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Aim: To highlight the effectiveness of orthodontic treatment and bilateral equalization of the
vertical occlusal dimension, along with the correction of asymmetric cervical and masticatory
muscle activities in patients with Class III malocclusion with lateral deviation of the
mandible and severely asymmetric condyle and ramus. Methods: Two normally growing
and one nongrowing Japanese patients with severe lateral deviation of the mandible, asymmetric
vertical occlusal dimension, and severely asymmetric temporomandibular joints are
discussed. In addition to orthodontic treatment, all patients received physiotherapy of the
cervical muscles and gum-chewing training for elimination of the masticatory muscular
imbalance. Patients also had postural training during treatment. All patients were treated
with a bite plate to equalize the bilateral posterior vertical dimension, followed by full multibracketed
treatment to establish a stable form of occlusion and to improve facial esthetics.
Results: This interdisciplinary treatment approach resulted in normalization of stomatognathic
function, elimination of temporomandibular joint dysfunction symptoms, and
improvement of facial appearance and posture. In growing patients, the significant
response of the fossa, condyle, and ramus on the affected side during and after occlusal
correction contributed to the improvement of cervical muscle activity. In contrast, less
improvement was observed in the growing patient who did not receive physiotherapy of
the neck muscles, postural training, or masticatory habit training during the posttreatment
period. The nongrowing patient showed little morphologic improvement of the cervical
spine, condyle, and fossa during treatment and after retention, even with physiotherapy of
the neck muscles and attention to posture and masticatory habits. Conclusion: Based on
these results, early occlusal improvement, combined with physiotherapy to achieve muscular
balance of the neck and masticatory muscles, was found to be effective. It is important
to assess the morphology and function of the neck muscles and cervical spine prior to
occlusal therapy in patients with an asymmetric vertical dimension, lateral deviation of the
mandible, and asymmetric temporomandibular joint structures. Therapy should correlate
orthopedic and surgical patient management as needed. World J Orthod 2004;5:9–24.
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