Module 2; Case 2

[Chad Carter (Course Director)]

Adedolapo,

I’m going to stir the pot a bit with the discussion here:

1) What points are you using to evaluate facial convexity?

2) What determines if it is straight, convex or concave?

Yes, absolutely subdivision malocclusions are appropriate.

1) How do you write a subdivision and what is your source?

Would love to hear if other folks have experienced confusion on subdivision.

Looking forward to your comments –

Carter

[Adedolapo Ayediran]

Hi Chad

The points for facial profile are Glabella- subnasale and soft tissue pogonium.

The convexity or concavity is determined by how the lines connect.

For subdivisons: I use the side CL II segment as my subdivision

• This reply was modified 8 months ago by  Adedolapo Ayediran.

[Chad Carter (Course Director)]

Adedolapo,

100% I agree with your convexity lines. I call very few folks “straight” personally because I have to be able to line those points up on a ruler. In this case, just by my eye, the angle of this patient’s convexity is slightly convex when drawn out. IF he was significantly concave then I’ll urge surgical correction more than a dental compensation.

Also for the subdivision that is the same way I describe it. I had not heard of the difference in sides you mentioned but Greg told me he has heard of this disagreement before.

One solution if you want to be extra clear for the exam is to describe each side:

Example:

1) Class I molar/canine left side

2) Class III molar/canine right side

Remember that response are best bulleted to help capture “points” with the examiners reviewing the test.

[Adedolapo Ayediran]

Good points.

Thanks Chad! Sounds good

[Maria]

For the facial diagnosis on this case, one of the key answers was “equal facial thirds” , but isn`t this patient slightly increased lower facial third? Would that be acceptable to be included? Because patient has a steep mandibular plane.

Thank you!

[Chad Carter (Course Director)]

Maria,

For discussion here, what points do you use for analyzing the facial thirds?

A “cheat” I will use is to have my fingers be calipers and put them up on the screen with those points on the soft tissue of the ceph so I can compare if there is a radical difference.

What do you see when you apply that hack?

You also mention because he has a steep mandibular plane angle. I understand that the Hyperdivergent Phenotype frequently has a long lower 1/3 but for this exercise (and in mimicking the exam) we are asking for the soft tissue – so the exercise is to block out the skeletal. Laser in on the vertical soft tissue and give that response. Does that help?

I completely understand the temptation to want to hit it all at once – and even sometimes to jump into treatment. That is definitely the pace of clinical practice where it’s a consult, fast treatment plan, and boom start braces. The exam is more segmented questions – you can economize the use of time by laser focus on their specific question.

Keep it up!

[Maria]

Yes, I use exactly the same “trick” with fingers to measure glabela to subnasale and subnasale to menton, but I guess sometimes looking to the photos in a composite and that being so small it can be hard.

Thank you for your tip!

[Chad Carter (Course Director)]

Yup… one advantage is on the exam you can make the photos larger. I used the traced ceph for looking at this case in particular.