Craniofacial growth changes using a modified activator in juvenile rheumatoid arthritis

The aim of this work is to prevent and to treat the progressive evolution of Juvenile Rheumatoid Arthritis, on craniofacial growth and morphology and above all on the temporomandibular joints. The study utilized clinical and radiographic data of 82 JRA patients aged 6 to 14 years old, 37 males 45 females. All with TMJ involvement almost all with typical “bird face” due to mandibular deficency and post rotation growth. The Authors used a bimaxillary activator, suitably modified. This free the joints, reducing the load on the condyles. Almost all JRA patients showed optimal long term results, with reduced seriousness of the skeletal discrepancy and with good restoration of TMJ function. The results of this study indicate that orthopaedic functional therapy, has controlled progressive evolution of the malocclusions in children affected by JRA (p<0.01). The Authors confirm the need and the importance of an early approach, followed by long term controls, to prevent severe damage of the TMJ.