Case 1 – prompt 4

[Chad Carter (Course Director)]

Maria,

Interesting thought. What leads you to that diagnosis? (I always think of the old McNamara adage that if the palate wasn’t wide enough for his thumb that he would do expansion)

Thoughts from others? What do others think?

[Maria]

Thank you for your answer !

Yes, also she has increased buccal corridors, slight high palatal vault. We don`t have a PA ceph or CBCT axial cut to measure intermolar width, but clinically looking I would describe her as being maxillary transverse deficient.

[Chad Carter (Course Director)]

Interesting thoughts…. for me I would not list a maxillary transverse deficiency for the following reasons.

1) Fundamental is that the board has said they are not out to trick us. So for time management sake I focus on the “high nails” – things that are frankly obvious and could be agreed on by 99% of orthodontists. The board recognizes there are people out there who are non-extraction vs. extraction or fans of a particular bracket system or arch width.

2) The sample cases provided by the board have answers listed as “Must Include” and “Could Include” and I’ve also seen “Must not include” when deciding that is a competent response. When I look at this case from that perspective I hear your terms of slightly high palatal vault and mildly increased buccal corridors. So maybe that could present as a “could include” for the case. I don’t think anyone is wrong to say there is no transverse discrepancy.

3) In a skeletal maxillary transverse discrepancy I am looking for blantant posterior crossbites, huge increase in buccal corridors – focusing on things that are right there in front of us.

Now I can see some folks would want to treat her case with expansion and that could work. I’m more on the simple mechanics side myself.

Does that help to focus on the “big rocks”?

[Maria]

Thank you for your feedback!

Yes it helps understanding how to guide my answers.

It is very hard to me when some cases are so subjective and open to different perspectives and none of the perspectives are wrong. For example, I cannot see the difference on why this case would not be viewed as transverse maxillary deficient and on case 2 of module 3 that case would be diagnosed with maxillary transverse deficiency. For me, both of them have transverse deficiency. But maybe is just me, I hope I can provide the correct point of view in the exam.

Thank you again!

[Chad Carter (Course Director)]

You’ve got this Maria! I know exams are stressful. You are putting in the time and preparing well. Sample cases are always a challenge but stay the course with speaking to the most obvious items. I have full faith in your success!

[Maria]

Thank you, Chad! I truly appreciate your help! This course has helped me a lot, congrats on the good work and dedication here! It makes a huge difference!