BONUS CASE 2

[Chad Carter (Course Director)]

FOLLOW UP ON THIS CASE:

Domain 3: Analyze the progress photos and panoramic radiograph, identify the remaining steps required to complete this patient’s treatment.

[BRIAN BROADWELL]

The dreaded domain, lol.

1. Protract and bond max right canine (expose as indicated)

2. Bond remaining teeth

3. Level and align (close left side open bite)

4. Complete left side Class II correction

5. Correct anterior crossbite

6. Increase overbite (by approx 1mm)

7. Correct root angulations (max left and right first premolars, man right first and second premolars)

8. Close excess spaces

9. Assess man right second premolar (radiographic signs of external resorption)

10. Detail and finish

11. Monitor the development of third molars and refer for assessment as indicated

[Joti Kaler]

• bring UR3 into the arch

• create more room for UL2 and bring it to the arch when there is enough space with appropriate torque application

• left molar is more than full step class II, poor interdigitation- make it full step class II by correcting slight rotation and vertical angulation

• Left canine is class II- bring it to class I by distalizing maxillary canine

• dental midlines are off-centered

• need to finish closing spaces in maxillary arch

• more consonant smile arc by extruding maxillary incisors

• upper laterals need distal root tip

• UL4 needs distal root tip

• there is a periapical radiolucency on LR5 that needs to be evaluated

• LL5 needs mesial root tip

• LR2 needs Distal root tip

[Dr. Golden]

Domain 1

1. Severe crowding on Upper
2. Mod crowding on LA
3. transverse discrepancy with constricted/ v shaped max arch form
4. lack of space for U3s
5. ectopic UL3 buccal eruption
6. diastema btw u1s
7. midline discrepancy
8. Ul2 in crossbite
9. Lower es in tract
10. Right side: Class I/ mesial step
11. Left: Class II (end on Class II- almost full cups) distal step
12. mild OJ and OB
13. LR4 blocked out due to lack of space
14. LR8 and U8s present; no LL8
15. U5s congenitally missing

Domain 2:

Pt should be treated now in order to correct bilateral posterior crossbite to prevent asymmetric jaw growth.

In addition, UR3 can potentially be impacted. In addition, to correct anterior crossbite on UL2; to prevent future recession and periodontal problems on lower LL2.

Domain 2:

Extract UEs; mesialize U6s into Class II occlusion.

Maintain U6 vertical position

Close spaces btw u1s

Maintain Upper incisor torque and angulation during space closure

Maintain U1 vertical position

Expand maxillary arch

Domain 2:

Extract Les

Maintain AP position of L6s

Maintain vertical position of L6s

try to maintain lower incisor torque. Since lower incisors will procline slightly during alignment; try and maintain incisor torque

Level Lower COS slightly

Domain 3: Not exactly sure about this answer

Minimize any heavy force on Lower arch until LR5 has stabilized

Take serial PAs to evaluate LR5 vitality/ PDL space

Possibly refer to Endo to test vitality

Refer to OS for CBCT to evaluate PDL and evaluation of ankylosis

Would love some feedback!

Thanks!

[Chad Carter (Course Director)]

Alice,

Sorry for the delayed reply here. I had the tab open to give a longer reply in my browser and it got buried.

I’ll comment in bold with some thoughts.

Domain 1. – I love they systematic way you approached this! It’s spot on with what we understand the ABO is asking for in responses.

1. Mod crowding on LA. (by LA do you mean lower arch? I’d spell that out or say man/mandibular arch)
2. diastema btw u1s (by btw do you mean between? I’d spell that out too)
3. midline discrepancy (What midline do you think is at fault? In what direction?)
4. Lower es in tract (What do you mean by “in tract”?)

Domain 2: (I love your Domain 2 responses. Again bulleted and treatment specific which is what shows Board level treatment standards)

Extract Les (I assume you mean the Lower Es here correct? probably worth typing that out for clarity for the examiners)

Domain 3: Not exactly sure about this answer

Minimize any heavy force on Lower arch until LR5 has stabilized (Great!)

Take serial PAs to evaluate LR5 vitality/ PDL space (Also great option!)

Possibly refer to Endo to test vitality (You could simply say, “vitality testing after initial stability” or “serial vitality testing” – remember after reimplantation that the vitality tests will not be reliable for many weeks)

Refer to OS for CBCT to evaluate PDL and evaluation of ankylosis. (Could also say “Monitor for signs of Ankylosis” by saying CBCT a picky examiner could say “Well, CBCT isn’t a solid predictor of ankylosis” – In the questionable ankylosis cases that I’ve worked with I’ve done radiographs, tapping the tooth for the sound and looking at bone heights …. then when those things looked “clear” we bracketed and tried to move the tooth – that’s when the proof is in the pudding as they say because an ankylosed tooth will not move and you’ll see side effects of other teeth pulling down towards the ankylosed tooth. Then when I popped the bracket off the suspected ankylosed tooth I could instantly see recovery of the side effects.)

Does that feedback help? Strong work!

Just a few days to go! Keep it up!

Carter