My Courses › Forums › Synapse Orthodontics: Module 6 › Surgery
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Surgery
Posted by Joti Kaler on February 10, 2023 at 2:22 pmHow in detail do we have to go? Like for Lefort do we need to say segmental? ( Does that only refer to 3 piece or 2 piece as well? Can we just say maxilly advancment and expansion?
Chad Carter (Course Director) replied 1 year, 11 months ago 3 Members · 5 Replies -
5 Replies
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Joti, I think there are two parts here:
1) Absolutely state the skeletal goals in the Trans/A-P/Vertical dimensions – if that is what the question asks.
2) If the question asks about treatment then I can see situations where the Board would expect that we identify a 3 piece vs. 2 piece LeFort I.
So general question for folks – What are the clues you look for in recommending a 2 or 3 piece segmental LeFort? And even more on that – what about a SARPE before a LeFort?
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If It’s a Class 2 case, I’d probably be more inclined to do a SARPE 1st then the BSSO.
If it was an Open Bite Surgical Case with 3 planes of occlusion I would consider treatment planning a 3 piece,
As an aside, I know from my clinical experience, oral surgeons in my area do not like to do 3 piece or even 2 pieces surgery.
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Anish, those are great plans!
SARPE definitely for a transverse only maxilla issue OR sometimes with severe transverse (>6mm) you need a SARPE first then a segmental LeFort after (LeFort multipiece cannot do >5-6mm)
You hit the nail on the head with the Multi-Plane occlusion – that’s I think ABO test worthy! [I don’t think IVRO vs. L-cut BSSO, etc. is really where they intend our specialty to focus – let surgeons do surgery – we set goals]
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The board Sample Case #7 asked about a camouflage class 3 tx plan.
Now lets flip that what would a class 2 camouflage case, would you think U4s ? Should our first instinct be to go to be retraction of maxillary arch with TADs?
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I do think of a classic Class II camouflage as extraction of U4s and L5s (if going for a Class I molar finish and the crowding works out etc). That is just “standard” though…. there are many options to consider. Sometimes it can be extraction U4s alone… many different ways to think about it. Retraction is very promising as well but I don’t do much whole arch distalization like some speakers show these days.
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