Refractory CMD Case

5 years of treatment, 3 years of “Hell”,

5 months of Torment;

4 days to basic comfort!!

Presentation 5/21

Glued On Splint, Hygiene??

Cemented Splint Fractured

Splint Ends First Molar

R

Lower Anterior with Splint Off

What is the Intent of Treatment?

Extra Length,Molars in

Occlusion,

Would the resultantVector distalize the

Mandible?

Not Very Comfortable,

Old Mandibular Splint

Where is She

Rubbing?

Incisal Ramp

Is itbuilt out

a bit far?

1st Mark, Splint Rocks!

WhatIs the

Effect of A Rocking

Splint?

What do you call this splint?

What is the Basic Design?

Is this a TannerSplint?

NO!!!

Can we use it? If so, what is next step?

If so, what is next step?

RelineAndRe-

surface

PGA

1st Adjustment

2nd Adjustment

3rd Adjustment - “Freedom”

3 day PO, Splint Great, Chewing with Teeth Bad

1st Adjustment, Feels Good

4th Day PO, “Cadillac” of Splints

First Smile in Months

4th day PO, 1st Adjustment

Still Cannot Eat or Leave Splint Out

What is Next Check?

What is Next Check?

2+ Fremulous #8

Now What??

Allow her to feel motionAllow her to choose the affected

toothAsk permission to reshape a

toothWhich one?#25, lower right incisor!!!

Is it the Bevel on #25, or the length?

Unposed photo’s, 4 days apart

What is the real Effect??

Occlusal Impact

This early result could be achieved with an anterior jig or prop, Lucia or NTI.

The important aspect of the PGA is the muscle and joint stability.

We are also on a diagnostic path that is leading toward a stable conclusion.

Any anterior dis-occluding device must be replaced with a stable occlusal design.

PGA simulates a stable occlusal design and is in the progression to a final restoration.