to do the last of our cephalometric analysis i did a few other ones today on kids and teens
i had an open bite one i had a deep bite one and now we have a class three one
so a little bit of sampling of everything today this is an adult super super super important
that you are taking steps on any and all of your class 3 patients i don't care if they're growing
they're not growing obviously this patient is 20 and as a female so in this no longer growing
20 and a male might still be growing so but you still need to take a safe because you need to know
what is going on too often i see doctors trying to take these invisalign or clear correct cases
was class three without theft and i'm like whoa we are moving blindly here we have no idea if we can
flare the incisors can we not flare the incisors what's going on is this a jaw surgery case can we
possibly do this without jaw surgery just because the clinchek or the clear pilot setup says you can
doesn't mean it's possible doesn't mean that you won't be pushing teeth through the bone um yeah
you really without a ceph you are not doing standard of care on a class 3 case hands down
every single case i can't tell you this enough even more so on a growing patient and remember
boys grow up to 2022 girls grow up to usually 15 16 17. um in class three you can have late
mandibular growth spurt so you want to get yourself on everything i won't even
help doctors with cases that don't have sex to be really honest um because i don't know so um
so as i've recommended before i like having both cephalometric analyses i like for my gps to have
both a susuni plus and a steiner especially on the harder cases the susuni's nice because it explains
everything in nice clear english right here now i can look at this because i'm trained and i
can be like whoa wow class three wow very flat incisors wow step steep mandibular plane angle
but i can get all that without seeing these numbers that's the benefit if i really really
wanted to see numbers i could run the numbers but a lot of orthodontists don't even bother with the
numbers because we already know what's going on but you guys don't have trained eyes for this
so you guys need to get the numbers anything that shows up in red is like blaring like big
problem huge problem now those other ones i showed you earlier today i don't think we had anything in
red so they really were kind of minor maybe we did on the open by case but definitely not in the deep
bike case um anything that has like multiple standard deviations and stars big big big big
problem so focus on those okay now sometimes your sasuni and your steiner aren't going to match and
they're slightly different numbers and remember i told you before that i am working on actually
i think i just finished it a little handout i'm going to make that free for anyone that does an
all a cart session with me or subscribes for any of our membership plans otherwise it's 20
you can contact me if you want to get a copy of it if you're not subscribing to anything or
purchasing a plan um but let me show you how to what these mean and what we're seeing here so
like i said i see a steep mandibular plane angle i see crazy flared incisors so i know for a fact
that i can't lean these i mean this is already dangerous the position we're in right now these
are going to have to come back these are trying so incisors always want to try to touch right
so they're going to do their best to reach and touch even if they have to stretch and put
themselves in an unhealthy position so if we had to put this back in a normal position we'd have a
very severe class 3 bite and maybe it doesn't look so bad here because this is reaching to try to
reach the bottom teeth but it's not in a healthy position so we need to put it back in a healthy
position which means that this would be impossible to do this case um i don't have the clinical
photos on this but based on just this this is a jaw surgery case i mean maybe you could treat it
compromised with lower body extraction i think this is way beyond a lower incisor extraction
and sequential distillation class iii elastic case just based on what i'm seeing but maybe you could
take out lower buys it's not gonna look great the soft tissue profile is gonna be looking worse
than it already does so not my preference but you could as long as you had all kind of paperwork and
compromise stuff signed just remember that once you do that kind of compromise you pretty much
are preventing them from being able to get the jaw surgery later so remember whenever you do
any type of treatment plan you need to explain all the risk benefits and alternatives and unless
you know how to explain the surgery what that looks like what that would be like what would
be covered by insurance what would it be even if you're doing it not doing it you really have no
business taking this as a compromise case you need to refer this patient to ortho so they can get
the information on what perfect would look like what would that look like what does that involve
you'd be surprised how often it is fully covered by insurance especially when it's done the right
way because if the patient's having sleep apnea or airway issues it often can be covered by insurance
and i've really i've had patients before that have been so upset that gps have botched them
basically because they didn't explain what all the options are and that is standard of
care so do not take a class three case i can't emphasize this enough without cefsef numbers
okay so what do we see here well the susuni basically tells you what i already said right
class 3 growth pattern okay what else upper incisor is protruded i told you i saw that
um lower incisor is slightly retreated or upright that's fine but that just means that
everything we're having dental alveolar compensation dac see that's in in um
red that means the teeth are trying to lean this is trying to lean back to reach this this is
trying to lean forward to leech that that's all it is it's just camouflaging itself but it's actually
putting itself in an unsteady position trying to reach so we can't keep it like this we have to
put this where it needs to go we have to put this where it needs to go more upright and it's going
to make the class 3 actually worse but that's what we got to do right that's what that means here the
upper incisor is leaning forward that's the angle okay we have a steep mandibular plane angle so
say again upper incisor is forward now what is the cause of the class three well if we look at
our sna and snb in our a and b it doesn't look so crazy it's not red we have a couple standard
deviations so basically this is a bi-max case bimax means that both jaws are actually forward
of the cranial base that's okay nothing wrong with that that just means you have a nice better airway
but the lower is more forward than the top one okay so if this patient is was growing
maybe we would you know do like some type of protraction face mask to help to um bring the
upper jaw forward a little bit you know to help to balance it out a little bit but too
late patient's not growing anymore patient is female so our only options are either a jaw
surgery or probably be taking out lower premolars and creating a compromised situation that's not
going to look so good soft tissue wise but if the patient wants a doesn't want to lose these
front teeth which is what's going to happen if you leave it like this eventually because of the
position there's going to be perio there's going to be tissue breakdown there's going to be bone
breakdown there's going to be root breakdown and those teeth are going to get loose and fall out
then you need to do the ortho so this is a necessity
all right hopefully this was helpful for you um definitely learn a little
bit more about saps um start using them don't be so afraid of them all right thanks so much