Mod 4, case 2

[Chad Carter (Course Director)]

Shadi,

Great discussion here!

1. This patient’s condyles look slightly asymmetric to me.

Absolutely good thing to mention! It shows attention to detail in reviewing the records and ensuring the patient is has asymptomatic TMJs.

2. I am confused by we are not extracting L4s to retract lower incisors ( while maintaining their torque) and get a greater mandibular advancement with surgery? Arent they protrusive to NB plane ?

Yes, they are protusive…very much so! Extraction of L4s is definitely an option. I’ll give my thoughts on why I would not have extracted L4s in this case (I did not treat this case).

– Ethnic norms rule the day! The esthetic concerns are the skeletal crossbite and they man asymmetry. The fullness convexity are all beautifully appropriate for here. The proclination of the man incisors are in solid bone and also ethnically appropriate.

– Planing a counterclockwise rotation of mandible so that will reduce protrusion.

– Treatment efficiency! About half of my patients are African American and extracting premolars in the absence of crowding OR bimax protrusion can be very challenging when closing space! Different genetics in different folks impacts the density of cortical bone and efficiency of moving teeth. So with stable incisor angle ethnically, I’d focus on the mandible rotation.

ALL of that taken into account – YOU CAN STILL CHOOSE TO EXTRACT L4s! That’s a great plan too… it’s just not what was done here.

Good discussion! Keep up the conversation folks

Carter