Conservative Management of TMJ Locking Without Splint: A Case Report.

Conservative Management of Intermittent Temporomandibular Joint Locking Without Splint Therapy: A Case Report and Review of Functional Adaptation

Dr. Sorabh Jain, MDS (Prosthodontics)
Special interest in Orofacial Pain & TMJ management
Mumbai, India.

+91-7303302651

http://www.DrProstho.com

Abstract
Intermittent temporomandibular joint (TMJ) locking associated with anterior disc displacement with reduction (ADDwR) is often managed with occlusal splints. However, evidence suggests that many such cases can be managed conservatively when appropriately diagnosed. This case report presents a 54-year-old female with long-standing joint clicking and recent intermittent locking, successfully managed without splint therapy. Functional diagnosis and guided intervention led to complete resolution of symptoms, highlighting the role of adaptation and the importance of avoiding premature appliance therapy.

Introduction
Temporomandibular disorders (TMDs) are frequently encountered in clinical practice, with disc displacement with reduction being one of the most common intra-articular conditions.

A significant number of patients are advised occlusal splints early in the treatment pathway. However, current literature supports a conservative and reversible approach, especially in cases without pain or degenerative joint changes.

This case emphasizes the importance of functional assessment and clinical reasoning over protocol-driven appliance therapy.

Case Report
A 54-year-old female presented with the chief complaint:

“My jaw gets stuck while opening, and I need to push it from the left side to open fully.”
History
TMJ clicking for 20–25 years
Intermittent locking for ~6–8 months
Locking at ~30 mm opening
Required manual manipulation of left condyle
No associated pain
The patient had previously been advised occlusal splint therapy by a TMJ specialist and presented for appliance fabrication.

Clinical Examination
Maximum opening: ~30 mm (with locking)
Assisted opening: 42–45 mm
Deviation: right side during early opening
Audible/palpable thud on assisted opening
No muscle tenderness
Functional Findings
Slow opening did not eliminate locking
Protrusive opening did not improve movement
Assisted condylar translation improved opening
End-feel: firm mechanical stop
Diagnosis:

Anterior disc displacement with reduction (ADDwR) with intermittent locking

Management
Considering:

Absence of pain
Mechanical nature of obstruction
Long-standing adaptation
A conservative approach was chosen:

Patient education
Avoidance of forceful opening
Guided jaw coordination
Observation
No splint therapy, occlusal adjustment, or adjunctive modalities were initiated.

Outcome
At 2-month follow-up:

Complete resolution of locking
Mouth opening improved to 42–44 mm
No requirement for manual assistance
Long-standing left joint click resolved
A transient, painless click developed on the right side, which reduced over time without intervention.

At subsequent follow-up:

Patient reported normal function
No pain or restriction

Discussion
Natural Course of ADDwR
Disc displacement with reduction is frequently adaptive and non-progressive. Many cases demonstrate spontaneous improvement when excessive loading and maladaptive movement patterns are reduced.

Splint Therapy – Indications
Systematic reviews suggest:

Occlusal splints are beneficial primarily in pain-related TMD
Limited evidence for superiority in mechanical, non-painful cases
In this case:

No pain
No inflammatory signs
Mechanical interference only
Hence, splint therapy was deferred.

Functional Adaptation
This case demonstrates a classic progression:

Long-term clicking → compensated function
Intermittent locking → transitional dysfunction
Resolution → re-established functional pathway
This aligns with the concept of biological adaptation of the TMJ system.

Clinical Insight
Premature appliance therapy may:

Interfere with adaptation
Create unnecessary dependency
Lead to overtreatment
This case reinforces the importance of:

Functional diagnosis before intervention

Clinical Implications
Not all TMJ locking requires splint therapy
Mechanical locking without pain can resolve conservatively
Functional examination is critical
Patient education plays a major therapeutic role

Conclusion
Intermittent TMJ locking associated with ADDwR can be successfully managed without splint therapy when appropriately diagnosed.

A conservative, observation-based approach allowed restoration of normal function through natural adaptation mechanisms.

Clinicians should prioritize minimal intervention and accurate functional assessment.

References
Greene CS. Managing TMDs: A new paradigm. JADA. 2010.
Manfredini D, et al. Occlusal splints for TMD: Systematic review. J Oral Rehabil. 2013.
Okeson JP. Management of TMD and Occlusion. 2019.
Schiffman E, et al. DC/TMD. J Oral Facial Pain Headache. 2014.
Türp JC, Schindler HJ. Occlusion and TMD. J Oral Rehabil. 2012.
Michelotti A, Iodice G. Orthodontics and TMD. Prog Orthod. 2010.

Correspondence
Dr. Sorabh Jain
Mumbai, India
Practice limited to Prosthodontics, TMJ & Orofacial Pain

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