Orthotown November 2017 - 14
message board
Nonsurgical Orthodontic Treatment
Townie "HappyOrthoD" has a young patient who could use treatment planning-
and surgery could be an option. Is it called for in this case?
HappyOrthoD
Member Since: 01/10/17
Post: 1 of 16
Introduction:
I had a patient come in for an initial consult. CC: I have an overbite, 11-year-old female in
late mixed dentition, Class II Div.2, 100 percent overbite, 5mm OJ.
Ceph showed upright upper incisors and proclined lower incisors. ANB of 7. I had
recommended surgery as the fi rst option (mandibular advancement.) Parent seemed upset
when I recommended a jaw surgery. I guess she didn't expect to hear about a jaw surgery. I
offered a nonsurgical ortho treatment. I was thinking extraction of U4s or treating her with
Forsus springs.
I would like to hear what others think about this case. And also, I would appreciate it if anyone
wants to share tips on how to offer/recommend surgical treatment option without making the
patient or parents feel uncomfortable.
Conclusion: ■
8/29/2017
Fenrisúlfr
Member Since: 02/25/09
Post: 2 of 16
Can you post the individual images?
She has a reasonably good soft tissue pogonion shape and projection, given the ANB. At this
stage, I would recommend RPE followed by CPHG to affect some differential growth. Leveling
the lower arch without excessive proclination will be challenging, so I would consider an intrusion
arch on the lower.
The HG can also serve as anchorage as you torque the upper incisors. I would present the
HG as an alternative to surgery. Based on her age, you should be able to treat this nonsurgically.
Discluding the arches, careful leveling and maintaining max molar AP posterior anchorage
are the key elements in successfully managing this case.
orthotown.com/messageboard/thread.aspx?a=11&s=6&f=693&t=293837&g=1: See posts 25,
26 and 29 for HG info ■
8/29/2017
HappyOrthoD
Member Since: 01/10/17
Post: 3 of 16
Thank you for your input. I was thinking intrusion arch on the lower too and even an anterior
bite plate appliance while waiting for the permanent teeth to come in. I don't use headgears (other
than facemask) as much as before for various reasons, but I'll offer it because she certainly will
benefit from it. ■
8/29/2017
14
NOVEMBER 2017 // orthotown.com
http://www.orthotown.com/messageboard/thread.aspx?a=11&s=6&f=693&t=293837&g=1
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