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PROSTHETICS

TREATMENT OF ANTERIOR AND

POSTERIOR OPEN BITE MALOCCLUSION

SECONDARY TO CONDYLAR FRACTURES

Mahesh Chauhan

INTRODUCTION form of composite build-ups, none of them required a root canal
The aim of a dentist should be to evaluate, diagnose, and treat treatment.
patients by accurately and effectively applying their knowledge and On initial examination, an anterior as well as significant right
skills to restore form and function. In today’s world, technological posterior open bite was observed, as shown in the scanned images
advancements have provided us with tools that were unimaginable (Figures 2, 3, 4). When the patient made an effort for maximum
just two decades ago. intercuspation, the mandible would slide and the teeth would loosely
Rapid developments in digital dentistry have streamlined many occlude temporarily under muscle force (Figure 6), but only with
of the complex steps involved in dental procedures. Aided by AI considerable effort and some discomfort.
technology, tasks such as reducing the margin of error, evaluating The patient also complained of an inability to chew on the right
outcomes, and assessing results have become much more precise. With side for the past nine years. An alleged history of trauma due to a road
intraoral scanners, digital impressions and bite registrations can now traffic accident resulting in a left condylar fracture was reported 10
be visualized instantaneously. This is similar to how a digital camera years ago, for which no surgical treatment had been provided.
allows an image to be seen immediately, whereas in film photography, On clinical examination, bilateral TMJ movements were palpable
one had to wait until the negatives were developed into prints to and non-tender. A posterior open bite on the right side and Class I
appreciate the results. Similarly, in restorative and prosthetic dentistry, molar relation on the left side were present. Mouth opening was
when using physical impressions and bite registrations, corrections — adequate, with a deflection towards the left side on opening.
whether from the dentist’s perspective or to verify if the patient’s bite Mandibular condyle fractures, commonly resulting from falls and
record was in centric relation — could only be confirmed after the motor vehicle accidents, are prevalent in the elderly and frequently
casts were physically mounted on articulators. lead to malocclusion.¹ Treatment strategies for this condition vary
The digital scanning method, besides being more accurate, is also depending on both the characteristics of the fracture and the individual
more hygienic, with interchangeable, autoclavable, or disposable tips. patient’s clinical profile.
In contrast, physical impressions need to be disinfected or sterilized Several pathological alterations within the temporomandibular joint
before being sent to the lab, and only then can the risk of infection be (TMJ) can contribute to posterior open bite (POB) as a consequence
considered eliminated. of the mandibular condyle displacement. The abrupt onset of POB can
occur due to joint effusion following mandibular trauma. Additionally,
CASE REPORT posterior disc displacement, posterior displacement of the condylar
A case is presented here of a 71-year-old female patient who requested fragment after a TMJ disc fracture, and thickening of the retrodiscal
the replacement of several old crowns that had developed secondary tissue can disrupt the mandibular closing mechanism, leading to a
caries. Radiographic examination (Figure 1) showed mild shortening disturbance in mouth closure and subsequent development of POB. 2,3
of the ramal height on the left side. The condyle on the left appeared The patient was advised to undergo surgery for the left-sided TMJ
to be dislocated in an anteromedial direction at the time of trauma at another centre; however, the anatomical risks associated with open
(due to the pull of the lateral pterygoid) and had remodelled in the treatment, the satisfactory outcomes of closed treatments, and the
dislocated position, leading to a difference in ramal height on both functional rather than aesthetic goals of therapy often make non-
sides. A soft diet, non‐specific rehabilitation therapy, and management surgical approaches more common in geriatric patients, as highlighted
with NSAIDs and a muscle relaxant were prescribed at her nearby in a recent European multi-centre study.⁴ Regardless of whether the
hospital during the acute period of the fracture. The patient is a known initial treatment is open or closed, condylar fractures are associated
case of Addison’s disease. with a significant rate of unsuccessful outcomes, as demonstrated in
She was advised to have 10 crowns, including the replacement of the case presented. The success of treatment for condylar fractures
her old crowns. The patient specifically requested zirconia crowns. She largely depends on the biological characteristics and adaptive capacity
also wanted to replace her old gold crown on tooth number 21, which, of the patient’s masticatory system.⁵
upon examination, was found to be in a good condition; therefore, she Malocclusion is one of the most common complications following
was advised to retain it. The crowns to be replaced were on teeth 36, the management of condylar fractures, with an incidence ranging
37, 24, 25, 15, and 46. from 1.4% to 13.5%.⁶ A key factor contributing to this complication
Although some teeth had very large and deep restorations in the is the extent of mandibular ramus deformity. The primary therapeutic

18 Dental Practice I March-April 2025 I Vol 21 No 2