Orthotown January/February 2020 - 21
message board
Treatment Plan for Transfer Patient
When a patient and her parents decline what seems to be necessary surgical treatment, what can this Townie do?
Hi all. I wanted some opinions on this 14½-year-old patient. I believe ideal treatment is
surgical, but patient and parents have declined that. She is full cusp Class II with very proclined
lower incisors. I plan to extract only U4s to address the U1s' proclination and overjet, but that
doesn't allow me to correct the lower incisors.
If I extract U4s/L5s, most of the extraction space will be used for molar protraction-again,
not addressing the lower incisor proclination. At this point, extraction of U4s and possibly lower
IPR to try to improve the lower incisors as much as possible is the most practical plan I see.
Anyone see anything different? Thank you! ■
SNP15
Member Since: 07/29/15
Post: 1 of 8
12/4/2019
We had a recent discussion on another forum regarding partial impaction of the lower second
molars. Check the probing depth on the distal of the lower 7s to see if there are any deep pockets
or hard-to-clean areas.
If so, you may want to consider extracting lower 5s (in addition to upper 4s) to allow the
lower 7s to drift mesially and leave a long-term healthier periodontal result. ■
Dr-T
Member Since: 05/19/09
Post: 2 of 8
12/4/2019
Are the right posterior teeth in crossbite? If so, some of the maxillary flare can be reduced
with expansion.
I agree this is a surgery case. I hate when these cases refuse surgery. This is a low-angle Class II
skeleton due to a mandibular retrognathia. What should happen is likely upper expansion.
Extraction of lower 4s and a BSSO tripod advancement.
There is no viable camouflage option that works here. And if you camo the case, it removes
surgery from the table for this young lady in the future. I tend to not camo these cases so that
she can still have surgery in the future.
I would be inclined to still extract lower 4s, establish ideal lower incisor position and leave a
huge overjet. That way she can still have jaw surgery when she is older and doesn't like the way
she looks. ■
justinudm
Member Since: 09/29/14
Post: 3 of 8
12/4/2019
How would you treat this patient?
It can be difficult to treat patients when their parents decline
necessary surgery. Luckily, there are other treatment options in
the interim. What would you do? To share your suggestions and
see how "SNP15" proceeded, go to orthotown.com/magazine and
find a link to this message board in the January/February lineup.
orthotown.com \\ JANUARY/FEBRUARY 2020
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