Case 1 Prompt 4

[Chad Carter (Course Director)]

“Would it be incorrect to state prominent soft tissue pogonion ?”

Absolutely it is good to call out the skeletal diagnosis and the soft tissue. Another way to say that is “Pronounced or Prominent Soft Tissue Chin Button”. Definitely shows up in those low angle Class II patients!

Anybody got tips on ways you might treat this? (Think 3 dimensionally)

[Chad Carter (Course Director)]

“Other answer choices I was considering was uneven maxillary gingival display; and mildly narrow buccal corridors, what are your thoughts on this?”

Sounds good to me. Just making sure by “mildly narrow buccal corridors” do you mean there is maxillary transverse excess or deficiency? [This is a debate I’ve had with residents and faculty about how we talk about buccal corridors – so interested in people’s opinions and what they say]

[Chad Carter (Course Director)]

“Also am I correct soft tissue is the the appropriate location to describe gingival displays or buccal corridors ?”

This is where I have them in my 3D/3T scheme which I use for diagnosis and treatment planning. Now we of course don’t forget that buccal corridors clue us in to maxillary skeletal issues and so discuss that in Skeletal Transverse

Keep it steady studying all!

[Adedolapo Ayediran]

Hello Chad;

1.In mosby’s it has buccal corridor as a soft tissue finding in the transverse plane, is this not correct?

2. And for the purposes of this exam, would you say a narrow buccal corridor would automatically warrant expansion of the maxillary arch?

Thanks

[Chad Carter (Course Director)]

Adedolapo,

Thanks for your message.

“1.In mosby’s it has buccal corridor as a soft tissue finding in the transverse plane, is this not correct?”

Yes, that is correct. Sorry if confusing above – I am saying Yes, it is a soft tissue finding that also can correlate with a skeletal finding.

“2. And for the purposes of this exam, would you say a narrow buccal corridor would automatically warrant expansion of the maxillary arch?”

No, not automatically. The notable exception is when there is a “relative transverse discrepancy” of the maxilla versus an “absolute”. This is talked about in orthognathic cases. An “absolute” would be the width of 1st Molar to 1st molar (and/or canine to canine) width shows maxillary deficiency. A “relative” discrepancy is when you look at them clinically see crossbites but it appears that way because the maxilla is so deficient in the AP. This is best seen when you hold the modules and then simulate a LeFort – all of a sudden if you advance the maxilla there are no crossbites and great occlusion. It also fills the buccal corridors.

Does that make sense? It’s a bit tricky to explain without holding models in hand.

Good thoughts,

Carter

[Adedolapo Ayediran]

thanks for clarifying.