Orthotown November 2017 - 19

donticsortho

Is there a shift from cr-co? ■
3/2/2016

No, as best I can tell there is not. ■

Member Since: 06/25/12
Post: 2 of 41

WKC
3/2/2016

I'd inform the parents that their daughter might require orthognathic surgery in the future
(plant the surgery seed), but for now the transverse can be corrected which will help establish a
better diagnosis and prognosis for the vertical and A/P components. IOW, you may have a very
different set of problems after the RPE. I'd treat it like a Phase I of a likely three-phase tx plan. ■

Member Since: 05/19/11
Post: 3 of 41

flybywire
Member Since: 06/28/04
Post: 4 of 41

3/3/2016

davidharnick

All about informed consent. Cheers. ■
3/3/2016

What would the three phases be? And if there is no CR/CO problem, what is the advantage
of expanding now as opposed to later with screws when she is ready for surgery? ■

Member Since: 08/28/02
Post: 5 of 41

zxzxzx
Member Since: 02/28/03
Post: 6 of 41

3/3/2016

I would expand her now. I do this with my Class III cases also. ■

donticsortho
3/3/2016

Yeah, I was quick to jump on expansion without looking closely at the fi lms. There is a
significant bone discrepancy between the left and right that may be too much to compensate
dentally. An occlusal splint may be a better way to check for a CR/CO discrepancy before
changing her occlusion permanently with an RPE. The 3 "phases" would be expansion, then
comprehensive to attempt compensation, then surgical if you can't avoid it. But as David said,
informed consent is crucial in this case. ■

Member Since: 06/25/12
Post: 7 of 41

flybywire
Member Since: 06/28/04
Post: 8 of 41

3/3/2016

WKC,
This case illustrates quite well the inadequacies of conventional orthodontics and treatment
planning. This is a 3D problem, and it will be very difficult to diagnose the problem and to
develop a plan for correction utilizing 2D records. Consider these three tenets of practice and
how they might affect your perceptions of the problem:
1. You can't believe what you see in the mouth (Dr. Thomas Basta, restorative dentist.)
2. Use a reference (A seated condylar position of the mandible.)
3. Stop trying to do the impossible.
Without adequate 3D imaging, the long-term solution will be very difficult to develop.
A CBCT would greatly enhance the view, but without a repeatable reference position for the
mandible, the lateral discrepancy is difficult to assess. Read Ryan Tamborino's posts in this
regard. Based on the frontal ceph, the asymmetry is of long standing. Read Dr. David Hatcher's
work on radiographic interpretation. Finally, integration of all of the data, development of a
treatment plan, and creating a desirable future for this patient will require time and effort on
your part. Radiographic interpretation, learning and using instrumentation, and understanding
what orthographic surgery has to offer will be part of a journey. While maxillary expansion would
seem appropriate, how that integrates into the overall treatment for this patient would be nice to
know. There are resources available, but these will take time. It would be in the best interests of
the patient to take a step backward and refine the approach. ■

orthobob
Member Since: 04/14/04
Post: 9 of 41

3/3/2016

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