Module 2 Case 1 Prompt 4

[Chad Carter (Course Director)]

Lily,

Good question! I think this is a perfect example of how we can sometimes get tempted to “treat to the numbers”. So in thinking of his lip position we should remember where is that measured from?

What are your thoughts? What line do you use and what are the reference points?

Now think of his Max / Man positions and how that might affect those measurements. What are your thoughts there?

Look forward to hearing more on this! Everyone jump in here. This is a great group topic!

– Carter

[Maria]

Jumping in this topic.

For me the upper lip looks protrusive as well using E-line as reference and visually because lower lip is retrusive the upper looks even more protrusive.

Also I could not see the rationale for one of the answers be retrusive pogonion. In my opinion patient has a mandibular deficiency, mandible is retrognathic but with a strong chin button, so I wrote the contrary actually “strong pogonion projection”.

Thank you!

[David Dayan]

I agree that soft-tissue pogonion is strong and agree with Maria regarding the lips. Same rationale as Maria.

Just my thoughts on it.

[Chad Carter (Course Director)]

David and Maria,

Love your thoughts and posts here!

1) Pogonion – My eye is looking at the True Vertical Line. I would not be pleased if his soft tissue pogonion finished treatment in that position. That leads me to identify it as retrusive. Maybe it’s more of a gray area that it appears to me.

2) Strong Chin Buttons – Heck yea! Those can be frustrating, huh? You have a severe Class II patient but nature has given them so much tissue that they don’t “look” as Class II as they are skeletally. “Strong Chin Button” would be a stellar add on for his soft tissue profile comments.

3) Lips – Sarver’s text has some wonderful chapters on lips. The problem with measuring lips is that we are doing it based on the nose. With this boy’s age his lips are almost at “peak” fullness. However the reference E-line is confounded by his nose (which still has much growth left) and his mandible which is deficient. Where would you want his lips to end up at the end of treatment? If I use my thumb to cover up the lower lip, my guess is I really like the upper lip position. I definitely don’t want it dished in further, I could accept a little bit more fullness understanding it will thin as he ages. For the lower lip I want that roll just anterior to the upper lip so that’s how I get to my goal of advancing that due to deficiency.

What do you guys think about that? Sarver also has the S-Line to use rather than the E-Line (not an ABO thing but a cool go-by) that helps deal with the wild-world of noses that grow to different sizes.

[Maria]

Thank you for your explanation!

I see your rationale for the lips now and I agree in terms of treatment that I wouldnt want that ditched in. But the question asks us to describe the soft tissue diagnosis, so would that be wrong to say upper lip is protrusive to E-line reference plane? Because I thought in this type of question we should stick to the diagnosis and not thinking on our future goals.</p><p><br></p><p>And for the pogonion diagnosis I agree that skeletally is retrusive, but like you mentioned he has a strong chin button, so isnt soft tissue pogonion projected forward in this case? Since the question asks us only soft tissue diagnosis I thought I should not include skeletal pogonion.

[Chad Carter (Course Director)]

They are definitely valid. Even writing “Upper Lip is protrusive to E-Line” and “Normal Pogonion based on strong soft tissue button” would be succinct ways to communicate “Hey, I recognize the measurement and here is why” – don’t write a full sentence or paragraph – stick to bullets.