... tlrl'mustlikl'f.vC/WSl'?Thereisnohistoryofsurgeryortrauma,nosuggesUonoffracture.noInflammallOnUlslbleovertheJOInttosuggestarthrrtlsandnosystemICcauseforarthritis.TraumaticsynovitisisapoSSIbilitybutdoesnotusuallycauseselectIVeImpallmentofmovement;alljOintmovementsarepainful.ThisleavesinternalderangementInvolvingtheintra-articulardiscasthemostlikelycause.TheprogreSSIonofc1rcklngtolockingWIthpainandIntra-artICulartrismusofrapidonsetistypicalofclosedlockandfitsWIththepatternofsymptomsandSIgnsseen In thiScase. In thiScasethepatientISstiliabletotranslatetheleftcondyleforward,causingdeviatlO/ltotherightonOJ)ening.lateralexcurSIontothelightwasnormalat8mm.Therelorethecause01therestrictedopemngisinternalderangementofthelightJoint."1;;;;;=~1'AINFUllltlS_UIFIe.1.3~pos$ible in lI1traa'ldexlJaiIl'tIa8lr15mlI5,Gleenillr0W5"ateITIOYefIIeflISthal.eposstie.,.edolROWS!hose\IIfllchft~,left, ... Alowerincisorismissing,suggestmgltJatsomeinterventionmayhavetakenplace.Fixedorthodontics In thelowerlabialsegmentISoccasionallyassociatedWIthgingivalrecesSion In patientsWIththinbuccalgingIVa.narrowalveolarprocessesandcorrectionofseverecrowdirlg.Plaque£ootrolmaybecompromise<!dUringthewearingofanorthodontlcapphanceand,evenoverarelatIVelyshortperiod,thiScancontributetothe problem. In ltJlSinstancethepabenthadundergoneextractionofthemClsorbuthadnotwornanappliance.EXAMINATIONIntraoral examination• rill'appea,l1nceoftilelowe,incisors ... Examiniltiunofthe fingers, wristsandelbowsshowsan increased r.1nge of joint movement.Intraoral examination•n,l'plIIicllt'SlIppClIrlllrceisshoWIJillFigure7.1.SheisInjillg10...