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Mod 4 Case 1
My questions are about Case 1.
1. Very clearly vertical control is the primary concern in the case, but I feel like a huge portion of the diagnosis is not discussed…while she is Class I as she stands, she appears to have a class III vertical growth tendency and is rotated down and back into Class I. Even eyeballing Wits she appears to have Class III dental bases. With TAD assisted intrusion or vertical control + growth and then accompanied autorotation to advance pogonion, her Class I skeletal and dental relationship would quickly become Class III and you would be forced to further upright man incisors and procline max incisors to compensate. This wasn’t addressed at all in the prompts and I think has large ramifications when evaluating treatment timing and treatment options.
2. The prompts focused on posterior intrusion/impaction for this patient, however her animation photo did not show excessive posterior gingival display…to me the posterior looked normal and anterior incisal display appeared deficient (which also matches up with the fact that the incisors were proclined and protrusive). If treating for esthetics and not just open bite closure, would it not make more sense to just hold the posterior dentition (not intrude or impact) and then extrude/upright max incisors?
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1 Reply
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Michael
Interesting points here. (BTW Anyone can jump on responding to anyone elses post! Trying to keep discussion going to we all help each other with this prep)
1. I like how you are eyeballing Wits and thinking about the impacts on the dentition and changing from Class I to Class III. For the cases I’m concerned about overrotating from Class I to Class III I generally see a larger posterior ramus to mandibular length ratio. Her posterior ramus is so short I’d feel comfortable but as you said “aware” during treatment.
2. You sure could extrude the incisors. The real point of this case it to help everyone focus on multi-plane occlusions and the myriad of ways to treat them. Personally, I think she is under animated on the records and so some intrusion would help – but I didn’t treat this case so I don’t know how it worked out.
Thoughts from others here about what Michael brings up?
Carter
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