Joint effusion associated with structural changes in the temporomandibular joint (TMJ) can result in severe pain and considerable functional impairment. This article describes the diagnostic and therapeutic approach used to treat a patient with severe structural damage to the TMJs in association with a ruptured disc and joint effusion. After describing the diagnostic procedures, the therapeutic procedures used in our purely conservative management approach are outlined. Treatment consisted of a combination of the following measures: 1) Information about the nature of the anatomical and dysfunctional events. 2) Fabrication and insertion of a special three-dimensionally aligned equilibration splint that was modified several times over the course of treatment. 3) Anti-inflammatory medication. Combination therapy resulted in the elimination of joint effusion, restoration of the original bite position, and subjective improvement of masticatory function. Consequently, there was no need for later restorative occlusal adjustment and/or surgical intervention. Keywords: temporomandibular joint dysfunction (TMD), osteoarthrosis, posterior disc displacement, disc rupture, clinical functional analysis, manual structural analysis, condylar position analysis, jaw motion analysis, magnetic resonance imaging (MRI), functional