Case Report Figure 3. Panoramic view generated from the initial CBCT scan Figure 4. Lateral cephalogram generated from the initial CBCT scan left condyle exhibits mild flattening of the condylar head. This flattening may be the result of an increased functional demand of the left condyle related to the anterior crossbite and left midline shift. The condyles are posteriorly dislocated with decreased posterior joint space (Figure 5). Treatment Options The following treatment options were presented to the patient: Figure 5. Initial condylar positions 1. Comprehensive fixed orthodontic treatment with Class III elastics and leveling of the anterior occlusal plane. Extraction of the mandibular left central incisor, closure of the extraction space by shifting the left lateral incisor and the left canine to the right and retracting the mandibular anterior teeth. 2. Limited orthodontic treatment using clear aligner therapy (CAT) to address the chief complaint by closing the maxillary midline diastema but not correcting the anterior crossbite. 3. Comprehensive CAT treatment with lower interproximal reduction (IPR) to address the diastema and anterior crossbite. 4. TMD splint therapy to address headaches and local muscle tenderness of muscles with mastication, followed by no orthodontic treatment or one of the above options. Summer 2019 PCSO Bulletin 37