Any Thoughts???

[wirebender1956]

does this patient really need or want ortho treatment? why not extract the teeth that are causing the difficulties? I see appliances and headgear etc as just a form of abuse in this case.

She is somewhat retarded but does have a self image and doesn't want the teeth extracted. From a medical point of view extractions are a big deal die to other medical problems.

 

[Betalab]

Do the upper posts bite on the buccal aspect of the lowers?.i reckon they will and I will put my money on the masseter to win the battle. Sounds like for all the opinions that you have it sorted in your mind. Look forward to the results.orthopaedic corrections with removable s will take lots of time..

-Patrick

 

[Kacey]

What about adding composite or something to fill in the occlusal enough to make it smooth on her tongue.

 

[wirebender1956]

Do the upper posts bite on the buccal aspect of the lowers?.i reckon they will and I will put my money on the masseter to win the battle. Sounds like for all the opinions that you have it sorted in your mind. Look forward to the results.orthopaedic corrections with removable s will take lots of time..

-Patrick

As to the masseter's chances in this battle, it isn't even a player. She doesn't bite at all. As I stated in the original post "chronic hypotonic muscle control. ........ she has NO muscular tone on any facial/head and neck muscles which results in a chronic open bite (3.75 inches) and absolutely no chewing ability."

Actually, such corrections don't take long at all if you employ the correct sort of mechanics. Teeth respond more favorably to finesse than brute force. True, I came here with opinions and an excellent track record with difficult cases spanning a lot of years but was looking for some thinking outside of my own head. Uprighting tipped teeth requires a certain sort of mechanics.....what I was looking for was perhaps a different way to achieve those mechanics. There are dozens ways to simply push on teeth but pushing only moves them bodily and that is the wrong sort of mechanics if your goal is to tip the teeth teeth upright.. from any direction.

 

[wirebender1956]

What about adding composite or something to fill in the occlusal enough to make it smooth on her tongue.

We might reduce the irritation that way but the tongue will still be trapped and the associated problems will still exist.

 

[Affinity]

Trying to picture your plan with the power chain.. Where is the fulcrum located? You mentioned a buccal acrylic appliance? If youre pulling lingual-buccally over the occusal, how will you get enough force without head gear? Or will you incorporate headgear?

 

[wirebender1956]

Trying to picture your plan with the power chain.. Where is the fulcrum located? You mentioned a buccal acrylic appliance? If youre pulling lingual-buccally over the occusal, how will you get enough force without head gear? Or will you incorporate headgear?

It takes surprisingly little force to move teeth if you incorporate the proper mechaniical forces. If you tried to just push them it would take a great deal of force it doesn't take much at all to tip them.

If I get a chance today I will try to do a rough sketch of the mechanics I plan to incorporate And upload it.

 

[Betalab]

As to the masseter's chances in this battle, it isn't even a player. She doesn't bite at all. As I stated in the original post "chronic hypotonic muscle control. ........ she has NO muscular tone on any facial/head and neck muscles which results in a chronic open bite (3.75 inches) and absolutely no chewing ability."

Actually, such corrections don't take long at all if you employ the correct sort of mechanics. Teeth respond more favorably to finesse than brute force. True, I came here with opinions and an excellent track record with difficult cases spanning a lot of years but was looking for some thinking outside of my own head. Uprighting tipped teeth requires a certain sort of mechanics.....what I was looking for was perhaps a different way to achieve those mechanics. There are dozens ways to simply push on teeth but pushing only moves them bodily and that is the wrong sort of mechanics if your goal is to tip the teeth teeth upright.. from any direction.

So the strongest muscle in the body doesn't play a role in this. Does she chew or is spoon fed? And her lower posts got laid over by gravity?.i will try to do a drawing of my extra oral face bow idea as well if I get the time
-Patrick

 

[wirebender1956]

So the strongest muscle in the body doesn't play a role in this.

chronic hypotonic muscle control.

Does she chew or is spoon fed?

Neither...she is tube fed. From my orignal post " absolutely no chewing ability."

And her lower posts got laid over by gravity?

No control of the tongue so it can't help counteract the weight of her cheek tissue....take away the toungue and the teeth lean to the lingual...take away the cheeks and the teeth will lean to the buccal.

 

[ortho artist]

When I read your description, I almost have it pictured in my mind. Then I look at her picture & I can't see it. We sure would like to see your creative results. (btw, bless her heart. <3)

 

[chief26]

opps

 

[chief26]

extractions Are A Bad Because Then You Will Have Deterioration Of The Mandible. Pt Is On A Ventilator...Which How Did They Get The Pic....Hummm...Cant Band Because Pt Cant Bite Down....Cant Do Braces Because Keeping A Dry Field Or The Pt Off The Ventilator Long May B An issue. So Double Ck That Dr Can Bond. How About A Creative Spring Aligner. Instead Of Reseting Anteriors Do The Posterior...U Would Have To Make It Stronger With Reinforcing Wire On Lingual And Buccal.Please Post.Pics Of Whatever U Make...

 

[chief26]

Second Look.....Mayb A Upper Appliance That U Can Use To Anchor To...If The Dr Can Bond Buttons To The Lingual U CouLd Run The Chain To The Buccal Of The Upper Appliance.....

 

[chief26]

Bonding Buttons Would Be The Quickest And Easist Bonding Procedure....If He Can Bond At All...

 

[ortho artist]

Bonding Buttons Would Be The Quickest And Easist Bonding Procedure....If He Can Bond At All...

Yeah, what about buttons on buccal of uppers with power chains to buttons on lingual of lowers? (excuse my crude drawing)


{like chief said}

 

[wirebender1956]

extractions Are A Bad Because Then You Will Have Deterioration Of The Mandible. Pt Is On A Ventilator...Which How Did They Get The Pic....Hummm...Cant Band Because Pt Cant Bite Down....Cant Do Braces Because Keeping A Dry Field Or The Pt Off The Ventilator Long May B An issue. So Double Ck That Dr Can Bond. How About A Creative Spring Aligner. Instead Of Reseting Anteriors Do The Posterior...U Would Have To Make It Stronger With Reinforcing Wire On Lingual And Buccal.Please Post.Pics Of Whatever U Make...

Bonding pads were along my line of thinking as well. I intend to weld a short piece of 045 tube to each pad and put a wire with stops through the tube which will allow the wire to rotate in the tube but not come out. This wil allow the teeth to tip when we pull laterally on them from the buccal. I am thinking of hooks out of heavy acrylic on the buccal of the mandible that are long enough to allow the doc to adjust the height as the teeth tip buccally to keep the power chains near the center of rotation.

Sorry I haven't had time to do an rough drawings yet... We are slammed at work cases 3 deep as far as you can see and I am training a new tech at the same time. When I get home, more work is the last thing on my mind.

At this point, I don't have models because the girl will have to be hospitalized to even get impressions. We have a rather long relationship with this doc. He does pro bono work with retarded and handicapped children with severe dental problems and we do the lab work for him pro bono. A year or so ago we worked with him on a case for a young boy who was literally chewing his fingers off. We were a last resort...if we couldn't keep his fingers out of his bite plane, they were going to have to extract all of his teeth. We designed "fixed/removable" cage of sorts that must have worked because he still has his teeth.

I do like the interesting cases.

 

[ortho artist]

Any updates on this case? just curious....

 

[wirebender1956]

None yet. Pt has had some other health issues that take precedence over teeth. She has to be put under to get an impression. Doc says that maybe we can start working on this in September. Good to have more time to think about this one.

 

[findadentist]

Crozat can be a good option but it should not create other complication. So, looking at overall oral condition, advice from a professional dentist is highly recommended.

 

[vkorthotech]

I had a case similar to yours. I fabricated a maxillary acrylic plate with a posterior bite plate. Then I attached thick lingual bars with soldered hooks to the posterior bite plate so the arms go down toward the tipped teeth. Have the doctor cement some buccal attachments to the lower teeth and uses elastics to pull the teeth.