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Cases
1st case
– #10 I felt like the mandibular molar mesialized and the maxillary molar was held in place from treatment as in it did not mesialize as much as expected from growth?
-#11 wouldn’t we expect some downward growth of the mandible?
2nd case
-#1 How is there a maxillary transverse deficiency?
– clockwise occlusal plane rotation for class III mechanics. This is because you get extrusion of the max molar causing a clockwise rotation of the mandible? Just wanted to make sure I was understanding it correctly.
TY!
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11 Replies
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Great discussion on cases:
1st case
– #10 – So over 25 months we would only expect 1.2mm of mesial movement. The tipping may through the eye off so I focus at the clinical crown outline and follow that. Maybe it’s 0.9mm instead of 1.2mm but it’s pretty close to average by my eyeballing it. A treatment effect is going to be a bit more distinct. Good eye for details!
-#11 wouldn’t we expect some downward growth of the mandible? – Absolutely there will be some downward growth and we can see that in the superimposition but the trend and dominate growth pattern is horizontal. Some people might write “Mandibular growth more horizontal than vertical due to hypodivergent growth pattern”
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Hi Chad,
On case 1 for module 2, it asks for CS staging. Although i wrote CS3, as i see concavities along C2 and C3, in the answer it said that the inferior border of C3 is flat, even though in the Mcnmara article (Table 1), it states that C2 and C3 must be concave to be considered CS3. Is this just a small thing? Am i over reading here? Thanks in advance.
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Balraj, You are right! Thanks for catching that. I will update the case.
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2nd case
– COUNTERclockwise occlusal plane rotation for Class III mechanics. (In a lateral ceph looking to the right)
Yes, it is a combination of the Maxillary Molar extrusion and Mandibular Incisor Extrusion. The dental affects manifest as the Counterclockwise rotation of that occlusal plane. (You may or may not see rotation of the mandible)
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Answering: 2nd case -#1 How is there a maxillary transverse deficiency?
This is a great question! So I’ll through out a follow-up to generate replies – when looking at just a composite 8 photos what things do you look for to diagnose transverse skeletal issues?
Good discussion! Hope other folks jump in on this as well. This is an excellent one to hash out together.
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Sorry just me again haha
Transverse from composite, I look for :
– Dental cross bite
– Shape and arch form
– buccal corridors
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Great! Those are all the key things I look for as well. The max arch in the occlusal shot appears “constricted” but then we don’t see any of the posterior crossbites that would be our dead give away. ..But the lower molars are significantly lingually inclined (accentuated Curve of Wilson). So if we imagine those lower molars uprighting so that there is less Curve of Wilson then we would run out of posterior overjet and perhaps even see the crossbites. It’s definitely not as obvious as other cases but seeing the maxillary constriction and the deeper Curve of Wilson then it makes it a nuance of this case.
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For Case 1,
6. why was it not listed to expand the maxilla. While there was not crossbite, I would clinically have the pt advance their mandible to see if there would be crossibite after the growth modification. often times there is a need for expansion, so how do we account for this or is that not something we should consider
7. when it asks for other treatment plans in this case my go to would be functional appliance. however, it said plan(s) so should we be listing mutliple plans. Like wait for growth completion and eval for orthognathic surgery? Also no tx is always an option but i’ve never seen that listed.
TY
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Good thoughts about the case here (Module 2, Case 1)
“6. why was it not listed to expand the maxilla.” I completely agree that maxillary expansion would be something I consider and I “simulate” it the same way you do. When I read the case question I was thinking the AP components of Class II and the suggested responses are geared that way as well. (Yes, Leveling Curve of Spee is primarily vertical). So sure…always good things to add in. Now Tip for the Exam: the samples posted on the ABO’s site all have about 4-7 responses per question… however when I typed my responses to questions I found I had 10-12. So no worries in including more but make sure for time management sake it’s not 20-25 responses.
“7. when it asks for other treatment plans” This is another good area to discuss. I initially thought the same thing when I was looking cases prepping for boards about whole case options (Surgical, Non-Surgical, No Treatment). However the question asks for “treatment options” – this were the board gives the freedom to talk about ways you’d get the job done. That is what the answer choices are focused at in this case. In the few samples from the ABO you will also see “answer must NOT include extractions” – this case I think is one of those where the board might say that. They would be testing our standard of identifying potential growth, attempting growth modification / functional therapy vs. “Oh it’s a Class II, I always do extraction 4s over 5s” – which would not look good for this skeletal / facial setup.
Does that answer your questions? Thanks!
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Hi there!
To follow up to this, when it is asking for treatment plans, are we okay to just generalize our responses with “Growth modification, class II mechanics, functional appliances, etc.” or should we be specifically listing out appliances that we would use like Twin Block, Headgear, Herbst, Carrier, etc.? I’m wondering if I’m trying to be too specific when I can take a step back and generalize my responses. Thanks!
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Samantha,
I agree if asked for a variety of treatment plans that big picture is good.
For example:
Surgery (LeFort, BSSO, and Extract L4s)
Non-Surgical / Non-Extraction with Class II corrector
Growth Modification Phase 1
No Treatment (always an option to think of! is it even the right time to do orthodontics?)
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