Orthotown April 2022 - 27
I agree with extracting upper/lower 5s. Upper 5s are smaller than upper 4s and the lower 5s
look a little odd. This should convince the mother you will minimize any soft tissue changes
(which I doubt will occur) while at the same time correcting the crowding along with the deep
bite. I cannot render an opinion on expansion. Like to see how the upper articulates with the
lower and the upper molar width. ■
9/8/2019
Extract 5s as narrow 5s/ and wide /5s. Discuss frenectomy needed as well. Use facemask and
Class II elastics to help burn some posterior anchorage if needed, but she has a large pogonion
and could benefi t from a pogonion reduction. ■
9/9/2019
Why does the patient exhibit maxillary protrusion and xs overjet (Class II pattern) vs. Class III
mandibular compensation? Incisors tipped lingually ... a lot! The frontal facial smile may provide
an important clue. She may function into a seated position, but does she spend most of her day
and night with her tongue between her posterior teeth and postured forward?
This case can be treated with extraction but some guy with a name I can't pronounce might
get a standing ovation at the AAO midwinter for claiming we're " killing them " with extractions.
No kidding, I was in the front row. It happened.
I would begin treatment with the upper arch non-extraction and see how much uprighting can
be accomplished. Then the patient can decide if extractions would help her achieve her cosmetic
goals. If she is happy with non-extraction of the upper arch, then you might still need to extract
a lower incisor or those ugly second bis, or disseminate
the extraction (liberal IPR-not a fan).
Expansion via RPE or archwire? Plenty of controversies
there as well. If an ENT fi nds her refractory to his/her
efforts, then go ahead and try to take credit for saving
her life. Maybe tune down that CBCT to stun, though.
Interesting how those presenting at that midwinter
presented their own kids as case studies. ■
10/14/2019
When planning extractions
in a narrow upper arch, is skeletal
expansion still necessary? ■
spif121
Member Since: 01/10/13
Post: 16 of 32
10/16/2019
drtoddorth
Member Since: 07/22/13
Post: 11 of 32
srensch
Member Since: 03/12/09
Post: 10 of 32
whiskeyriver
Member Since: 02/05/13
Post: 9 of 32
The conversation
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Orthotown April 2022
Table of Contents for the Digital Edition of Orthotown April 2022
Orthotown April 2022 - Intro
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Orthotown April 2022 - Cover2
Orthotown April 2022 - 1
Orthotown April 2022 - 2
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