Craniomanibular dysfunction in a patient with rheumatoid arthritis: oral rehabilitation despite immunosuppression

Background: Rheumatoid Arthritis (RA) is the most common inflammatory disease of the joints, affecting various joints. It is observed predominantly in women in the age of 35 and 45 years. Therapy consists of various medications, ranging from anti-inflammatory drugs to immunsuppressant agents and surgical therapy. Materials and Methods: The presented poster reports the case of a 66 year old female patient with RA and permanent immunosuppressive therapy by Retuximab and Denosumab. Due to increased craniomandibular dysorders the patient has been treated with a condylar prosthesis of the right temporomandibular joint and dental implants in the upper molar region. Results: The reported patient presented with longlasting suffering from head- and neck- pain of unclear origin. After clinical and radiological examination a severe craniomanibular dysfunction with arthritis of the temporomandibular joint as a consequence of RA could be diagnosed. In 2008 arthroscopy, followed by arthroplasty with an interponate of the fascia of the musculus temporalis was performed. Due to recurring pain and mouth opening restriction removal of the condyle and implantation of a condyle prothesis was performed in 2014. Simultaneously insertion of dental implants placed in the upper molar region (regio 24 and 26) was performed by internal sinus floor elevation. Discussion: In case of a severe RA significant improvement of craniomandibular disorders could be achieved by arthroscopy, arthroplasty and implantation of a condylar prosthesis. Thereby improvement of mouth opening could be achieved. Further, simultaneous insertion of dental implants in the upper molar region was performed to competely restore oral function. The presented implantologic treatment presents under specific, complicating circumstances such as RA and immunosuppressive medication a limiting case of implant rehabilitation. Keywords: Rheumatoid Arthritis, Condylar Prothesis, Dental Implantat, Craniomandibular Dysfunction