Concluded Case

C/c 26yr, Female reported with a mild myofacial pain and tension, difficulty in mouth opening in the morning. occasional mild swelling on both sides around tmj. pain in the mandible, around the TMJ, ear, referring to temporal region. no sensitivity, no carious lesions, but mild pain in maxillary posteriors and all teeth in the mandible. Please note the difference in the condyles.. or is it just too much observation. My ∆- Earnest syndrome &/or Impaction Differential dagnosis?

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Mandible seems in forward position. Deocclude all teeth by placing removable flat acrylic occlusal plate in night n observe in morning. Pain will go n muscles will b relaxed if it happens plan for FMR/occlusal calibration. Impactions can cause pain but it will lead to permanant trismus. Here u said its evident in morning. I am sure patient is bruxer too...
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Bilateral horizontal impaction on lower and upper sides. Advice surgical extraction. Follow up after 10 days If the pain still persists then better take tmj views also.
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Mandible seems in forward position. Deocclude all teeth by placing removable flat acrylic occlusal plate in night n observe in morning. Pain will go n muscles will b relaxed if it happens plan for FMR/occlusal calibration. Impactions can cause pain but it will lead to permanant trismus. Here u said its evident in morning. I am sure patient is bruxer too...
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38 &48 horizontaly impacted may cause pressor on mandibular nerve during mandibular movement so pain feeling in mandible during day 18& 28 is also compromise is also cause of my facial pain tmj pain is due to impacted 38&48.there remove requored.later on 18 & 28 also required removal
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Pain in the morning is a reliable evident that she is a Bruxer , so adive Night guard and do follow up . Impacted molars could also cause TMJ pain, but in this case it might not be a chief etiological agent. But of course Extract all the 3rd Molar. Thank you
Impacted 38 and 48 need to be extracted OPG reveals low sinus floor 18 and 28 intruding into sinus which may be causing myofacial pain Extract 18 and 28 also with sinus uplifting TM fossa appears abnormal possibly due to friction
Agree with@@Dr. Anurodh Mishra the impacted molars of all the quadrants are not in a favourable position they need to be surgically extracted specially 18 &28 need sinus lifting procedure during extraction.
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does the patient have history of bruxisim ..if yes needs to be treated accordingly .Both the lower molars are impacted ,could be reason for pain early morning ..should go for surgical xtion of the same .
Horizontal Impaction is evident in both lower quadrants .... advise surgical extraction
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Definetly all the 3rd molar are cause of pain....they need to be removed surgically
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Plz advise for extraction of 18,28, 38,and 48
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