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Case II
1. Can you explain the maxillary transverse deficiency? The molars do not have buccal crown torque. There could be more buccal overjet but I didnt see the deficiency- can you explain?
2. A general question about CVM. I usually put a range like between CVM 4-5. Is it better to commit to one stage?
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6 Replies
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Great question about the transverse!
You are correct, I do not see buccal crown torque on the molars either. I also agree that she lacks buccal overjet. In fact it’s also edge to edge through the premolars.
So the thought process here is U6-U6 and L6-L6 width. If we had calipers and were measuring the casts and doing our residency treatment planning forms then it might be more obvious. However looking at the picture we can see that if she is so tight that there is no buccal overjet, what will happen in a Class I relationship? Imagine taking the models and shifting into Class I, or having her slide her jaw into Class I. Boom! Edge to edge molars if not downright crossbites.
That help out? Similar to thinking about the Absolute vs. Relative transverse issues – it’s about intermolar and intercanine widths.
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Growth Assessment:
Growth is always a spectrum! Now for the board exam you want to be sure that you are justifying. You don’t want to give the appearance that you’re writing multiple answers to just spread out and cover your bases. I add my reasoning using the indicators that match up with the article. “Visible inferior curvature” and “shape of vertebrae”. The most informant is are they growing? Done growing? Significant growth happening? and what treatment is important at this time.
How do others approach this?
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I feel like I was going to put one value down but justify that she could still be growing; other growth indicators maybe needed to ‘confirm’ treatment plan such as hand wrist radiographs and interview with parent about recent menarche, growth changes.
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Love it! Solid board quality answer.
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Similar question here. My verbiage was “late C3, early C4 due to noted curvature of the inferior border of C3 and C4 and relative trapezoid shape of C3 and C4. Clinically significant growth remaining.” Is it critical to use terminology like circumpubertal?
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David,
Excellent point to clarify.
I do use the term just because it’s the exact terms from the boards article and I’m trying to calibrate myself to what language the board wants in communicating.
Carter
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