CASE STUDY Part 1 of 3 Clinical Management of the FJO-TMD-Migraine Continuum By Randy K. Newby, DDS Fig. 1 Fig. 2 ᕢ Pogonion is significantly anterior of the ANS Arc indi-cating a skeletal Class III. Also note that this patient has a strong chin. ᕣ Pogonion approaches the Anterior Arc. ANS is signifi-cantly behind the Anterior Arc. This indicates a skeletal Class III with a deficient maxilla and normal mandible anteriorly. ᕤ Constructed Gonion is 6 mm behind the “Posterior Arc”. In an adult female Go should fall 4 mm behind the Posterior Arc (Fig. 4). 12 ᕥ PNS falls on the Cribriform Perpendicular, which is normal, but again ANS is significantly ave any of you ever had an orthodontic case that was well done, fulfilling the time honored “Andrew’s Six Keys” 6 to occlusion only to have the patient post-treatment start to manifest TMD issues? I have! The following three-part series is a case study of one such patient. In Part 1 of this series, the patient’s case will be presented as well as a discussion of some of the basic protocols I use when diagnos-ing and treating TMJD-ID (temporo-mandibular joint dysfunction, inter-nal derangement) patients. In Part 2, I will demonstrate the use of the daytime FACT (Functional, Advanc-ing, Condylar, Translation) and the nighttime Bionator appliance 10,11 used to stabilize the joints in TMJD-ID patients and mitigate symptoms. In Part 3, I will describe the various H finishing techniques, including the SSV (Spahl Split Vertical Appliance System), 10 the Biofinisher, 7 and others. If you haven’t already noticed the title of this case, which was hijacked from my mentor, Terrance Spahl’s most recent book 10 (Fig. 1). The title is a tribute to him and perfectly describes the case that I’m presenting here. The Case For those of you who are not intimately familiar with the Sassouni Plus Analysis 4 , a review of the five arcs used in the analysis are shown in Fig. 2. Important observations from the Sassouni Plus tracing (Fig. 3) are: ᕡ A and B points both lie on the A Arc indicating a skeletal Class I. 12 Fall 2021 JAOS
Journal of the American Orthodontic Society Fall 2021: Page 12
