Session 2, Sequence of Study

A. McGann opening comments: Welcome to session 2. Your 10 patients have accepted YOU as their treating dentist

and have indicated this by taking records (for a fee). All the 10 cases are of the ‘bread

and butter kind”, accept as many of these in your practice as this is where the big

business of ortho is based. YOU now need to prepare these cases for the 2nd

consultation. Your patients want to know “How much”, “will it hurt”, “how long will it

take”. You have different skills to successfully complete the agreement to start

treatment at the 2nd consultation than the first. But remember, don’t say too much,

since they already want you!

The records of these 10 cases must be processed (ceph tracing, model measuring,

dental vto prediction) and a treatment decision made. This must be done BEFORE they

arrive, so remember if you are using the POS case diagnosis system, you need to factor

in this extra time for the instructor to review your case. Wait too long and the patient

may lose interest and all is wasted time and effort.

I have written for you another ‘expectations” sheet of questions that you need to

follow along in your learning. Answer as many questions as possible. Find this

document in the student ‘book’ (pdf) right in the front.

Let’s get to work!!!!!

If you have not yet registered for the POS forum, you really should do it now.

http://forum.posortho.com/smf/index.php To see the pictures and reply to posts you must be a

member. To avoid spam, we have to ask you to not only register on-line, but also to send an email to

support@posortho.net so they will know you are legitimate!

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B. Here is what you need for “SESSION 2”:

1. Headphones to listen to Audio in your computer 2. Downloads for session 2 3. ** optical MOUSE and mousepad is highly recommended. Any brand. And of course your

computer with IPsoft. It will take you 2x as long with touchpad to do these exercises. 4. if you have not already installed “Screenhunter 5 plus” program for making screenshots,

please do this…last notice to get it done. http://www.wisdom-soft.com/products/screenhunter.htm US$19.95. download, run, register with

product key they send to you, then arrive a little early to class to receive the specific setup

instructions to enable you to make screenshots at lightning speed.

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C. Sequence of Study

Step 1: Decide if you wish to navigate through this course using the ‘streaming

video’ of McGann teaching session 2 , or if you wish to follow the written instructions

(or both).

To access the streaming video, click on this link

(from technical support)

Step 2: review your book and powerpoint on this website for

case 1010, session 2,

Step 3: find and OPEN the powerpoint for lateral ceph points.

(in your digital download)

Step 3: Open IPsoft, and change patients to the patient file for “pos 1010”. Open

Dentalcad program by clicking on the far right icon under the ‘help’ words

*to open dentalcad

“Import” the start ceph ‘hand tracing, starting lateral ceph, frontal ceph, double

occlusal study model view, the panoramic xray for case 1010. You get these from the

records you downloaded in session 1 for the 10 cases. Each time, simply import the x-

ray or model and click “save” and label the record with ‘start” or “progress” to

distinguish the files.

Step 4: Tracing lateral cephs for pos 1010. Start by watching the Video before you start tracing, with me showing you how this

is done. From your downloaded session 2 files, look in the records processing videos

file folder. Start viewing the first video, lateral ceph trace. (headphones will make you

hear better and not disturb others). If the video will not open, first run the tscc.exe file

which enables your computer to view “.avi” videos.

For pos 1010, we will start with the hand tracing of the lateral

ceph. Here you can ‘follow the dots’ as you learn the points and

how to manipulate the program.

Next, trace the “1010.start ceph.tif” by yourself, without the lines and points,

referring to the “answers” found in the file folder for session 2.

Step 5: Tracing lateral cephs next 7 cases

Next, open each case from case 978 to case 979 (7 cases) and trace the start ceph

after importing the file from the session 1 records file folder. Check your work with the

answers. You CANNOT be EXACT with the answers, since who can place a point within 100th a

millimeter. If you are +/- 2 degrees or +/- 2mm, then you are ‘good to go’. There is error in

finding the points and structures, especially when there is head positioning error. You need to

understand this about the ‘tool’ of cephalometrics.

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Step 6: Tracing the frontal ceph, pos 1010, 979,999

Repeat what you did for the lateral ceph

a) Review video

b) Trace frontal ceph

c) Check answers *Frontal cephs, McGann tracing, are used to screen for bad bites (menton is not

centered on the sagittal plane (middle line from nasion), and to find skeletal

asymmetry (compare numbers right vs left) or cants (planes are off by at least 2-3

degrees to be noticeable).

d) Trace frontal cephs in cases 979 and 999.

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Step 6: Model measuring, pos 979

Watch the video on model measuring, then import the jpg file model measuring by

the dots from the ‘model measuring exercise.records.case978” file folder. Trace by

the dots and archwire to get familiar with the F2, F3, F5 keys. **do NOT select from

the list, as this is slower and you can miss points this way.

There are also ‘general’ model measuring ‘tutorials’ on your digital download

**computer support: If F2 (or F3/F5 keys) do not work for you, try Fn+F2, Ctrl+F2,

Alt+F2. If none of these work, send a request for help to support@posortho.net to

schedule a remote log-in to your computer.

Step 7: Model measuring for first 8 cases Trace the model measuring for the first 8 cases, cases 1010 to 979 in the list.

Repetition will make you learn this valuable tool, which is the door to dental vto

(visual treatment objective), knowing what is going to happen before it happens!

Refer to the answers, again, not expecting to get the exact number, just a “similar”

number. I would actually prefer that you do NOT compare numbers, but instead wait

to see if you get a “similar picture” in the ‘alignment dental vto”…if so, you are good

to go.

Step 8: Editing Once you know how to trace cephs and models, an assistant or hungry student

can do this work for you. The DOCTOR work is EDITING the work done by someone

else.

Editing lateral ceph: (do this on pos 1010)

a) Click on the upper and lower profile to see if the sublabial point is at the level of

the incisor apex. This is the rotation of the soft tissue on the dental vto to make

the lips move forward or back with the teeth. These points are the 3rd point from

the last point on the upper profile and the 3rd point from the start on the lower

profile.

b) Turn off vectors and ‘click drawing on and off” to see if the structures are in the

correct place. Pay particular attention to the bone around the teeth (palate, labial

bone, lower lingual, lower labial) and the position of the molars and incisors.

c) Turn off vectors, turn off drawing, turn on points (may take couple of on and off to

make them appear). Check the points for placement, turn on drawing,

calculate+save.

Editing Model Measuring: do this on pos 1010

a) Open start model measuring, Lock archwire, turn off archwire, zoom

b) Check points for accuracy. Be sure that the CENTER of the blue dot represents

the widest mesial-distal width and the red line represents the rotation of each

tooth. **ALL THESE MODELS in the answers are correct…so study what is

correct!! Done by McGann, the inventor of this tool. If you see something

different, calibrate your mind to this!

c) Check archwire placement. The standard for the archwire placement is in the

middle of the incisal edge for permanent dentitions (average the crowding),

and just in front of the incisors for mixed dentition. Rotate the archwires and

shape of the mandible as needed to center these shapes by rotating the lower

right corner after selecting (shape of mandible and upper archwire determine

the dental symmetry of the lower and upper arches respectively) **ALL THESE

MODELS are correct in the answers. Done by McGann, the inventor. Changing

archwire position can give you a ‘wrong answer’ in the alignment dental vto.

The points are the points!

Step 9: Alignment VTO Open pos 1010 and make an alignment dental vto. First open the start lateral ceph,

click the vto button, save as ‘start’. Ask yourself if it makes sense by the amount of

anterior overjet and crowding (incisors move forward with crowding). Check the

alignment vto in powerpoint case 1010 to see if your line drawing is “similar” (not

exact).

*I changed colors for easier viewing

Step 10: bicuspid extraction VTO, moderate anchorage To see what would happen if you extracted bicuspids in pos 1010, we will make a

‘moderate anchorage” dental vto prediction (close the extraction space 50:50 with the

molars moving forward half the extraction space and the anterior segment using the

other half for alignment of crowding, then if any space remains, retraction of the

anterior segment.

Open the start model measuring and make an exact copy of this job you previously

did by clicking the “paste analysis to new page” button. Label this project “mod anch

model” (we use ‘model’ for non growing, ‘vto’ ending for growing predictions). Click

LOCK THE ARCHWIRE, so you do not move it (if you do, you must start over!)

To predict the final outcome of extracting upper 5s and lower 4s (one of the common

class III treatment options), move the points 34/44Mesial back ½ the extraction space

and 15/25Mesial points back ‘not quite’ half the extraction space (this difference is to

correct the slight amount of class III. “1/2 minus the class III”). Calculate+save.

Now open the start lateral ceph and click the VTO button to make the moderate

anchorage dental vto. Yours should look similar. If not, review your model measuring

dots and archwire placement.

POS 1010, non extraction with expanded archwire prediction.

Let’s see if we can reduce the non extraction incisor advancement by using an

expanded archwire, some of the crowding alignment going lateral instead of forward.

Make a copy of the start model and save as “non ext model”. Highlight the lower

archwire and click F3 until you get to “non extraction ovoid #1” and position this

expanded archwire on the lower arch, repeat for the upper, calculate+save, open the

start ceph, click vto button, label the resulting dental vto “non ext model”

** get a similar picture. Non ext model.

Step 11: Treatment decision. Reviewing the dental vto pictures of the 3 possible treatment approaches, make a

treatment decision for YOUR patient.

a) Non extraction, archwire to maintain

b) Extract upper 5s, lower 4s, moderate anchorage

c) Non extraction, expanded archwire.

Step 12: Mark Treatment decision in red + Obtaining the (g5)

treatment plan

In the Orange treatment options tab, select treatment options from the list that

might apply to your patient. IN this case be sure to include non extraction, bicuspid

extraction, and orthognathic surgery treatment option, as some orthodontists (in your

community) may choose one of these. “Mark” treatment plan 90 in red, as your

treatment decision. Note that when you mark this in red, it will be copied to the

patient report. When reopening this patient file, you will click ONE TIME (1x) on the tx

decision marked in red to view the treatment plan. If you double click the treatment

plan link, while you are connected to the internet, you will get the “g5” treatment

plan, the plan from the previous level of POS teaching. Download this g5 tx plan to the

patient file and click the save button.

Step 13: Getting the G6 Treatment plan for editing in MS Word

The g6 treatment plans are currently contained in a patient file “G6.section1”. You

should have imported this into your IPsoft from the digital download in session 1. If

not, now is a good time! The patient file is labeled “1.sect1.plans.pos”. To import,

click “file-import”, find the file, click OK.

If you have already downloaded this treatment plans patient file, then ‘change

patient” to g6.sect1.

(after you have many files, you will want to write down the patient ID in your

computer and treatment plan you want…eg. 4229/90..so you can get back to the

patient!! For now, you will be editing in MS Word, keeping a copy and then

copy/paste the edited treatment plan from Word to the patient file.

Find treatment plan 90 in the list, click ONE TIME (1x) ONLY to open the g6 plan.

Next, right click + select all, right click + copy. Open MS Word, PASTE to a new

document, Save into a file folder for the patient. Editing the plan specific for the

individual patient (pos 1010) will be the next step. For NOW, simply review the

“consultation key points” as this will be suggested topics and ways to say things at the

2nd consultation with the patient/parent.

Step 14: Alignment + Bicuspid extraction Dental vto and

treatment decision for the next 7 cases.

Repeat what you just did over and over again!

Growth Adjusted lateral ceph: (cases 978, 1016, 651, your guess on 1000)

Differential Horizontal growth changes the dental vto prediction on growing

patients. In the McGann Estimated system, for all patients passing through stage 3

growth (CVM and wrist x-ray if available) we make a copy of the starting lateral ceph,

then move the mandible, symphysis, lower incisor, lower molar, and lower profile

forward an estimated amount of millimeters to reflect this growth.

Class I dental: girls +3mm, boys +5mm

Class II dental: girls +2mm, boys +4mm

Class III dental + wits <-5: girls +5mm, boys +8mm

** you cannot start the case until you have a ‘GOOD PICTURE’ (dental vto) to support

your treatment decision. Work with the dots until you get a good picture, then the

dots will tell you how to treat the case (info coming later).

Step 15: Review the powerpoints for each of the 7 cases (on this

website, and in the student book (pdf) download).

Step 16: Do the complete records processing and treatment

decision for the last 2 cases, pos 1000 and 1001, timing yourself

so you know this preparation takes some time and you cannot

wait until the patient shows up!! Ortho is different than General

dentistry!!

Step 17: Take the session 2 examination. Multiple choice questions taken from your

expectations sheet. This is self graded and a copy sent to your IAT instructor. To

receive AGD (academy of general dentistry) continuing education credit for ‘self

study’, you must have a 70% score or higher.

Step 18: complete the evaluation and send to

iveta@posortho.net so we know how you are doing!

You are now ready to move on to Session 3! Congratulations.

These 10 cases have accepted your diagnosis (and fee) and have

been scheduled for band and bond.

** After Module 1 live (follows session 4), you want to have

some cases to place brackets on!! So find some patients, do

your consultations, and bring records to Module 1 live.

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Optional, suggested additional study.

a)There are live 2nd consultations given at the McGann Live session 2

(streaming video) that would be suggested as good for your business!

b) Review the clinical videos plus all that you have downloaded and is

on this website.

c) Review the ‘extra cases’. The more ortho you see, the more you will

understand and the more confidence you will build!