Use of Intermaxillary Traction Appliances and Exercises to Strengthen the Masticatory Muscles of Patients with Anterior Open Bite Caused by Temporomandibular Joint Osteoarthritis: Case Reports

  • Park, Hyun-Jeong (Department of Oral Medicine, College of Dentistry, Chosun University) ;
  • Ryu, Ji-Won (Department of Oral Medicine, College of Dentistry, Chosun University)
  • Received : 2022.05.26
  • Accepted : 2022.06.11
  • Published : 2022.06.30


Temporomandibular joint osteoarthritis (TMJ OA) causes destruction of the temporomandibular joint (TMJ) and can lead to occlusal changes such as anterior open bite in some patients. Consequently, these patients may experience difficulty in chewing food items and exhibit abnormal functional habits such as bruxism, preventing healing of the TMJ condyles. Treatment protocols include the use of traction appliances to reduce stress on the condyles. Unstable occlusions can lead to weakness of the masticatory muscles which, in turn, worsen the occlusal changes and complicate pain management. Therefore, the current study evaluated the condition of the masseter muscle using ultrasonography and educated patients on the execution of gum-chewing exercises for muscle strengthening. It also aimed to assess the effects of traction appliances and strengthening exercises on the masticatory muscles of patients with occlusal changes caused by TMJ OA.



This study was supported by research fund from Chosun University Dental Hospital, 2020.


  1. McNeill C. Management of temporomandibular disorders: concepts and controversies. J Prosthet Dent 1997;77:510-522.
  2. List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia 2017;37:692-704.
  3. Caldas W, Conti AC, Janson G, Conti PC. Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice. J Appl Oral Sci 2016;24:411-419.
  4. Murray GM. The lateral pterygoid muscle: function and dysfunction. Semin Orthod 2012;18:44-50.
  5. Kim YK. Temporomandibular joint disorder and occlusal changes: case reports. J Korean Dent Sci 2018;11:21-31.
  6. Bansal M. Prevalence and diagnostic features of osteoarthrosis of the temporomandibular joint: a review. Int J Res Orthop 2016;2:1-4.
  7. Arai C, Choi JW, Nakaoka K, Hamada Y, Nakamura Y. Management of open bite that developed during treatment for internal derangement and osteoarthritis of the temporomandibular joint. Korean J Orthod 2015;45:136-145.
  8. Al-Moraissi EA, Wolford LM. Does temporomandibular joint pathology with or without surgical management affect the stability of counterclockwise rotation of the maxillomandibular complex in orthognathic surgery? A systematic review and meta-analysis. J Oral Maxillofac Surg 2017;75:805-821.
  9. Ryu SS, Kim SH, Kee WC. A case report on the treatment of an TMJ osteoarthritis patient with anterior open bite using an intermaxillary traction device. J Oral Med Pain 1998;23:379-385.
  10. Kim JH, Park HJ, Ryu JW. Association between temporomandibular disorder and masticatory muscle weakness: a case report. J Oral Med Pain 2021;46:155-160.
  11. Wajid MA, Chandra P, Kulshrestha R, Singh K, Rastogi R, Umale V. Open bite malocclusion: an overview. J Oral Health Craniofac Sci 2018;3:11-20.
  12. Janson G, Laranjeira V, Rizzo M, Garib D. Posterior tooth angulations in patients with anterior open bite and normal occlusion. Am J Orthod Dentofacial Orthop 2016;150:71-77.
  13. Germa A, Clement C, Weissenbach M, et al. Early risk factors for posterior crossbite and anterior open bite in the primary dentition. Angle Orthod 2016;86:832-838.
  14. Massilla Mani F, Sivasubramanian SS. A study of temporomandibular joint osteoarthritis using computed tomographic imaging. Biomed J 2016;39:201-206.
  15. Savtekin G, Sehirli AO. Rheumatoid arthritis in temporomandibular joint: a review. Niger J Clin Pract 2018;21:1243-1246.
  16. Sidebottom AJ, Salha R. Management of the temporomandibular joint in rheumatoid disorders. Br J Oral Maxillofac Surg 2013;51:191-198.
  17. Kellenberger CJ, Arvidsson LZ, Larheim TA. Magnetic resonance imaging of temporomandibular joints in juvenile idiopathic arthritis. Semin Orthod 2015;21:111-120.
  18. Alimanovic D, Pedersen TK, Matzen LH, Stoustrup P. Comparing clinical and radiological manifestations of adolescent idiopathic condylar resorption and juvenile idiopathic arthritis in the temporomandibular joint. J Oral Maxillofac Surg 2021;79:774-785.
  19. Zhang Y, Liu Q, Xu X, et al. Long-term effect of bilateral anterior elevation of occlusion on the temporomandibular joints. Oral Dis 2021. doi: 10.1111/odi.13914. [Epub ahead of print]
  20. Kim HS, Lee SH, Youn T, Kim HG, Huh JK. Anterior open bite with temporomandibular disorders treated with intermaxillary traction using skeletal anchorage system. J Korean Assoc Oral Maxillofac Surg 2012;38:284-294.