Orthotown March 2018 - 18
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Punt This Perio?
One member asks his fellow Townies: At what point can orthodontists no longer be of service?
charlestonbraces
Member Since: 06/05/09
Post: 1 of 26
Introduction
37.10 female, cc of crowding, history of generalized moderate periodontal disease being treated
for a little over a year by a periodontist who has given the OK for ortho (see attached letter).
Unfortunately, the photos don't show the extent of the recession since the assistant couldn't get
the lower lip to stay off the L incisors. I have included the model photos as well, hoping to show
the extent of the recession at least on the LL2 (which I have outlined in pencil), but even then,
the lip trapped a bubble in the impression.
There is moderate U/L crowding, generalized recession, severe recession with no attached
gingiva LL2, the bone loss looks moderate-severe on the lower incisors, especially the LL1 and
to a lesser extent the LL2.
Assuming I have to extract LL2, I just feel that if I try to move these incisors, I will end up
losing the LL1 as well. I think I am going to bring up to her that I only feel comfortable treating
the U arch. But I know she is going to lose an incisor or two in the next 15 years. Then she will
remember me as the ortho doctor who refused to treat her lower arch and now I have lost these
teeth and have a huge gap. And the mechanics will be a nightmare with the shifted center of
resistance and increased lever arm. Maybe I should punt the whole darn case!
Not a lot of root buried in the bone on some of these incisors.
Darn lip
18
MARCH 2018 // orthotown.com
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