1. Refractory CMD Case 5 years of treatment, 3 years of “Hell”, 5 months of Torment; 4 days to basic comfort!!

2. Presentation 5/21

3. Glued On Splint, Hygiene??

4. Cemented Splint Fractured

5. Splint Ends First Molar

6. R

7. Lower Anterior with Splint Off

8. What is the Intent of Treatment? Extra Length, Molars in Occlusion, Would the resultant Vector distalize the Mandible?

9. Not Very Comfortable,

10. Old Mandibular Splint Where is She Rubbing?

11. Incisal Ramp Is it built out a bit far?

12. 1 st Mark, Splint Rocks! What Is the Effect of A Rocking Splint?

13. What do you call this splint? What is the Basic Design? Is this a Tanner Splint? NO!!! Can we use it? If so, what is next step?

14. Reline And Re- surface PGA

15. 1 st Adjustment

16. 2 nd Adjustment

17. 3 rd Adjustment - “Freedom”

18. 3 day PO, Splint Great, Chewing with Teeth Bad

19. 1 st Adjustment, Feels Good

20. 4 th Day PO, “Cadillac” of Splints

21. First Smile in Months

22. 4 th day PO, 1 st Adjustment Still Cannot Eat or Leave Splint Out

23. What is Next Check?

24. 2+ Fremulous #8

25. Now What?? Allow her to feel motion Allow her to choose the affected tooth Ask permission to reshape a tooth Which one? #25, lower right incisor!!!

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

27. Unposed photo’s, 4 days apart What is the real Effect??

28. 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.