Part 1 of 3 | Clinical Management of the FJO-TMD-Migraine Continuum

Have 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 diagnosing and treating TMJD-ID (temporo-mandibular joint dysfunction, internal derangement) patients. In Part 2, I will demonstrate the use of the daytime FACT (Functional, Advancing, Condylar, Translation) and the nighttime Bionator appliance10,11 used to stabilize the joints in TMJD-ID patients and mitigate symptoms. In Part 3, I will describe the various 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 book10 (Fig. 1). The title is a tribute to him and perfectly describes the case that I’m presenting here.

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Randy Newby

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