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Mandibular asymmetries: a multidisciplinary management

Abstract

Mandibular asymmetry with different level of severity is frequently encountered in the general population. Also, in our orthodontic practice there are a high percentage of growing patients presenting a chin deviation (30-75%), but not every patient with chin deviation requires treatment. The point at which “normal” asymmetry becomes “abnormal” cannot easily be defined and is often determined by the clinician’s sense of balance and the patient’s sense of imbalance. Although ‘normal’ is difficult to define, a definition is undoubtedly necessary if rational treatment goals are to be established. It is also critical to recognize that even if ‘normal’ has no bearing on what is necessary for health, reconstruction of teeth and supporting structures, to reach a balance according to ideal/normal standards of symmetry should be a target of treatment. In other words, even if the presence of an asymmetry does not necessarily imply that it is non-physiologic or that therapy is indicated, when the treatment is started in order to restore the “lost” symmetry there is the need of establishing normal standards to follow. Alterations in the temporomandibular joint (TMJ) can cause occlusal changes. The expanded taxonomy of the diagnostic criteria for Temporomandibular disorders (TMD) embrace several TMJ disorders, including congenital developmental (i.e. aplasia, hypo ⁄ hyperplasia), acquired (i.e. neoplasms) and inflammatory (i.e. systemic arthritides, rheumatoid arthritis) disorders that can cause progressive development of skeletal as well as dental occlusal changes. Skeletal changes could result in mandibular asymmetry, if the joint is affected unilaterally. Mandibular asymmetry may also develop as a consequence of an alteration of the TMJ growth, since the condyle and the articular cartilage play an important role in the regulation of mandibular growth. Sometimes, the orthodontist can be the first clinician making the diagnosis since TMJ signs and symptoms and facial asymmetry occur in the age when the specialist generally sees the patients. It is therefore essential that orthodontists recognize the condition before planning and starting the orthodontic treatment. The management of these patients requires necessarily a multidisciplinary approach in order to achieve the best balance and function.


Dr.in Ambrosina MICHELOTTI BDS, DDS, Orth spec, Associate Professor

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Prof.in Ambrosina Michelotti graduated in Dentistry (DDS) in 1984. In 1991 she’s got the degree of specialist in Orthodontics and since then she has been teaching in pregraduate and postgraduate courses in Orthodontics and TMD at the University of Naples Federico II. Since 2001 she is associate professor in Clinical Gnathology. She is director of the post-graduated program in Orthodontics and responsible of the Master course on “Orofacial pain and Temporomandibular Disorders” at the University of Naples Federico II. Her clinical interests are limited exclusively to the treatment of temporomandibular disorders and to the orthodontic practice. She has authored or co-authored more than 130 papers published in Italian and international journals. She also gave numerous lectures at international congresses. Her research interests are mainly focused on the basic physiology of the jaw muscles, on the etiology, diagnosis and management of temporomandibular disorders and on the relationship between the jaw musculature and orthodontics.

She was the president of the European Academy of Craniomandibular Disorders (2010), President of the Neuroscience group of IADR (2011); President of SIDA (società italiana di disfunzioni ed algie temporomandibolari; 2012-2013); President of the RDC/TMD Consortium at the International Association od Dental Research (2013-2014), Associate Editor of the European Journal of Oral Science, Associate Editor of the Journal of Oral Rehabilitation, member of the Editorial Board of the European Journal of Orthodontics and referee of several national and international journals.