image in which further evidence of effusion can be appreciated. Treatment Plan The initial step in treatment for this patient is to stabilize her occlu-sion and TMJs and reduce pain. An intraoral orthotic (FACT appliance) was fabricated based on radiographic guidance and neuromuscular trajec-tory principles. 10,11 The patient was instructed to wear the appliance full time and, after a period of healing and stability, will be further evalu-ated for oral and maxillofacial reha-bilitative treatment. References 1. Piper, M. “TM Joint Imaging.” IGI Global , 2020: 582–697. 2. Isberg, A. Tempormandibular Joint Dysfunction: A Practioner’s Guide . 2000. 3. Ikeda, K. TMJ 1st Orthodontics: Concepts, Mechanics, and Stability . Topnotch Kikaku Ltd., 2014. 4. Sylvester, D. “Association between disk position and degenerative bone changes of the temporomandibular joints: an imaging study in subjects with TMD.” Cranio , 2011, 29(2): 117–126. 5. Spahl, T.J. The clinical management of the FJO/TMD/migraine continuum: an evidence-based construct . Dallas, TX, USA, Taylor Publishing, 2018. 6. Piper; and Alomar, X. “Anatomy of the temporomandibular join.” Semin Ultrasound CT MRI , 2007, 28(3): 170– 83 7. Alomar; and Provenzano, M. “How should the articular disk position be analyzed?” J Oral Maxillofac Surg , 2012, 70: 1534–1539 8. Tamimi, D. Specialty Imaging: Temporomandibular Joint and Sleep-Disordered Breathing E-Book . Elsevier Health Sciences, 2023. 9. Tamimi. 10.Spahl, T.J. “Why Migraines Start With Your Teeth.” JAOS , 2021, Fall: 8–11. 11.Newby, R. “Clinical Management of the FJO-TMD-Migraine Continuum.” JAOS , 2022, Spring: 30–37. Discussion As can be seen, CBCT is a power-ful tool for assessing temporo-mandibular joint health. When combined with MRI, hard tissue and soft tissue can be fully appreci-ated. Such information is critical to determining not only stabilization of current symptoms but also future rehabilitative treatment. Under-standing the basics of TMJ size, shape, positioning, and appearance lends confidence and power to treating patients with underlying TM joint issues. CBCT allows visualization of a dynamic joint that tends to cause quite a few problems for the human race. It is important to understand that we are not just moving teeth. There is a front end and back end to the entire system. If we are going to practice moving teeth, we must understand what is going on at the back of the mouth or, at the very least, respect that there is a jaw joint that functions with the teeth. The subject of MRI was included simply to demonstrate the power of that imaging modality and its util-ity. Combine both CBCT and MRI, and they make a powerful team. The overarching theme of the articles in this series has been the importance of appropriate imag-ing—specifically CBCT—and under-standing some of the basics of the anatomy we are looking at and trying to treat. CBCT is not required to treat airway or TMJ health, but it certainly helps. This journal contains articles eligible for PACE and CERP Continuing Education Credits. Scan the QR code to the left to complete the CE quiz and purchase your CE credits. AGD Credits will be uploaded to your member portal automatically. orthodontics.com Spring 2026 23
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