Orthotown May 2023 - 24

MESSAGE BOARD 2
chicagoortho
Post: 19 of 27
2/21/2020
Everyone's reasons for not doing the posted treatment
plan will make for a good thread. Didn't think
of it? Considered it but ruled it out for the following
reasons. n
chicagoortho
Post: 21 of 27
2/21/2020
Hello, Justin. Don't worry about beating me up.
Have at it. The case I posted was a two-upper bi/
lower incisor extraction case. No surgery. The
commonality between your patient and mine was
the necessity to reduce protrusion without overretraction
and/or having to do a mandibular advancement.
Let's go through your patient's options for
treatment.
1. Non-extraction. Of course, if you work hard
enough, you can expand/advance/rotate the
vertical plane, but you won't reduce protrusion
doing this. This is your best option if you place
avoidance of extractions higher than smiling
aesthetics.
2.
justinudm
Post: 20 of 27
2/21/2020
So, the case you posted is a surgery case. The
mandible is deficient, and the distal half of the lower
7s look to still be in the vertical portion of the ramus
posttreatment. The case is still 1/4 cusp Class II on
the left? and 1/2 cusp Class III on the right (at the
canines). The lower incisors are still flared and now a
lower incisor has been removed, essentially removing
surgery from the table in the future.
In my opinion, a better treatment option would
have been surgery or extracting the lower premolars
necessary to set the case up for surgery and leave
overjet. I'm not beating up on you. I went through
this during my first 18 months of practice and realized
surgery is a vital aspect of everyday orthodontics.
I would have clearly discussed surgery with this
girl and shown her other cases I had treated before
offering a compromised option. I am always amazed
at how parents get it and want to at least look into
surgery with an OMFS. n
3.
Extract four bicuspids. It will reduce protrusion,
but only the most confident of us won't
worry that we may not be able to slip anchorage
enough to avoid either overretraction of the
upper anterior teeth and/or finishing in Class II
and having to discuss future mandibular
advancement. IMO, this approach is for those of
us that are " occlusal purists; " i.e., Class I molars
or the highway. Not me.
Wait until he is older, extract four bis and do
mandibular advancement. This approach is
a nonstarter. You can recommend this, but
this boy will just go to another orthodontist,
because his social presentation is not such that
he can wait that long for relief.
4.
Set him up for a two-phase, presurgical plan.
Extract four bis, decompensate, idealize each
arch, but leave in full-step Class II and then
treat surgically when older. IMO, this boy does
not need this. He is just not that retrognathic.
This is a camouflage case, not a surgical case.
5.
Extract U/4s and a lower incisor. Not extracting
bis in the lower arch will ensure overretraction
cannot occur; indeed, you are only extracting
the amount of tooth material needed to hold the
L/1 position on the ceph. It will reduce protrusion.
This is the best approach for ensuring
smiling aesthetics nonsurgically, but it requires
we compromise on the final fit of the teeth.
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