The force scans on most four bi extraction cases favor a Habitual Force Pattern #1 or #2. This type of force pattern will tear up the TM joints and accelerate neuromuscular issues throughout life.
The image could be better, but still shows an asymmetric airway, sinus, palate, and a drastic difference in the hight of the articulating eminence. The mandible had to grow to a narrow maxilla and the result was too many teeth in a small arch. Four bicuspid extraction orthodontics retrofitted the teeth in between the “V” shaped maxilla and the “U” shaped mandible. The result is posterior teeth that do not receive force directed along the long axis. The clinical photos show how the periodontal recession has adapted to a more normal curve of spee as compared to the teeth. Also, note the glassy etched teeth seen in erosion. So many concepts are tangled in this case.
Teeth and bones are strong in this case, but the muscles, envelope of function and health of the TM joints are in real trouble. This case will actually be treated as a chronic pain patient, yet the teeth have minimal restorations and held up in a stressful occlusion. This patient will undergo deprogramming splint therapy and an equilibration.