CASE STUDY Fig. 13 “Before you are too critical about the way this case appears, keep in mind this patient has been wearing this same overlay partial for over 35 years and says he could not function without it.” Fig. 14 comfortable with the NTB, have them continue to wear it at night. Dr. Spahl often alternates retainer wear at night. One night the NTB is worn, the next night, a wraparound Hawley is worn. This protocol is not started until the 2-4 year threshold of NTB wear has been reached. Why was this patient at high risk for TMD issues even after good orthodontic treatment was completed? The Sassouni+ Analysis 3 provides some answers to that question. A properly positioned maxilla should have the ANS coincident with the Anterior Arc (Fig. 13). The patient being discussed in this article has an ANS that is significantly behind the Anterior Arc and the overall maxilla length is short (Fig. 14). Pogonion (Pog) approaches the Anterior Arc, which is normal. Constructed Gonion is 6 mm behind the Poste-rior Arc; 4 mm is normal for an adult female (Fig. 15). Therefore, the mandible is long posteriorly. Dr. Carapezza’s shoe (maxilla) and foot (mandible) 2 (Fig. 16) analogy is applicable here. Often in orthodon-tics, the maxilla is narrow and entraps the mandible laterally. In this case, the problem is horizontal. The maxilla is short and posteriorly displaced and cannot adequately house a long mandible without compressing the condyles.(Fig. 17) Fig. 15 34 Spring 2022 JAOS
Journal of the American Orthodontic Society Spring 2022: Page 34
