Orthotown June 2013 - (Page 18)

orthotown.com // message board A Townie discusses extracting lower premolars in Class II cases. » Orthotown.com Message Boards > Clinical Topics > Clinical Orthodontics > Why Ever Do a 4 Bi in a Class II Case? Goodmany2k Member Since: 11/12/09 Post: 1 of 15 t v Why Ever Do a 4 Bi in a Class II Case? I resort to extractions mainly in severe crowding cases or moderated crowding with open bite tendency or protrusiveness. In full Class II molar cases, my partner will extract upper 4s and lower 5s, but he always ends up retracting the lowers and we finish with large overjet. Of course you can try Class II mechanics, but I find the extraction of lower premolars is not necessary in most Class II cases. Anyone agree? n MAR 15 2013 vraj Member Since: 02/25/09 Post: 2 of 15 In general, I agree and would be very hesitant to extract lower bicuspids in a full-cusp, non-growing, mandibular deficient Class II since you almost always end up chasing overjet or eventually over-retracting the upper incisors. In less than a full cusp Class II, some factors that influence my decision include mandibular growth, degree of lower crowding and the ability to level COS without excessive proclination of the lower incisors. n MAR 15 2013 zxzxzx Member Since: 02/28/03 Post: 3 of 15 As I am sure you know, once you extract in the lower arch, you are at the mercy of the Gods of Growth. Sometimes it works and sometimes it does not. If you are treating Class II male with tall parents, there is probably little to worry about. A 12-year-old female with short parents is essentially an adult for ortho purposes. In my opinion, the number-one goal for treatment of teens is normal overbite/overjet. If you achieve that, you have treated successfully and can be proud of what you did. Leaving a patient with overjet is not right. n MAR 16 2013 Shwan Member Since: 08/02/10 Post: 4 of 15 The factors that should be considered, in my opinion, are the degree of crowding in the lower, the type and thickness of periodontal tissue in front of lower incisors and degree of proclination of lower incisors (i.e lower incisors to mandibular plane angle). There is nothing wrong with extraction of lower 5 in some cases to get a nice Class I molar relationship. n MAR 16 2013 charlestonbraces Member Since: 06/05/09 Post: 5 of 15 For me, the primary goal is ideal overbite/overjet. With ideal overjet, you would likely have Class I canines. If you extract 2 U4s but still get Class I canines, that’s fine with me. The problem is when they are Class II with severe lower crowding and lower incisors already dumped. n MAR 16 2013 zxzxzx Member Since: 02/28/03 Post: 6 of 15 Shwan Member Since: 08/02/10 Post: 7 of 15 18 Why is this more desirable than a Class II molar relationship? n MAR 17 2013 It is not really. In fact, I was talking about half unit Class II cases (or anything less than full unit Class II) with crowding in the lower. In that case, for me, it is better to extract in the lower and get Class I molar relationship than to move upper molar mesially and get Class JUNE 2013 // orthotown.com http://www.orthotown.com http://www.Orthotown.com http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown June 2013

Orthotown.com Highlights
Wired for Success: Incorporating Laser Treatments into Routine Orthodontic Practice
I Am So Tired
The Latest Technologies Advancing Ortho Care
Why Ever Do a 4 Bi in a Class II Case?
Best Flowable Composite?
What’s Your Practice’s Online Reputation?
Office Visit: Self-made in Manhattan
Orthodontic Practice Rescue – Becoming the Pre-eminent Orthodontist
Do You Have a Laser Yet? It’s Time to Get One!
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Orthotown June 2013