Orthotown September 2015 - (Page 42)
case presentation // feature
A Response-Driven Treatment Plan:
Navigating a Difficult Case Without a Road Map
by Richard Schechtman, DDS
As orthodontists, we pride ourselves
on the ability to evaluate a patient based
on clinical and radiographic findings,
and derive a treatment plan that meets
both the esthetic expectation of the
patient and the functional occlusal goals
of the doctor.
An experienced clinician finds that the
majority of his or her patients' malocclusions fall into categories that repeatedly can
be treated in methodical ways with favored
appliances and systematic sequences (a
somewhat "cookbook" approach). Such
an approach provides order and practice
efficiencies, and makes running a busy
practice with good quality possible.
Not every patient gives us the gift of
a malocclusion that treats on autopilot.
Occasionally we have to put on the brakes
from the seven-minute consults and sameday starts, and think. Patients who present
with difficult malocclusions require a
different roadmap with diagnostic forks
in the road:
Start with Plan A.
Monitor for response
Continue same
Alternate Plan B
The following is one of the most
difficult cases I've treated without any
cookbook to follow, requiring periods of
treatment response vigilance before deciding upon the final plan.
A 14-year-old female presented with
the chief complaint of crooked teeth.
Menses had started at age 12, leaving
her near the conclusion of her pubertal
growth. The profile was straight and there
was a small chin deviation to the left.
There was a significant mandibular arch
asymmetry deviating left. Cephalometric
evaluation revealed a two-degree ANB
angle but a negative Wits analysis, and mild
skeletal hyperdivergence. The maxillary
incisors were retroclining, contributing
42
SEPTEMBER 2015 // orthotown.com
to an edge-to-edge overbite and overjet.
The mandibular incisors were mildly retroclining. She had a Class III malocclusion
subdivision right with a Class II relation on
the left side.
Also present were anterior (UR2) and
bilateral posterior crossbites (more pronounced on the left side), deviant midlines
(upper deviated 2mm right, lower deviated
3-4mm left), severe maxillary crowding
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Table of Contents for the Digital Edition of Orthotown September 2015
Orthotown.com Highlights
Embrace Progress: How Staffing Helps Mitigate the Threat of Corporate Dentistry
Vertical Control
Combined Orthodontic Restorative Treatment
Industry News
How CBCT Can Help Jaw Alignment and Airway Issues
What’s On Your Tray? Banding and Bonding
What is Your Retainer Protocol?
New Products
Practice Solutions
Leveling the Playing Field: Partner with Staffing Experts
The Time for a Cloud-Based HCM Solution
Poll
A Response-Driven Treatment Plan: Navigating a Diffi cult Case Without a Road Map
GORP Review 2015
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