What is the recommended treatment for a mildly anteriorly displaced mandible (lower jawbone) on the right side?

Management of Mildly Anteriorly Displaced Mandible on the Right

For a mildly anteriorly displaced mandible on the right side, orthopedic splint therapy followed by orthodontic treatment is recommended to achieve mandibular symmetry and proper occlusion.

Diagnosis and Assessment

Before initiating treatment, a thorough evaluation should include:

• Clinical examination for signs of mandibular condyle displacement including:

  • Altered dental occlusion
  • Facial asymmetry
  • Limitation of mandibular movements
  • Pain on palpation of the temporomandibular joint 1

• Imaging studies:

  • Orthopantomography (OPG) for initial assessment (sensitivity 86-92%)
  • CT with multiplanar reconstructions for more detailed evaluation if needed 1
  • Posteroanterior cephalometric radiographs to quantify the asymmetry 2

Treatment Approach

The treatment approach should be based on the degree of displacement and functional impairment:

Conservative Management (First-Line Approach)

1. Orthopedic Splint Therapy:

   • Custom-designed splints to reposition the mandible in a symmetrical position
   • Splints help maintain the mandible in the corrected position while addressing muscular imbalance 2

2. Orthodontic Treatment:

   • Following splint therapy to establish proper occlusion
   • Ensures that the intercuspal position coincides with the position of symmetry 2
   • Addresses any dental midline discrepancies or posterior crossbite that may be present 3

3. Occlusal Adjustments:

   • May be necessary to correct the occlusal plane, particularly if it's superiorly inclined on the affected side
   • Correction of steep posterior occlusal plane on the shifted side 3

Monitoring and Follow-up

• Regular follow-up to assess improvement in symmetry and occlusion
• Monitor for potential complications:
  • Persistent malocclusion
  • Temporomandibular joint issues
  • Facial asymmetry 1

Special Considerations

• Growing Patients: Have greater potential for remodeling and may respond better to conservative treatment 1
• Occlusal Plane Analysis: The relationship between occlusal plane inclination and mandibular deviation should be evaluated, as the superiorly inclined occlusal plane is often associated with mandibular deviation in the same direction 3
• Functional Analysis: Assessment of condylar movement patterns is important, as there's a close relationship between the direction of mandibular lateral displacement and condylar lateral shift during functional movements 3

When to Consider More Aggressive Management

Consider more aggressive management if:

• Displacement worsens during follow-up
• Occlusion becomes abnormal
• Pain persists beyond expected timeframe
• Significant functional limitations develop 1

This approach has shown improvement in mandibular symmetry in approximately 11 out of 20 patients with mandibular asymmetry and chin deviation after a mean observation period of 41.1 months 2.