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Case 1 Questions
– I’ve seen both low/high labial frenum used. Which one is correct?
– What is an “absolute” maxillary transverse discrepancy and how is it different from narrow maxilla
– This module discussed ankylosis, on the test would it be incorrect to say infraoccluded? how can you be sure if it is ankylosed? Just the bone on the pano should angle in?
– Prompt 4, I could only really see CS2, how could we identify it was CVM5?
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10 Replies
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Frenums:
I think of “low” as Maxillary – coming down with gravity; And “high” as rising up; Whenever I identify a tissue area of concern, I notate the location. I do this for treatment plans I present with patients/parents, for my own documentation, or a boards case. So here I’d note High Labial Frenum #22 & 27. For the board that points the location so the recognize you identified the area. For patients, it clearly maps out what your concerns are for periodontal risks/health.
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Absolute vs. Relative Transverse Discrepancy
This is helpful to think of having the patients models in your hand. An absolute transverse discrepancy is evident when you measure the 1st molar width or canine width in both the maxillary and mandibular arches and the arches are incompatible widths. Can be transverse deficient in maxillary or mand.
Now for a relative transverse discrepancy visualize a patient with me: Skeletal Class III, concave profile, retrusive maxilla, protrusive mandible. Alright the patient smiles and you see bilateral posterior crossbites and excessive buccal corridors – now let’s take the patient’s models and “simulate” moving to Class I molar – giving a maxillary advancement and mandibular setback. Sometimes you may see that once placed in Class I molar/canine that the models show no crossbites. So there is no “absolute” transverse deficiency. There is a “relative” or apparent transverse deficiency that is solved once the jaws are surgically moved into an ideal position.
Keep the questions coming along!
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will the boards use cases with incomplete records; where we need to remember previous images/measurements? for example prompt 2 only has ceph and pan present
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The board won’t give you a question where you’re asked to recall prior information. Each prompt will have all the required information for you.
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Growth: Yes, on that case only 2nd and 3rd vertebrae are visible. [These cases were selected for teaching points but it does bring up what is similar on the exam – not all records are perfect!]
So we see the curve on CS 2/3 inferior borders … so greater than CS3.
We can tell he is a teenager …so less than CS6. It’s not wrong to put CS4/5 and state the reason. The decision to go with CS5 here is based on the shape of that third vertebra which looks more like a marshmallow than a bar of soap (my favorite descriptors from the article!).
Good question! It’s frustrating when we don’t get the full record we want.
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Ankylosis:
You asked “on the test would it be incorrect to say infraoccluded? how can you be sure if it is ankylosed? Just the bone on the pano should angle in?”
For me, this is one of those groupings of findings. We could have an ankylosed primary molar, tipping adjacent permanent teeth, supraerupted opposing teeth, infraoccluded primary teeth, vertical boney defect…
Absent a clinical exam or trying to move the tooth, then yes the presentation of the occlusion and the pano radiographic bone evaluation are the indicators agreed on the in the boards article.
The reference article for this is Kokich – Congenitally missing mandibular second premolars:clinical options – AJODO, Oct 2006.
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I was going to also state I couldn’t make a good diagnosis on the image provided either
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Anish, is that super frustrating?!?! We are not trying to be tricky here but some case records are less than ideal and that may be what you see on boards as well. Now, none of it will be set up as a penalty situation but just like Part 1 and 2 of Dental Boards had records that were not perfect, it’s the same with orthodontics. Always good to state what you see and critique records if needed. If I get a Ceph that only gives me a hint of the condition but is not diagnostic then I get a new Ceph! That’s also being a board certified standard – knowing when we need new records. So excellent oberservation!
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Curious about etiology of deep bites and gummy smiles, I am familiar with etiology of open bites do we have a detailed list of possible etiology of a deep bite or gummy smile?
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Anish,
For the Gummy Smile the best details are in Bill Robbins “Global Diagnosis”. (He has an article from years ago and now in a text book.
Potential Etiologies are:
1) Short Upper Lip / Hyper active Upper Lip
2) Altered Passive Eruption
3) Dental Alveolar Extrusion with or without Attrition
4) Vertical Maxillary Excess
For deep bites I haven’t seen an article with a etiology but there are a collection of “signs”
I think of low angle (hypodivergent), deep curve of spee, and supraeruption man incisors.
What do you think of those? Got some to add as well?
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