Orthotown May 2019 - 26

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fesdds
Member Since: 05/22/08
Post: 5 of 16

Diane, that is the same question I have. Is she looking for something different or is it more
that she does not gel with the other docs? n
3/12/2019

dhmjdds
Member Since: 11/16/04
Post: 6 of 16

Also, ceph seems to show significantly more overjet and open bite than do the photos. Where is
CR here? Can you be certain that even the ceph is accurate? This is critical for treatment planning
in a case like this. And does she have any TMD symptoms? Those condyles don't look great. Tread
very carefully as both ortho and orthognathics can reactivate ICR or DJD. n
3/13/2019

SNP15
Member Since: 07/29/15
Post: 7 of 16

I will recheck the CR, but from my clinical exam the ceph appears to be accurate. No TMD
symptoms but history of grinding. She had the other opinions 5+ years ago and didn't move
forward, so it seems she's trying to get back into it. Thank you all for your responses. n
3/13/2019

Fenrisúlfr
Member Since: 02/25/09
Post: 8 of 16

I would not want to impact the maxilla at all. That would bury the upper incisors. She has
a very steep mand. plane and I suspect a CR-CO slide as well. She would benefit from CC-wise
OP rotation (with a Crot at the maxillary incisor tip) in order to maximize chin projection and
improve the neck-throat angle. Once decompensated, she may need transverse correction as well,
so a two-piece LeFort might be a consideration. n

3/13/2019

parshooter
Member Since: 02/21/07
Post: 9 of 16

tcarlyle
Member Since: 02/29/08
Post: 10 of 16

Perhaps maxillary and mandibular advancements. n
3/24/2019

Methinks that the TMJs have undergone some remodeling over the years. The current imaging
is not adequate to assess fully, but it appears that both condyles have undergone some osseous
changes. Progressive remodeling is classically associated with the patient complaint of "my chin
appears to be receding over the years". One might want to get some further definitive imaging,
perhaps even an MRI and really look into what is going on with those TMJs. Don't be hasty to
treat, and IF and WHEN anything is provided for her, warn the patient and the referring doc
that she could be in for further TMJ changes. Just a few random observations here! n
3/24/2019

SNP15
Member Since: 07/29/15
Post: 11 of 16

Thank you all for your advice! I had another consult with the patient today and she says after
thinking about it more, her chief complaint really is lower crowding and U1s that are shifting.
She does not want to go through with the surgery after consulting with him and everything he
explained.
I explained that I can align her teeth possibly with exo of L4s also but without surgery the
bite correction and facial change would not happen. My question is, at what point do you decline
treatment? I've heard a lot of ortho lectures offering different levels of treatment with a strong
informed consent to keep expectations real.
If this patient is only worried about alignment and not bite correction, is more harm being done
to just align the teeth (with possible lower extractions) than to do nothing at all? Thank you. n
3/25/2019

dhmjdds
Member Since: 11/16/04
Post: 12 of 16

MAY 2019 // orthotown.com

If she has decided that surgery is absolutely off the table, why not align the lower with extraction
of a single incisor, rather than two bicuspids? You'll have a significantly shorter treatment time
and end up with less overjet. Since the actual CR/relaxed position seems to be what we see in the

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Orthotown May 2019

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