My Courses › Forums › Synapse Orthodontics: Module 6 › Module 6 Case 1
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Module 6 Case 1
Posted by Leah Stetzel on February 3, 2024 at 5:29 pmHello,
Can you provide rationale for the additional records?
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CBCT – to evaluate bone structure in 3d?
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Myofunctional therapy — anterior open bite- tongue posture?
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Electromyographic eval — ?
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Polysomnogram- to eval for sleep disordered breathing
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Pa ceph- to evaluate transverse asymmetries?
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Serial cephs- to evaluate growth
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Tec99- I presume to rule out progressive condylar resorption
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Periodontal charting- I understand poor OH
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I also thought med history and history on habits would be warranted?
Chad Carter (Course Director) replied 12 months ago 3 Members · 5 Replies -
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5 Replies
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Can you also provide rationale for “correct mandibular volume body asymmetry”?
I guess I am wondering what exactly we should be seeing from this case? I’m sure you all included it for a reason! Thank you!
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Leah – replying to your question Can you also provide rationale for “correct mandibular volume body asymmetry”?
This is a surgical esthetic goal when we review cases for our Dentofacial Deformities Board. There are two ways we plan it surgically.
1) Reduction – through Inferior border shave of the mandible to reduce excess.
2) Addition – through plating of a MEDPOR Implant so that it esthetically supports the symmetry we are creating skeletally.
DISCLOSURE: This is a product from Stryker and posting the link here if you are interested in reading about different facial implants we use in my practice for malar deficiency and mandibular asymmetry. No financial interest and no mention of this from the board
https://www.strykermeded.com/media/1192/medpor-facial-contours.pdf
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Here are my thoughts on the additional records for this case:
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CBCT – to evaluate bone structure in 3d? Yes absolutely, though we can tell this was reconstructed from a CBCT so we know we have it but this is obviously a case with skeletal issues in all three planes with gross asymmetry.
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Myofunctional therapy — anterior open bite- tongue posture? Yes, I don’t personally have experience with this but it is listed in the Boards reading list and I know some people swear by myofunctional therapy.
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Electromyographic eval — ? This tests for muscular activity. The diagnostic procedure will evaluate which muscles are active or atrophied. Is his growth affected by poor muscle function or is it genetically predispositioned?
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Polysomnogram- to eval for sleep disordered breathing Yes, excellent to know presurgically because it can dictate how much of an advance we plan or if we tack on a genioturbucle advancement while doing a BSSO.
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Pa ceph- to evaluate transverse asymmetries? Yes, an option for when you don’t have CBCT to reconstruct from
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Serial cephs- to evaluate growth 100% – we try to avoid orthognathics until growth is complete – unless it’s a very limited early case with a planned revision later.
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Tec99- I presume to rule out progressive condylar resorption – Yes, exactly – check to make sure there is no active disease.
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Periodontal charting- I understand poor OH – Correct and it can help decide if any teeth are hopeless and if that impacts your extraction decisions.
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I also thought med history and history on habits would be warranted? 100% great add on. AAO standards say it’s included anyways but it’s not presented in the records so I completely agree you should ask for one
What other records would people like? Such an interesting case
Carter
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Hi Chad,
Piggybacking off of the first prompt.. when addressing the second prompt outlining surgical treatment objectives, could one of the responses be “Potential bilateral joint replacement pending further diagnostic tests”? Just to cover your bases? Or would this moreso fall under the actual surgical treatment plan rather than objectives? Or do you just take the question at face value and assume since they provided no further records or info that the joints are fine?
Thanks,
Kate
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Katie –
I like your line of thinking here. I see no harm in adding that in as a comment!
It shows a couple things to examiner:
1) You recognize there might be pathology which needs to be ruled out.
2) You recognize that the surgical plan (quarterbacked by OMFS) can impact your setup and orthodontic finish and retention (all key in the outcomes assessment and case management objectives)
Good discussion!
Carter
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