig. 1). A working diagnosis of Class III malocclusion with midfacial hypoplasia, with a differential diagnosis of TMD, was reached. The treatment plan included midfacial development to enhance the functional space available for the mandible in an effort to relieve the TMD discomfort and balance the facial profile. A biomimetic oral device (DNA appliance, Vivos Therapeutics, Inc. USA) was prescribed to meet these requirements (Fig. 2) with a Y-split design without second molar coverage. The device was worn for 10-16 hrs. per day, including while sleeping, but not while eating. Gradual adjustments were made to the appliance approx. every 4-6 wks. Treatment started in 2014 and gradually the TMD symptoms regressed. In addition, the third molars erupted into occlusion (Fig. 3). The patient was satisfied with this approach and the treatment appeared to be stable after approx. 7yrs. (Fig. 4).