Weekly Question and Answer session. Nov 28, 2018

We had another wonderful session today with an adult patient who had a underlying class II skeletal discrepancy which was associated with proclined upper incisors, severe overjet and a palatal impinging overbite. Having said that though, she had a class I dental relationship. In addition she had dental extractions in the lower arch which resulted in distal drifting of the lower anterior segment.

On initial discussion, treatment was going to involve orthognathic surgery however on more detailed evaluation of the case, discussion was focusing more around the possibility of opening the spaces for the previous lower extractions to allow advancement of the lower anterior teeth and provide some type of anterior coupling. In addition there was a discussion about the use of a Mulligan intrusion arch with the added benefit of not only intruding the over erupted lower anterior teeth but also uprighting the measilly inclined  lower molars and with these treatment mechanics, in conjunction with the removal of the wisdom teeth early on could possibly avoid surgery.

This case once again demonstrates looking at the problem list and the goals of treatment in order to obtain a good diagnosis and ultimate ideal treatment plan for a patient

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