Part 2 of 3 | Clinical Management of the FJO-TMD-Migraine Continuum

In Part 1 of this series, a patient’s orthodontic case was presented. Despite finishing the case to the standard of Andrew’s Six Keys of Occlusion2 (Fig. 1), the patient started to manifest TMD symptoms 20 months after the completion of orthodontic treatment. I then treated the patient with an anterior repositioning appliance known as a Levandoski splint (Fig. 2).³ When occluding with the splint in, the condyles are in the vicinity of the Gelb 4/7 position (Fig. 3).⁷ The splint was to be worn full time, even when eating, and removed only for cleaning. This allows inflammation in the retrodiscal tissues to subside and the TMD symptoms to improve.