Case 2 prompt 5 and prompt 6

[Chad Carter (Course Director)]

Maria,

Really appreciate you digging into these cases! (Everyone else be sure to follow these discussions! We don’t have a ‘like’ button on this platform)

PROMPT 5

1) Could you please explain the rationale for “extruding maxillary canines for proper guidance”? From my point of view they seem correctly positioned vertically, but guidance is not there because of Class II relationship. Both Canines appear to be 0.5 mm intruded based on their incisal relationship to the central incisors (right side more than left).

2) On prompt 6 one of the answers is “appropriate overbite/overjet”. Could you please explain why, because from my observation I thought overbite improved but patient still has increased overbite. Also, could we include here as answers “maxillary second molars tipped buccally”, “non-coincidental midlines” and “increased Curve of Wilson” ?

She started with a deep bite (about 50-60% at my look). Normal overbite is 2-4mm or 30%. She is within those measurements. I know some folks like to finish with 1mm but per norms she’s on target. The second molars do appear more buccal but I cannot appreciate it as tip. I don’t see the clinical difference on midlines (are you saying a 0.1mm discrepancy?). I also don’t see an increased curve of wilson – are you mentioning this because of the tip you’re appreciating on the second molars? If you are reporting that then I would specify it is at the second molars because I definitely don’t see it along the rest of the arch.

[Maria]

Thank you!

From intraoral frontal occlusion picture I can see maxillary second molars buccally and I am just eye balling that is because of tipping, for being completely sure we would need an intraoral occlusal maxillary picture that the maxillary second molars would appear.

Midlines non-coincidental yes mildly but maybe just me.

Increased curve of wilson, yes because of molars and mandibular posterior teeth in intraoral mandibular occlusal picture look lingually inclined to me. I see more of the buccal surface of those teeth. But again maybe is just me. Thank you for your feedback.

[Chad Carter (Course Director)]

Excellent! Good eye going all the way through each record.

[Pegah Kamrani]

for prompt 6, could we add:

-torque discrepancy U3s (need Buccal root torque UL3) and Lingual root torque LL3

-also am I crazy or is there a decent spacing between her ur4 and ur5? or is it the amalgam playing tricks on me? haha

[Chad Carter (Course Director)]

Pegah,

I like the torque comments!

And yes, those are the amalgams playing tricks on our eyes. Every time I look at this case I’m like “Dang! Leaving some space, huh?” but it is those dark amalgam restorations.