My Courses › Forums › Synapse Orthodontics: General › BONUS CASE 1 – Part 1 of 2
Tagged: bonus_case
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BONUS CASE 1 – Part 1 of 2
Posted by Chad Carter (Course Director) on February 1, 2023 at 10:16 pmAlright first BONUS case – I’m going to post questions based on testing domains defined by the ABO. Review these records and let the replying begin! I’ll post some thoughts of mine as well.
9 year old Hispanic male with Chief Complaint of “Our dentist said we needed to talk to an orthodontist”
1) Domain 1: List the skeletal diagnosis for this patient.
2) Domain 1: What is the growth assessment for this patient with records presented (include reasoning for such assessment)?
3) Domain 1: What is the rationale for treating this patient at this time?
4) Domain 2: What treatment is indicated at this time?
5) Domain 2: What are the skeletal treatment objectives?
6) Domain 2: What growth is expected if there is no treatment?
Chad Carter (Course Director) replied 5 months, 3 weeks ago 4 Members · 8 Replies -
8 Replies
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GREAT! TY. Do you want us to reply with answers or wait for the answers?
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Sure go ahead and post here. Then we can all tease it out in discussion!
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• Skeletal diagnosis
‣ mandible to the left
‣ Flat cranial base
‣ Retrusive maxilla
‣ slightly Retrusive mandible
‣ skeletal class III
‣ Protrusive lips
‣ Open vertical
‣ Hyperdivergent growth tendency
‣ large gonial angle
‣ steep mandibular plane
• growth assessment
◦ CVM 1
◦ flat lower border to CS 2-5
◦ Trapezoidal shape to CS 2-5
◦ 2 years before peak growth
◦ ideal time for Class III correction and expansion
• rationale for treating pt at this time
◦ Patient is in ideal growth for class III correction
◦ If we don’t treat while patient is growing, maxilla won’t be able to grow properly locked in mandible
◦ Maxillary and mandular anteriors will compensate and take too much force
• treatment indicated at this time
◦ Interceptive treatment
◦ RPE and facemask
• skeletal treatment objectives
◦ Increase SNA
◦ Increase SNB
◦ Decrease ANB
◦ Maintain FMA and control vertical
◦ maintain incisor proclination
• what growth is expected if there is no treatment
◦ Class III vertical growth
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On fire! Keep the posts coming. Look forward to other’s thoughts as well. I’ll post some of mine own as we cycle through the cases.
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1) Domain 1 – List the sekeletal diagnosis
1. Skeletal Class 3
2. Retrognathic maxilla
3. Mild retrognathic mandible
4. Depressed mid-face
5. Hyperdivergent growth pattern
6. High mandibular plane angle
7. Hugh gonial angle
2) Domain 1 – What is the growth assessment for this patient with records presented (include reasoning for such assessment)?
1. Pt. is at CS2 stage, slight concavity on C2 border, flat border of C3 and C4
2. 75% growth remaining
3) Domain 1 – What is the rationale for treating this patient at this time?
This is the ideal stage for growth modification to treat Class 3 skeletal discrepany. As per Franchi 7 Baccetti’s article, CS2 stage is the ideal stage for FaceMask therapy with RPE
4) Domain 2 – What treatment is indicated at this time?
Phase 1 treatment with Reverse Full Face Mask therapy with Palatal Expansion
5) Domain 2 – What are the skeletal treatment objectives?
Advance maxilla (Increase SNA)
Hold mandible
Increase ANB
Expand maxilla
Emphasis on Vertical control (FMA)
6) Domain 2 – What growth is expected if there is no treatment?
Increased growth in vertical dimension (Hyperdivergence)
Mandible will grow in AP direction resulting in worsening Skeletal Class 3 profile
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9 year old Hispanic male with Chief Complaint of “Our dentist said we needed to talk to an orthodontist”
1) Domain 1: List the skeletal diagnosis for this patient.
1-Retrusive maxilla
2-Mandible within normal limits
3-Class III skeletal
4-Steep mandibular plane
5-Slight short ramus
6-Hyperdiverget tendency
7-Increased gonial angle
2) Domain 1: What is the growth assessment for this patient with records presented (include reasoning for such assessment)?
1-CVMS stage 2
2-Concavity on the boarder of C2 and trapezoidal shape of C3 and C4
3-Patient more than one year before peak of growth
4-Full growth potential (great potential)
3) Domain 1: What is the rationale for treating this patient at this time?
1-Correct anterior crossbite as soon as possible to allow full potential growth of maxilla
2-Check if the patient has a CR-CO deviation when manipulated (might be posturing mandible forward)
3-Patient is before growth peak velocity which is a great time for a treatment of growth modification with maxillary expander and Facemask (Reverse Pull Headgear)
4-Anterior crossbite could retrain proper growth of maxilla and cause gingival recessions on mandibular incisors if bite is traumatic in long term
4) Domain 2: What treatment is indicated at this time?
1-Growth modification phase 1 orthodontic treatment
2-Rapid palatal expansion associated with Reverse Pull headgear
3-Reevaluate after expansion and reverse pull headgear to check if 4×2 brackets needed
4-Bite turbos on palatal surface of mandibular incisors to allow bite to jump (correct anterior crossbite)
5) Domain 2: What are the skeletal treatment objectives?
1-Increased SNA
2-Maintain SNB
3-Increase ANB
4-Control vertical (avoid extrusive mechanics)
6) Domain 2: What growth is expected if there is no treatment?
1-Continuous growth of mandible
2-Restrained growth of maxilla
3-Possibly decrease of ANB number
4-Possibly increase of steepness of mandibular plane
5-Hyperdivergent tendency might increase anterior third facial height
Could you please post your thoughts for the answers from this case? Thank you 🙂
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Maria, I think your format, wording and answers are spot on. This is the sort of style that the ABO is presenting as our speciality standard. Bravo!
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