Module 2 Case 1 Prompt 1

[Chad Carter (Course Director)]

Lily,

Similar to your first question, I look forward to hearing your thoughts about incisors relation to diagnosis of the transverse.

The things I look for in diagnosing skeletal transverse deficiencies:

1) A PA ceph where I can actually measure (or CBCT cut)

2) Posterior crossbites as you mentioned

3) Wide buccal corridors

4) And the one that tricks most people a “relative” vs. “absolute” transverse discrepancy – this is present in other discussions but a quick summary is “what would this occlusion look like if advanced to Class I?” Would there be edge to edge or crossbites in the posterior once advanced to Class I? e.g. if you were treating surgically would you need a multipiece LeFort in order to get it to fit? This is measured on cases as the relative with of the maxillary 6-6 and mandibular 6-6.

Does that help?

Thanks

Carter

[Maria]

Jumping in this topic here.

I also included in the skeletal components here narrow maxilla.

1- I agree I also usually would look to PA or CBCT cut, but we only have our clinical observations here. Would you think that the ABO boards could penalize us here for including narrow maxilla as an answer?

Patient has increased buccal corridors, just by looking to the palate shape and size in maxillary occlusal view it strikes as narrow to me, higher palatal vault. Also mandibular posterior teeth have some lingual inclination.

2-Also wanted to ask if those bullet points could be included:

-Long ramus

-Strong pogonion projection

-Broad symphysis

3-If we say “hypodivergent” “lower gonial angle” do we necessarily have to add low mandible plane angle to be considered fully proficient answer?

[Chad Carter (Course Director)]

1) I would not include a narrow maxilla on this patient’s diagnosis. While anyone is welcome to expand ,and I know many people expand 99% of their patients, I don’t see any of the frank features indicating a skeletal issue for the maxilla.

2) For your additional points those are all good thoughts that make sense to me. Nice bonuses added on.

3) I understand that the terms “Hyperdivergent” “Normodivergent” and “Hypodivergent” all refer directly to the mandibular plane angle. So I would not personally write out “Hypodivergent” and also “Low FMA”. As we have reviewed a little bit before, there can be “Hypodivergent Type” patient’s that include a cluster of clinical features. I would stick with speaking about each feature with each tissue in each dimension. Someone can have a “High FMA” / “Hyperdivergent” and still have a dental deepbite as well…. teeth are weird!

Keep at it!

Carter