Orthotown June 2016 - (Page 10)

clinical orthodontics // message board Class II Case: Extract, Forsus, or Surgery? A complicated situation, with many available treatments- what do Townies think about each of the options? Orthotown.com > Message Boards > Clinical Topic > Clinical Orthodontics > Class II Case: Extract, Forsus, or Surgery? panda30 Member Since: 10/19/15 Post: 1 of 25 Related Message Boards Class II With Thumb Sucking Habit Class Habit Invisalign Class II Adult, Clincheck Help Invisalign Class Introduction This patient is 11 years old and has increased overbite, mouth-breathing habit and constricted airway, Class II dental and skeletal (ANB=6, Wits=6.5), the IMPA is currently 100 degrees. I've referred him to ENT for an evaluation (my first) due to the airway on the ceph. I've shown this case to all my co-residents and none of us agrees on a treatment plan, so I would like to see what Orthotown has to say. The treatment plans that we came up with thus far are: 1. Surgery. Maybe advancing the mandible will help with the airway. 2. Extractions. Upper 4s only or upper 4s and lower 5s have been suggested but I'm concerned about extracting with such a deep bite to begin with. Will it be a losing battle to keep the bite open? 3. Non-extraction with Forsus. Concerns are the lower incisors are already at 100 degrees and they may flare out more. Suggestions? Thanks in advance! ■ 4/11/2016 Fenrisúlfr Member Since: 02/25/09 Post: 2 of 25 Skeletally, he seems max. prognathic with the mandible in a reasonable position and procumbent maxillary incisors. Extraction of upper 4s and lower 5s would work great here. Leveling shouldn't be an issue if you get on the 7s. I'd retract the upper 3-3 with a T-loop CLAW (differentially gabled) to intrude simultaneously. He has mandible growth remaining, so non-extraction on the lower arch can lead to lower incisor flaring, inadequate overjet during space closure and an inability to reduce protrusion adequately, and/or impacted lower 7s. ■ 4/11/2016 ucla98 Member Since: 09/28/07 Post: 3 of 25 He has ½-step Class II molars on both sides. Therefore, I would only extract upper 5s. Less retraction equals less worry about bite deepening and slightly gummy smile. The lower IMPA is 100 degrees but it's stable and the norm for his race. There is essentially zero crowding in the lower arch. I hate to extract lower teeth and retract the lower incisors back against his tongue. I'd retain this case with bonded fi xed 1-1 and upper and lower Hawley's. I wouldn't worry about the lower 7s; they should erupt fine. He's only 11. ■ 4/11/2016 Fenrisúlfr Member Since: 02/25/09 Posts: 4 & 5 of 25 I wouldn't worry about retracting lower incisors against the tongue. Extracting lower 5s will resolve anterior crowding and the anchorage loss will close the rest of the space. Non-extraction Continued on p. 12 10 JUNE 2016 // orthotown.com http://www.Orthotown.com http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=693&t=267317&g=1 http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=693&t=265830&g=1 http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown June 2016

Orthotown.com Highlights
Embrace Progress: AAO 2016 Recap
Class II Case: Extract, Forsus, or Surgery?
Corporate Profile: 12 Strategic Insights for Patient-Producing Postcards
What’s On Your Tray? Tray for Bonding Brackets
Clinical Orthodontics: A Glimpse of Today’s Residency
Software Solutions: In-house server or cloud-based system? The answer depends on your practice—and preferences
AAO Product Showcase
Anchors, a Way: Closing the spaces caused by congenitally missing teeth
Poll
Ad Index

Orthotown June 2016