Cases Module 3

[Chad Carter (Course Director)]

Case 1 Prompt 2

There is a typo. Good catch! It should be extract the Lower Right E (Second primary molar) due to caries. We’ll get that updated on the site.

[Dane Lenaker]

Had the same q – thx for clarifying.

[Chad Carter (Course Director)]

Case 2 prompt 5

– When do we advance incisors in addition to procline or instead of procline? And what mechanics could you use to get true bodily advacement

There are two parts here – mechanically we think of advancement as the bodily movement of the tooth. There are a couple ways to accomplish this and I’ll rank them from most invansive to least: surgical advacement, TPA with sliding push arms (called a trombone appliance by some and especially useful in patients with history of bilateral Cleft Lip/Palate), or more basic archwire mechanics. The archwire mechanics I see helping advance the incisors are initial NiTi to Steel progression where we are unraveling crowding – some will be tipping, some bodily movement. If I want to PREVENT movement forward then I’ll do a tight cinch on the NiTi wire. However if I want to “Let ’em Fly” then I’ll not cinch the wire or just have a light cinch back to allow the flexibility of the NiTi advance and procline the teeth. Another way is to use a Proud Archwire – bending a stop before molars so that when you tie it in it doesn’t quite reach the brackets but you tie it in with force (have you seen one of these before? don’t know if I’m using a term that I heard from others or if it’s common).

Second part – Advancing incisors that we can “document” is the U1 to NA measurement. Maybe you want to change the proclination of the U1s with NO change to U1-NA. Going to be tough but if that’s your goal then you’ll need to come up with the mechanics to do it. On the questions the are just asking objectives – remember the board exam is the ideal patient with ideal compliance and where everything you dream of works ideally (ha!). So in this patient’s case we look and see that the incisal edge of the U1s is right at the a line drawn between the maxillary canines when looking from the occlusal – therefore we do want to procline the U1s for their angle relative to SN but we also want that incisal edge moved forward so we want to advance the U1s. And yes…we’ll get some of that advancement as we procline.

Good discussion! Does that help?

[Joti Kaler]

I have not seen one of these before, but you described it well so I understand. Thank you (:

[Chad Carter (Course Director)]

Case 2 Prompt 8

– 5 degrees distal tip on maxillary molar during finishing, are we saying distal down? I know distal down is a super class I but wanted to confirm this is what it meant.

Correct, there is a 5 degree distal root tip on maxillary molars to allow that stolarization or distal down. Just need to make sure it’s level in a Class II finish.

Anyone else have other terms they use to talk about a Super Class I finish?

Keep up the studying!

[Heather Smith]

Hii, for case 2 prompt 5,

I had put to also procline the lower incisors to help alleviate the lower crowding. But in this case do we want to maintain the curve of spee for md advancement, and is that why we don’t want to procline the lower incisors?

thanks

[Chad Carter (Course Director)]

Heather, sorry for the delay on the reply!

Great comment and great thoughts! Yes, keep the curve of spee. You will get a little bit of proclination but in a surgical setup I want to “maximize the advancement” by not proclining man incisors presurgically. Post-surgically you may have heard of or seen a bit of sagging or “relapse” which can be solved with Iowa space or proclining incisors as you level that Curve.

Keep it coming! Good luck studying you got this!

[Joti Kaler]

Case II – For the skeletal diagnosis I originally put constricted in the premolar region, but the answer was maxillary transverse deficiency. At what point do we know it is a true maxillary transverse deficiency, because I thought the molars looked okay and it was just in the premolar region. TY

[Greg Gittleman (Course Director) Gittleman (Course Director)]

For this one I would put it as overall maxillary transverse discrepancy although I do see what you’re referring to with the constriction being more pronounced in the premolar area. The reason I would do maxillary transverse discrepancy is that in addition to the premolar area, the molars appear to be a bit tight and have some “superior convergence” or dental tipping to mask the underlying skeletal discrepancy. In addition, given his significant A-P discrepancy, if his mandible was advanced and in the “ideal” position, he would present with more apparent transverse deficiencies. I hope that makes sense! Let me know if not!