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Module 4, Case II
Hi, in the skeletal diagnosis of this case, the maxilla was protrusive after we adjusted the SN-MP/FMP. However, the skeletal treatment objective was to maintain the maxilla in AP. Isn’t the treatment objective should be based on the diagnosis?
2- SN-MP was 44 which indicates hyperdivergent while FMA was 26 which is normodivergent. I thought whenever both are skewed we should use FMA. I thought he was normodivergent ?
Thank you
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3 Replies
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Heather, what great questions! Hopefully others jump on this conversation too!
1) Yes, you are spot on with a protrusive maxilla as a diagnosis and that treatment follows diagnosis. Now for treatment… what are our options to AP skeletal treatment of the maxilla? In a growing kid headgear is possible for restriction, we also have reverse pull, cervical pull and then the surgical advancement options. In a non-growing adult though there is not an option to setback the maxilla [if you want to go down this rabbit hole let me know, there is a theoretical surgery that I’ve discussed with at least a couple dozen surgeons who say it’s not possible]. On top of this, from a soft tissue perspective it is ethnically appropriate and esthetic. Therefore – our goal is to maintain the maxilla in the AP.
2) Once again, you are spot on that going to FMA as a reference when there is a steep cranial base is correct. The number does say normodivergent. The response listed is “Hyperdivergent tendency”. I call this a “cautionary diagnosis” for many of my patients. The tendency is based on all the other features of the mandible that indicate vertical growth – Antegonial notching, posterior growing condyle, short ramus height. She is “hanging on” as normodivergent but is a patient I will be very cautious in control of the vertical because of those other signs.
Great great stuff to think on!
Final week of studying! You will crush this exam!
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Nice thoughts! Thank you!
Could we say as answer “hyperdivergent” or should we clearly state ” hyperdivergent tendency”?
Also, would it be wrong to include in as other bullet points: “steep mandibular plane” , “short ramus”, “increase gonial angle”?
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Maria,
Those other observations and definitely valid.
For me, I would write “hyperdivergent tendency” because I want to communicate 2 things 1) I know this is within normal for a “number” and 2) I recognize that I will need to vertically control the case.
Good to be observant and have many terms in your tool kit!
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