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case 1
prompt 1; to me this NLA looks very obtuse and not within normal, what do you use as a guide when evaluating these ?
prompt 6 skeletal objectives prior to surgery, the answer provided seems more like a treatment plan what’s the best way to distinguish between the two?
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1 Reply
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Anish
Prompt 1; for the Nasolabial angle, the definition is the tip of the nose (following along columella) to subnasal point then from subnasal point to the lower lip. I don’t have a protractor out (ha!) but this gentleman appears to have a nasolabial angle of close to 90-ish degrees. The norm is 90-100 degrees for males and slightly larger for females. Acute angles would be much smaller (less than 80 degrees say) and Obtuse would be larger (110 degrees or more). The one caveat I keep in mind is that we are truly looking at the lips because THAT’s what we can influence with orthodontics. We are not treating noses with braces… though you may refer. Beware of upturned nasal tips which make the angle obtuse but doesn’t mean your going to procline the upper incisors out to 150 degrees just to lift the lip and close the nasolabial angle.
Prompt 6 asks for the “dental objectives” (max and mand dentition) prior to surgery. This case is highlighting that the board will want you to be able to distinguish mechanics and dental position in order to achieve a surgical setup. It’s understanding that mechanics make “it worse” before it then get’s better for surgery. In a treatment plan, I would highlight more my mechanics. In objectives, I’m laying out things which will be part of my plan but I am detailing movement in all three planes of space for max/man molars and incisors plus any relevant extractions as part of the dentition.
As orthodontists we are sometimes too smart for ourselves! So here is a little exercise… close your eyes are imagine NOT knowing all you do about orthodontics and the formula you were given for Class II treatment is X. Anytime you see a Class II you do X. You don’t know why that’s just what you do. The board is according you the certification because you are genius enough to know each patient is individual and that it could be X,Y,Z,Q,R,P or a mixture of all of those. So in a surgical situation I feel like they are checking out to make sure you understand decompensation and DON’T say put in a functional appliance to reduce overjet when they have asked for how to do a surgical setup.
Little bit clearer? You’ve got this.
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