The comments

Dr Sylvain Chamberland says:

I think mesognathic profile is misused. The ceph above show a retrognathic mandible with a low mandibular plane angle (FMA).

A classe II div 2 malocclusion has typically retroclined maxillary incisors, proclined  lateral incisors often overlapping over the centrals. Some case have 3 or 4 incisors retroclined. The case shown above has 3 retroclined one proclined.

The prefix "meso" "dolico" and "brachy" are use with the suffixe "cephalic" but not with "gnathic". So I don't understand why your syllabus use mesognathic.

However, mesocephalic mean normal rounded face in the frontal view (picture A) . Brachycephalic refers to a short and broad face (picture C) and dolicocephalic refers to a long and narrow face (picture B).

A class II div 2 patient has most often a brachycephalic face, sometimes it might be mesocephalic, but not dolicocephalic.

I hope that help.

Best regards and good luck for your RDA.

Karina says:

Hi,
I have a question shouldn't in the above Cephalometric profile view showing the Class II division 2 be a mesognathic profile versus the Retrognathic profile?
i am a dental assistant studying for my RDA and studying for the test i came across the Division 2 description: Maxillary central incisors are upright or retruded, and lateral incisors are tipped labially or overlap the central incisors with deep overbite. = mesognathic profile. Please help/explain.
Thank you,
Karina

Dr Sylvain Chamberland says:

Thank you Stephen

I am more than happy that you like this website. On thing I can tell you. It means a lot of work and reading and searching to get "decent" and valuable information.

Best regards

Sylvain

Stephen Desjardins says:

Excellent site... Je le consulte souvent et j'encourage mes patient(e)s de regarder cette page avant de se soumettre au procédure du piercing orale/faciale. Je ne sais pas si ça génére bcp do références, mais ça ne nuit pas.... Bravo!

SD

Dr Sylvain Chamberland says:

The pain you describe "shock like pain" in your complete right side of both jaws indicate me that the source of your pain might not have been "the impacted canine".

I am very surprise that it took 5-6 months to cure. Usually, it is 1-2 weeks.

If you are still experiencing pain in the lower jaw, may be you should look for dental caries, pulpal tooth infection.

You need to see a "good" dentist.

Best regards

RADHA RANI SINGH says:

i was having a impacted canine on right side upper jaw.i was experiencing shock like pains in my complete right side in both the jaws.it was surgically extracted and it took 5-6 months to get cured.still i feel painful sometimes while eating in my lower jaw .i wanted to know will it be cured permanently or not.how long will it take?

Dr Sylvain Chamberland says:

I know too few about Rickets analysis to comment on those numbers.

When i wrote this article, it was to provide general guides lines and to develop the clinical judgment on assessing third molars removal.

Rickets numbers might be ok for one particular case but if there is a perio pathology with the crown of the 3rd molars, who cares about Rickets value?

Best regards

Dr Sylvain Chamberland says:

Dr Goenawan,

Thank you for your kind remarks.

However, i disagree with your opinion on partial odontectomy. I am concern about your remark: "rate of success almost satisfactotily".

Oral surgeons in my area do this approach qite often and they never encounter significant complications. If complications would occured, they are not different from the usual complication that occur with removal of wisdom teeth.

the recommended technique is to cut the crowm from the radicular trunk, then use a surgical round bur to grind the trunk some 5 mm below the margin of the alveole, suture the gum and let it heal.

most radicular trunk remain embeded in the alveolar bone. My surgeon who did several partial odontectomy in his carreer told me that he withnesses self- exfoliation. It was extremely rare.

the rate of success of partial odontectomy is "always satisfactorely."

 

Best regards

Dr Sylvain Chamberland says:

Thank you Doctor Tillery for your kind remarks.

Dr. Roveglia Stefano says:

A little remark about "extract these ones, wait for those ones": around 18 years of age, according to Grobety and Pfeiffer, between the distal margin of the second molar and Xi of Ricketts analisys, must be 30 mm in order that the third molar find out its right position. Between 8 and 18 years the rule is: age + 21mm between the first molar and Xi. What think about thath? My best regards.

hans goenawan says:

Very nice presentation dr Sylvain, but I ve never done any partial odontectomy because I think partial odontectomy is very risky for not all patients could keep the area clean and healthy. And could cause an infected condition. So my decision is always perform a totally odontectomy, even the root is very closed to the mandibular canal, or encircling the nerve, but with a gentle and based of the previous cases, the rate of success almost satisfactorily.

Dr Don E Tillery, Jr says:

Excellent and comprehensive review of the thought processes that must be exercised by clinicians and patients when making treatment decisions about third molar extractions. The examples are prudent and the information is well supported by the literature. I would hope that beurocrats who involve themselves in cost containment would have an opportunity to review your article.

Dr Sylvain Chamberland says:

Thank you Dr Aulakh for your comment.

Regarding experience with partial odontecomies, I did not saw that many cases during my orthodontic practice years. The main reason is that I am an orthodontist, not an oral surgeon.

However, I know this approach is often use by the oral surgeon in my area when the risks of causing nerve damage are high and the  Xray (and nowaday a CBCT scan) show that the roots are circling or overlapping the alveolar nerve.

The case presented above in the section "root near the inferior alveolar nerve" show pictures 6 weeks after partial odontectomy and 19 months post odontectomy without any complication.

I went back to my patients file and found a 45 years old patient who had a mandibular osteotomy. If I recall correctly, I think the tooth was ankylosed so well that it was impossible to remove the tooth without causing aberrant fracture of the proximal or the distal segment.

The tooth was sectionned, the roots were removed but the crown was left in place. Follow up at 31 months post surgery show nice healing. No complications occurs.

I might have other cases in my files but it is difficult to recall which one and how many. This is some kind of an indication that no complications have ever occured in my practive with partial odontectmy. If there had been complications, I would certainly have remember...



 

Thank you for the question.

Best regards

Dr Sylvain Chamberland

Kent Lauson says:

Great post with very logical and practical explanations.
S. Kent Lauson, DDS, MS, Orthodontist

Dr Raman Aulakh says:

Very nice comprehensive article Sylvain.
Whats your experience with partial odontectomies ?
Do you monitor long term periodically and are there any potential post-op complications?

Dr Sylvain Chamberland says:

Thank you Dr Webb for your kind words.

I wish you can use this article for your own patients. It is the intent of this website.

If you have any questions or suggestion of a case that could be discuss and helpful for layman, we can do it. Visit the french version of this site and you will see what I mean.

Best regards

Sylvain Chamberland

Michael Webb says:

Excellent article. Easy to follow with layman terms for everyone to understand. Answers all the questions I hear every day in the office.