Orthotown May 2024 - 10

MESSAGE BOARD 1
Phase vs. Full Tx
A doc seeks a way through treatment without engaging in Phase I
CliveStaples
Post: 1 of 20
7/31/2017
Hello, Orthotown colleagues.
Chief complaint: " I am fine with the way my teeth look. " The patient is 10 years old, and lost her LLc early. I typically
treat this type of case with Phase I intervention to reopen the space of the lost LLc. I have been doing Phase
I on cases like this for a long time, but am trying to become more open-minded to full treatment without Phase I.
I could use a little help crossing that bridge. How would you treat this case without a Phase I intervention?
I think she could be treated by extraction of LRc to help the midline, then carefully plan on extraction treatment.
My worry is that in pursuit of a stable bite, I won't give her enough lip support. On the other hand, when I see her
IMPA is 88 degrees, it makes me feel like my Phase I treatment may be taking the patient out of the most stable bite
for the sake of opening room for the LL3. What are your thoughts? n
Fenrisúlfr
Post: 2 of 20
7/31/2017
Molars seem Class I and she has a lot of remaining growth, thus, the lower E-space does not need to be used to
facilitate molar correction. I'd consider extraction of LRc to fix the midline and an LLHA, and put her on recall. n
drharrell
Post: 3 of 20
8/6/2017
Looking at her face, there are signs or biomarkers of airway allergy issues. (Dark circles, flattened malar region,
etc.) Ask if she snores or stops breathing at night. Parents may or may not know. Lateral ceph will not tell you much
about actual size of the airway. Look up the BEARS algorithm on sleep-disordered breathing in kids. Have parents
fill it out. I would get a CBCT to evaluate sinuses and airway before deciding on extraction. I would start with
Phase I to open the bite and some mandibular advancement. She is mandibular recessive. I have been using Healthy
Start (thehealthystart.com). No financial interest, but I've used early treatment appliances on these types of patients
with great success. My two cents. n
MAY 2024 | 10 | ORTHOTOWN.COM

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Orthotown May 2024

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