Orthotown July-August 2023 - 24
MESSAGE BOARD 3
Brachy-Facial with
Flare and Upper Space
A patient's simple request unearths a treatment plan challenge for Townies
CliveStaples
Post: 1 of 8
1/21/2019
33.4-year-old patient with a CC of: " Want to close my gaps between top front teeth. " This Class I, brachyfacial
marine has some flare that is causing a gap between his upper incisors.
He is missing his UL6 and missing a crown on his LR6. I asked him to get the LR6 recrowned ASAP but can't do
much about the crater left behind by his missing UL6. He doesn't appear to be flared when he smiles, and that is not
part of his CC. Just wants the space closed.
This cases pushes me into uncomfortable territory, so I'm posting. With regard to treating with extractions, I feel
like I'm in a Catch-22.
I'm most comfortable at this point telling the patient that his bite is compromised, so it may not be possible to
close all the space, but to proceed with lower IPR. Thoughts? n
justinudm
Post: 2 of 8
1/21/2019
Man, you see some tough cases! This case is way harder than it looks. The upper incisor angulation actually isn't
too bad. The lower is flared. I would likely discuss surgery here, i.e., a tripoded mandible to open the vertical by way
of an eruption of the lower posteriors postsurgery. I don't think you will get the upper space corrected otherwise. n
davidharnick
Post: 3 of 8
1/21/2019
I would consider a lower incisor extraction because there is already lower crowding and it is unlikely you can
get enough retraction by lower IPR to close the upper spaces. Of course, should have a model set up or 3D (which is
what I prefer). You can also eval IPR only and then decide. I find the U/L kind of proclined to me. Good luck. n
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Orthotown July-August 2023
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