Patient Spotlight: Donna T.

My condylar resorption story is a bit different compared to younger patients. My resorption was the result of bad luck and bad physics spanning 6 decades. I was a little kid with big teeth and not enough room in my mouth. Treatment at that time was extraction of teeth to “make room”.

Me as a child.

Today there is a better understanding of how detrimental early extractions are to a child’s still-developing skeletal structure. Three of my four cuspids were removed, leaving my bite very unstable without incisal guidance for occlusion. This was the beginning of the progressively worsening relationship between my teeth and TM joints. It was the perfect storm for condylar resorption – traumatic occlusion leading to damaged teeth and discs, improper maxillary growth, and ultimately wear and tear on the joints and surrounding tissues. Symptoms began in my teens and I was diagnosed with TMJD. I adapted and functioned pretty well for years while the damage was occurring, but my joints and bite were unstable – like a chair with only 1 leg for support. In 2019, my adaptive capacity reached its limit. Conservative measures weren’t halting the destruction of my joints and I was losing function with increasing pain.

I am now 14 months post-op from bilateral TJR and LeFort. My decision to have this major surgery and my careful and educated choice of an experienced and caring surgeon are two of the best decisions I have made in my 62 years. Over the years I’ve spent hours in the offices of various dental professionals, oral surgeons, and endodontists, spending too much money. I’ve kept a positive attitude about it mostly, accepting that this teeth/jaw mess was just a part of me, that I’m fortunate to be healthy otherwise. There were definitely times, however, I was just done with all of it! I was so tired of the frequent dental visits and treatments for damaged teeth, tired of pain, tired of wasting money, and tired of feeling ugly because of the changes in my face. 

The symptoms that started in my teens were typical TMJD symptoms. Through the years my teeth took a lot of abuse, leading to cavities, cracks, root canals, and abfractions. I had a dentist tell me once that I “brushed my teeth too hard”. My tooth trauma was instead due to my malocclusion causing excessive force on my molars. Since my teeth were still crowded, I opted for braces at 48, pushing me over the edge into real trouble. I think my mouth and joints were somewhat stable with my crooked teeth, and that straightening my teeth changed the dynamic forces at work, something my joints weren’t happy about. I chose poorly when it came to the orthodontist. He’s popular in my area, but now I know he’s only concerned with his own finances and having teeth look straight, not identifying or caring what the real issues are. 

Within a couple years, a molar that had already been root canaled became seriously infected, landing me in the ER twice for antibiotics. The tooth always felt bruised. Now I know this was the only site where teeth were in contact. In 2015 the tooth was extracted and later a dental implant was placed. I was never comfortable with the crowned implant as there was too much pressure on the site still. I visited my oral surgeon in 2016 to have the implant checked out. After my CBCT, he told me the implant was stable but the film showed that my joints were in trouble and I needed to get it fixed “before the joints failed”.

In late 2016 I began undergoing C20 splint therapy with a very experienced dentist. My splint was adjusted frequently, sometimes multiple times a week. My joints would literally shift while I sat in the dental chair. While I was told that most patients have success with splint therapy after 3 months, my joints never stabilized. We hoped they were remodeling in a positive way. Instead, it was a demolition. After 9 months, we made the decision to go ahead and finalize the splint for night-time wear and as-needed use. Restorative dentistry, i.e. lots of bonding, was done on my left side, building it up to match the height of the right side since my right side was shortened from carrying all the weight of my bite. 

I had a good year where things seemed stable and I felt like a normal person. Then changes started happening again in 2019 - muscle spasms, joint pain, decreased opening, increased facial asymmetry, a retrognathic profile developed, and my splint no longer was a relief to wear. My implant had to be removed because my occlusion traumatized it. My bite opened on the left side. The teeth still “fit together” (molds were taken) so we knew the trouble was at the joint level. A CBCT was done and it showed marked and active degeneration. I knew that things would only get worse from here, so I started exploring my options for specifically addressing the joint as conservative measures weren’t going to cut it anymore.

I’d heard of TJR but my dentist had discouraged it. He only had knowledge of negative outcomes. He told me of a previous patient with artificial joints that weren’t any better than “tinker toys”. He was supportive though, agreeing that I really didn’t have other options. I read many studies and reports online and joined some Facebook groups. I learned that TJR was a real thing, that it can be successful (especially with a skilled surgeon and custom joints). I was excited! Next was my search for a surgeon with experience and expertise. While many surgeons are on suggested lists, I believe there are only a handful that plan and perform the surgery with the utmost skill and care. TJR with LeFort is a demanding and precise procedure with no room for error. I believe that my choice in surgeon is why I’m doing so well, and of course my annoyingly positive attitude helps. My surgeon’s vast experience and knowledge allowed him to carefully adjust to my individual physical differences and idiosyncrasies, including my “mature” age. He was out-of-town and out-of-network, but my gut told me that he was the right choice. In the end, he was worth every mile and penny. Intuition is important to listen to.

I had orthopedic analysis metal allergy testing performed and it showed that I am highly reactive to nickel, so I chose the all-titanium joints. Appeals had to be made to my insurance company for approval. They initially considered my condition and surgery “dental”, denying coverage. Along with letters from my dentist and oral surgeon, I presented my case to them as a medical condition, specifically degenerative joint disease, and the importance for corrective surgery. Approval was then given for insurance coverage. I needed one last pre-op CT scan for joint fabrication because my joints had changed again. My left condyle had collapsed, closing my open bite.

On June 28, 2021, I went into surgery like a kid going to Disneyworld. I was excited and fearless. The first few days were rough -- really rough. By day 5, I noticed that my new joints already felt better than the old ones and that was a relief! Recovery from the joint replacement felt “easy” after the first few days. Healing from the LeFort was the tough part. It still is at times. Recovery is definitely a journey, with each new month bringing new healing.

New joints freshly post-op.

My most recent panoramic scan.

Sometimes there are bumps in the road, like having a molar and premolar extracted 4 months post-op. Bone grafting was also done and later dental implants were placed. My most recent pano x-ray shows quite a history! My little mouth has been through a lot. Today I know I am so much better, especially since I don’t think (obsess) about my jaw much anymore. I’m proud to have my new joints and to be doing well. My grandkids and I think my new hardware is pretty cool :) My teeth and occlusion aren’t perfect, but that’s OK. I’m thankful and appreciative for the incredible improvements I do have.