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Case 1
1) When we have a steep cranial base, I see that we still diagnosed the maxillary and mandible as mild retrusions, I am assuming we do not account for cranial base flexure ? do we need to also put adjective mild, mod severe, or will ABO also accept ‘maxillary md retrursive’
2) Are the terms shallow mental fold & mentalis strain interchangeable ?
3) In an open bite case like this with this much maxillary protrusion and mentalis strain, why would u /l 4 exos not be considered an option?
4) ideal treatment plan, would boards want in a high angle patient to just expand and wait for growth?
TY
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7 Replies
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Good questions, Anish!
“1) When we have a steep cranial base, I see that we still diagnosed the maxillary and mandible as mild retrusions, I am assuming we do not account for cranial base flexure ? do we need to also put adjective mild, mod severe, or will ABO also accept ‘maxillary md retrusive’”
There is accounting for the cranial base flexure here. (11 degrees (SN – FMA) – 7 degrees = estimate a 4 degree correction). I think in her case putting “Mild” communicates to the examiner that you recognize a steep cranial base and have adjusted for it – she is mildly retrusive in your complete diagnosis not just a quick glance at SNA or SNB (that’s a key thing everyone! Foot stomping here – do not just use SNA or SNB along – look at the whole picture just like Anish did!)
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Answering the others as well
“2) Are the terms shallow mental fold & mentalis strain interchangeable ?”
They are not interchangeable for me. They might both be present at the same time for sure! One can definitely be present without the other though. Does that answer your question?
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I don’t think I understand the terms. Even in module 1’s case I was confused on this terminology .
Is there a reference guide I can review ?
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Anish, my “go to” source for soft tissue diagnosis is Proffitt’s “Contemporary Treatment of Dentofacial Deformities” which is on the ABO list.
I’ve posted two screen shots below from the definitions of what a labial sulcus is normal – S shape.
Now mentalis strain is where you can see the activation of the mentalis muscle as they strain to keep the lips closed – if the patient is relaxed then you will see the lips separate and the mentalis muscle relaxed. If a patient is straining to close their lips it activates the mentalis muscle and flattens out the curvature of the chin.
Does this help more?
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“3) In an open bite case like this with this much maxillary protrusion and mentalis strain, why would u /l 4 exos not be considered an option?”
Interesting, I love U4s/L4s extractions for bimax protrusive cases. In her case those man incisors are already retroclined so then keeping our Class I molar/canine becomes an issue. I’m going to pause and ask – What do other people think? Benefits or drawbacks of U4/L4 extractions in this case?
“4) ideal treatment plan, would boards want in a high angle patient to just expand and wait for growth?”
So the answer in this question ties into the answer above as well. This case was meant to understand controlling the vertical dimension. There are several boards articles on this and it’s the dimension where control is frequently lost. Therefore, we want to prepare you to see the exam and immediately nail the question with “Boom, vertical control question” – growth, surgery, or auxillaries/mechanics to control. Final thought – yes be mindful of growth. I see so many adults who had premolars out as teens, vertical growth, and now have anterior openbite in the 30’s. Thank goodness for TADs and my surgeons!
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I have a question about the treatment plan on this case as well. This patient has proclined maxillary incisors and retroclined mandibular incisors. There was also mild spacing and a narrow maxilla. I am aware that the highest priority in this case is the vertical control and the obvious hyperdivergent skeletal pattern.
However, the open bite appears to me to be consistent with a habit. We are not given such information, but on treatment options I gave an option to place a habit appliance if habit is present.
I understand that we are lacking information and the exam would like to see certain answers. Is it generally not advised to ascertain problems that could be present if you are not given that information?
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Nice thought Michael!
Definitely having the treatment option of a habit appliance is a good idea. I think it’s completely fair to include your “suspect” of a habit due to the presentation.
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