Hard and Uneven Ridge

A 57-year-old woman has left TMD (Fig.1 <) and food impaction between #3 and 4 eight months post #18 extraction apparently without bone graft in China.  There is anterior deep bite with severe lower anterior crowding.  She had unsuccessful ortho in her young age in China.  She is interested in ortho.  Ortho referral is recommended.  Occlusal wear is severe, especially at #19 and 30.  It appears that comprehensive treatment is required.  In fact impression has been taken for #18 guide (Fig.2).  A challenge is limited mouth opening.  Splint should be tried for TMD.  The hard and uneven ridge (Fig.2 arrowhead) will be securely trimmed with flap surgery and surgical handpiece rather than bone trimmer.

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Xin Wei, DDS, PhD, MS 1st edition 06/15/2020, last revision 01/01/2021