Orthotown May 2023 - 22

MESSAGE BOARD 2
and leave overjet. But most people don't want to do
that.
[I like the upright position of incisors to the face, so I
don't really wish to retract them.]
The LL1 already has a mucogingival defect. No
way a Class II corrector/dental mover should be
placed that can further move this tooth out of bone.
Once again, I ask for you to post a similar case you
have treated in the manner you describe, with before
and after records, including superimposed cephs.
Because if you are doing something that I cannot, I
would love to learn. n
procliniation of L2-2. What these authors are doing
is using dentoalveolar landmarks to prove skeletal
change. This makes no sense.
Instead, bony landmarks like pogonion and ANS/
PNS should be used. When you look at the tables and
raw data on these same studies, they show 1 mm of
change in pogonion. Well, that's within the realm of
measurement error.
So, next I reread the famous meta-analysis
showing that 3-3.5 mm of jaw growth is achievable
with functionals. The issue here is that the authors
of the accepted articles for the meta-analysis are all
friends of each other and have a vested interest in
continuing the functional appliance myth-i.e. they
want to be on the lecture circuit.
Plus, in a case like the OP shared, there is an
3Mortho
Post: 7 of 27
2/11/2020
Thank you for your comments. Can you elaborate
on your opinion that a functional appliance would
not be an option in this case? I do not think the
patient will accept the idea of surgical treatment. n
8 mm+ issue. Explain to me exactly how getting
3 mm of growth (if you believe that) will help? You
will still have a 5 mm skeletal issue to contend with.
Add the fact that the patient has a thin gingival
biotype with an existing recession.
Next, I started to look at and classify the nature of
Fenrisúlfr
Post: 8 of 27
2/11/2020
A functional will blow the lowers out of the bone.
With tissue this friable, it is simply a very bad idea. n
Class II skeletons. The literature said 20% of Class IIs
are due to a maxillary excess. That's false. I think
it's less than 5%; most Class II skeletons are due to a
mandibular deficiency or two-jaw deficiency. Especially
when you consider Andrew's GALL line of the
six elements of diagnosis and treatment method.
More often than not, when I idealize incisors on
justinudm
Post: 9 of 27
2/11/2020
OK, here is my perspective. This is how my thinking
on Class II skeletons evolved over time. I have
said this before, but functional appliances do not
grow jaws; they move teeth through the jaws.
I discovered this after the first 18 months of private
practice when I started to superimpose my
before-and-after cephs. I then went back and reread
all the ABO board articles and discovered a disturbing
trend. All these articles used A-point and
B-point to prove skeletal growth. This is an error in
thinking because A-point and B-point move with
the tipping of the U/L incisors. A-point moves back
as U2-2 move back; B-point moves forward with
my Class II skeletal patients' cephs, they are either
a mandibular retrognathia or a two-jaw deficiency
case. So, we know that Class II skeletons due to
deficient jaws just do not grow. My superimpositions
showed me this-all you really get is vertical growth
of the jaws. The AP position of the jaws does not
improve that much.
So, the functional literature is a mess. I would
encourage all new graduates to superimpose cephs
and find out for themselves. This is important to
understand. We need to be treating these cases with
surgery. We need to be asking about snoring and
sleep apnea, and doing appropriate treatment based
on that and what we know about jaw growth (e.g.,
that you will never get to a Class I skeleton in a child
such as the OP's). n
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