Gallery:
CBCT:
Panoramic. My LR8 (lower right 8/third molar/wisdom tooth) is mesially (towards the center line) inclined and impacted here. We’re attempting to upright it with Invisalign as of April 2026.
Airway:
Assessment:
Chief Complaints
Bite, TMJ issues, appearance of jaw
Signs & Symptoms
- Hx. of smoking (quit at 17)
- extraction of U/L 4’s
- snoring
- TMJ popping/discomfort
- ringing in ears
- daytime fatigue
- grinding during the day
- bite feels off/uncomfortable
Clinical Exam Conditions
- Head Posture: Forward Head Posture
- Facial Features: Allergic Eye Shiners, Excessive Buccal Corridors
- Vertical Upper Jaw Position: Mild Vertical Maxillary Excess
- TMJ Pain (R/L): Mild
- Masseter Pain (R/L): Moderate
- Anterior Temporalis Pain (R/L): None
- Posterior Digastric Pain: None
- SCM Pain: None
- Trapezius Pain: Moderate
- Maximum Opening: > 50 mm (55)
- TMJ Dysfunction: No Clicking/Popping
- Deviation/Deflection: No Deviation/Deflection on Opening
- Indicator Line: 42 mm
- Intermolar Width: 31 mm
- Mallampati: Class IV
- Tonsils: Grade 1
- Tori: None
- Exostosis : Mild
- Tongue Posture: Low rest posture
- Tongue Features: Scalloping
- TRMR – TIP: Grade 3 – < 50%
- LPS Overflow: Grade 4 – >50%
- Upper Arch Alignment: WNL
- Lower Arch Alignment: Mild Crowding
- Overjet: Mild
- Overbite: Moderate Dental Deep Bite
- Relative AP Molar Relationship: Class II Molars
- Transverse Dental Relationship: Edge to Edge Bite R to L
- Missing Teeth: Missing U&L 4’s
- Other Problems: Still has wisdom teeth, LR8 mesially inclined
- Airway MCA: 153.6mm2 (at risk for OSA less than 150mm2)
Assessment
- Sleep Disordered Breathing
- TMJ Dysfunction
- Ankyloglossia
- Hypotrophy – Maxilla
- Hypotrophy – Mandible
Treatment Recommendations
- Refer for Surgery Consult
- Refer for General Dentist Visit [root canal for discolored lower incisor]
- Comprehensive Orthodontic/Surgical Treatment