Orthotown March 2020 - 24
message board
Can This Be Treated Nonsurgically?
A Townie inherited a difficult case where surgery seems like the best
option, but the patient wants to see what the alternatives are
NyceBiteR
Member Since: 10/21/08
Post: 1 of 22
This patient came to my office after 2.5 years in Invisalign with another orthodontist that she
finished a couple years ago. She reports an open bite that developed or worsened during college.
Before any ortho treatment, she had contact only on the molars. With the previous orthodontic
treatment, considerable molar intrusion was programmed into the aligners. She had 8s extracted,
extensive IPR and vertical elastics. The previous orthodontist had given her a surgical option,
but she declined.
After treatment, her anterior open bite closed but she still has no contact 2s-6s bilaterally
and has developed TMJ symptoms that are interfering with her life. The oral surgeon she saw for
TMD referred her to me because her joints are healthy and he believes all pain is coming from
the lack of good occlusal contacts.
Her maxilla and anterior teeth look well positioned in her face, so I think the best surgical plan,
if we went the surgical route, is to level and align the curve of Spee, then set back the mandible.
Of course, the patient wants to see if she can avoid surgery. Because I like to go by Dr. Ruff's
mantra, "You want to do surgery on people who look like they need surgery," and this patient
doesn't have a "surgical face," I was wondering if any of you would try a nonsurgical plan that
involves extraction on the lower arch to allow leveling of the curve of Spee, retraction of the
anteriors, allowing the mandible to auto-rotate closed. Perhaps some molar intrusion with TADs?
Her lower incisors can definitely afford retraction. I would tell her that relapse space opening is
a risk without diligent retainer wear given the fact she's an adult with no crowding. Is anyone
concerned about my ability to close the space if I extracted two premolars on the lower? Would
one lower incisor do the trick?
Any other thoughts? ■
1/6/2020
justinudm
Member Since: 09/29/14
Post: 2 of 22
Should have been surgery from the start. Three-piece maxilla due to the step in the occlusion
from U3-3 and U4-7 bilaterally.
While I think Dr. Ruff is excellent, I disagree with the notion of doing surgery in patients
only who look like they need surgery. Either you can safely fit the teeth together without surgery,
or you cannot. In this case, nonsurgical treatment should not have been attempted in the first
place. That was a huge anterior open bite. ■
1/6/2020
24
MARCH 2020 // orthotown.com
OT0320_MB2NonSurgical_AG.indd 24
2/25/20 9:36 AM
http://www.orthotown.com
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