It has been said that there are no easy cases, and I think that I believe it after the run of new patients I've had the past six months. So, once again, I am turning to all of you to get your thoughts on unusual circumstances. This woman was referred for a restorative evaluation by one of the great periodontists with whom I work. She is 55 years old and has a failing bridge that is severely periodontally involved. The bridge is 13 years old. She reports that she grinds her teeth and wakes up with right-sided headaches several times a month. She also reports that the only teeth that touch are on the left side and that has only been that way for the past two years or so. She states she was in an abusive relationship 14 years ago and that she has been struck in the face and remembers being hit on the right side very hard. On exam, there is no muscle tenderness except for a slight tension in the R temporalis. She has a fully normal range of motion, although she struggles to move laterally in either direction. Doppler exam was positive for crepitus bilaterally throughout the range of opening, closing and lateral movements. The CBCT shows beaking of both condyles on the medial poles. The only contact she has is in the left posterior dentition and her midline is off to the right by about 2 mm. OK, so here is the question for this blog. What the heck is going on???? What do you see that are clues and what do you think is causing the unilateral posterior open bite? Has she always been this way or is it really something new?