Maximum mouth opening was 25 mm, accompanied by pain rated at VAS 7/10. Lateral and protrusive movements were mildly restricted. No joint sounds were detected. Palpation revealed tenderness in the right masseter and lateral pterygoid regions.

Panoramic radiography showed no abnormalities in the TMJ or dentition. There were seven metal inlays and two full-cast crowns in the oral cavity, but none of them showed any abnormalities in shape or other aspects (Figure 1).

Intraoral examination revealed anterior mandibular displacement with loss of posterior occlusal contact (Figure 2). The mandible rested in a forward position, and attempts to guide it into centric occlusion provoked pain (Figure 3). The patient reported difficulty achieving stable occlusion during chewing.

Figure 1.Panoramic radiograph showing no abnormalities in the temporomandibular joint or dentition.

Figure 2. Anterior mandibular displacement with loss of posterior occlusal contact.

Figure 3. Forced retrusion temporarily restored centric occlusion but provoked pain.

Because occlusal evaluation was not feasible due to the unstable mandibular position, manual therapy was performed first. Treatment targeted the sacroiliac joint and acromioclavicular region to reduce musculoskeletal strain because these joint mobilizations were insufficient to improve trunk alignment (Figure 4and Figure 5). Techniques included gentle mobilization, softtissue release, and postural correction.

Figure 4. Manual therapy applied to the sacroiliac region.

Figure 5. Manual therapy applied to the acromioclavicular region.

Following manual therapy, the patient reported a sense of “lightness” in the trunk and shoulders. The mandible spontaneously returned to a nearcentric occlusal position without forced manipulation.

Selective occlusal adjustment was then performed on the posterior molars to stabilize centric occlusion. The primary occlusal adjustment involved eliminating occlusal interference at the lingual lateral surface of the right and left upper second molars. A manual muscle response test was used only as an adjunctive cue and not as a diagnostic tool. Neuromuscular response techniques such as the Bi-Digital O-Ring Test have been used to evaluate functional changes in muscle activity and postural balance [9]-[11], but in this case, adjustments were based solely on conventional clinical findings, including premature contacts and occlusal interferences.

Immediately after treatment, maximum mouth opening improved from 25 mm to 55 mm, and TMJ pain decreased from VAS 7/10 to 1/10. The entire procedure required approximately 25 minutes (Figure 6).

Figure 6. Selective occlusal adjustment; mouth opening improved from 25 mm to 55 mm.

At six-month follow-up, the patient remained asymptomatic, with stable occlusion and maintained mouth opening. No self-care or lifestyle guidance was provided.

Previous studies have demonstrated associations between craniocervical posture, cervical muscle dysfunction, and TMD [4]-[7]. Altered head posture can modify mandibular rest position, muscle activity, and occlusal loading patterns. Dysfunction of deep cervical flexors has been linked to impaired neuromuscular control of the mandible [7].

Pelvic and trunk alignment may influence mandibular function through myofascial chains and neuromuscular coupling. The sacroiliac region, thoracic spine, and shoulder girdle are interconnected with the craniofacial region through fascial pathways described in Anatomy Trains [12][13][22]. Pelvic alignment has been shown to influence mandibular movement and postural control [19]-[21].

Musculoskeletal disorders in distant regions may contribute to craniofacial symptoms [14].

The rapid improvement in this case may be explained by:

Reductionofmyofascialtension affecting mandibular posture; Restorationofneuromuscularbalance within the cervical and trunk regions; Improvedproprioceptiveinput influencing mandibular positioning; Releaseofcompensatorypatterns that maintained anterior displacement.

Recent studies demonstrate that postural correction can improve mandibular function and reduce TMD symptoms [20][21].

Several studies have reported improvements in TMD symptoms following physical therapy, cervical mobilization, or postural correction [10][11][15]-[18]. However, few reports describe such rapid and substantial improvement in mouth opening and pain.

This is a single case report, and causality cannot be established. The specific contribution of manual therapy versus occlusal adjustment remains unclear. Further research, including controlled studies, is needed to clarify the biomechanical mechanisms underlying these observations.