Topics of the day:

1. Paul Johnson on Sassouni cephalometric analysis
2. Chin cup and the sore chin
3. Re: Facemask chin irritation
4. Re: Chin cup irritation
5. Response to Facemask Irritation
6. Re: Facemask Irritation Problem
7. Re: Facemask Irritation Problem
8. Irritation (skin) with chin cap
9. Response Screw implants
10. Facemask on Down's Syndrome patient
11. ESCO - The Electronic Study Club for Orthodontics


Date: Wed, 21 Jan 2004 11:29:03 -0800 (PST)
To: "ESCO POST" <>
Subject: Paul Johnson on Sassouni cephalometric analysis

S 7. An aid in the extraction decision.

Inadvertently, S 8 got posted in 2003, before S 7

Dear group,

These thoughts may help answer the question posed by Dr. Gupta:

Figs. 1 and 2 have too many MB to go on a single e-mail (that was until Dr. Halazonetis pointed out how to compress the images using 150 dpi in scanning); therefore, fig. 1 had to be included here on S 7, and fig. 2 was on S 8.

The attachment (1) illustrates an extreme DEEP BITE SKELETAL case from the perspective of the Sassouni Analysis.  The osteological part illustrates that teeth should not be removed, if at all possible.  A percentage of orthodontic patients fall into this category, and extractions, especially on the mandibular arch (and also on the maxillary arch), would not be desirable.

Please enlarge the top left part of fig. 1 maximally, using the magnifying glass with the plus sign inside the “glass,” to appreciate the rationale for the points in S 7.  It is the lateral skull view.

Considering that orthodontics is an art rather than an exact science, I would prefer minor crowding on the lower arch one year after the end of retention rather than extract and get bite collapse in this deep bite situation.  Bite collapse could cause the operator to wish that those teeth that were removed were back in there, for vertical support.  “You can always take them out, but you cannot put them back.”

Here is another beautiful aspect to this analysis: it not only tells you what to do, it instructs you, more importantly, what not to do.

One of the most difficult practice decisions is to decide when extractions are necessary in the “borderline” case where the dentition can be treated successfully either way.  Sassouni’s graphic representation, with no numbers, is a great help deciding which would be the best approach.  If the analysis tips the scales toward the “Deep Bite Skeletal” (Fig. 1) configuration and Dentistry’s Gnathological Principles are a part of our armamentarium, then non-extraction might be the diagnostic option.  Extracting in these deep bite cases could create the need for some difficult mechano-therapy to rectify the loss of units.

 Hippocrates said, “First of all do no harm.”  “Borderline” extraction cases are the challenge for us.

 (1) Attachment Fig. 1 was reprinted with permission from Elsevier: Sassouni, Viken, D.D.S., M.S., D.Sc., A Classification of Skeletal Facial Types, American Journal of Orthodontics, 55(2): pp. 109-123 © 1969.


 Paul Johnson (retired orthodontist)

Tustin, CA 

Date: Wed, 21 Jan 2004 08:55:03 +0200
From: "adrian becker" <>
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>
Subject: Chin cup and the sore chin

Dear Carol,
Using supply-house face masks are rather like buying false teeth from 
an undertaker! The chin cup cannot possibly fit and must therefore be 
padded out to achieve some sort of comfort. I once saw an article in the JCO 
(10-15 years ago) on the abc of custom made face masks. I tried it and have 
never bought a face mask since. The chin and forehead are covered with 
accurately fitting clear acrylic, are more comfortable, less obvious and are far 
more likely to be worn for the longer hours that are needed. I even have a 
fairly significant percentage of children who will wear them to school. I now 
only have sore chins from those who wear them full time, which seems related 
to sweating and, possibly, a consequent fungal infection. I usually try 
using a face tissue in the chin cup as a first line. If that does not work, I 
will suggest an antifungal or a steroid antifungal cream. If that does not 
work quickly, then I will give them a short respite and then start again. 
These problems are not common, despite the fact that I live and practice in a
tropical climate.

Adrian Becker

Date: Wed, 21 Jan 2004 09:08:33 +1000
From: "Brett Kerr" <>
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>
Subject: Re: Facemask chin irritation

Hi Carol,

I used velvet as a liner with success.  I also heard either Petit or Joho suggest moulded silicone as an interface, but I would still use a velvet liner over this.


Brett Kerr,
Date: Wed, 21 Jan 2004 09:53:36 EST
Subject: Re: Chin cup irritation
To ESCO and Carol of New Orleans,
I tell my patients that it is best to have something that they can replace every night.  What I recommend are the flat cotton pads sold in drug stores as "makeup removal pads" and can be purchased in bulk at Costco.  I give all chin cup patients a starter pack of 20-30 at delivery.  Another solution done by a patient was to sew oversized squares of old flannel pajama material  that were replaced nightly and she just threw them in the wash with her regular loads.  (she made 10-12).  The problem with chin cups is the combination of sweat and often times saliva (some kids drool a lot wearing a face mask) that can build up on the permanent padding of the chin cup and cause the irritation.
If it does get irritated despite the above efforts, I heard somewhere that anything used for diaper rash works well.  I pass this on to my patients but have had no feed back on its effectiveness. 
Hope this helps.
John McDonald
Salem, OR

Date: Thu, 22 Jan 2004 09:50:50 -0800 (PST)
From: "George Papanastasoulis" <>
Subject: Response to Facemask Irritation
Hi Carol and the rest of the group, it is great to
hear from everyone again.

Concerning your question about facemask irritation on
the chin, we experienced the same problems, and found
the solution which works for us: simply put we have
the patients buy Dr. Scholl's shoe inserts (the beige
inserts, non scented with air holes in them).  The
patients then merely cut out the form of the chin
portion and adhere it to the chin pad via two way
tape.  The irritation (redness) does not persist
because of the air pockets and spongy effect of the
cushion.  Hope this helps, and let me know about your

George Papanastasoulis
Montreal, Canada

Date: Thu, 22 Jan 2004 09:50:50 -0800 
From: "Jeff Genecov" <>
Subject: Re: Facemask Irritation Problem

We have had great success with a chamois cloth. We have them cut the chamois in the shape of the pad and put it between the pad and the skin. Some of the moms have even made a removable cover out of the chamois for each of the pads so it can slide on and off easily.  A real, as opposed to synthetic, chamois works best, and it can be washed as needed to remove the oils from the skin that are absorbed. The real chamois can be bought at any auto parts store.


Jeff Genecov, DDS, MSD, FICD

Date: Thu, 22 Jan 2004 08:41:50 -0800 
From: "Robert Haeger" <>
Subject: Re: Facemask Irritation Problem

Dear Carol Stuckey,

I have found A & D diaper rash ointment very successful at healing this chin irritation.  We also ask parents with especially irritated patients to purchase baby socks and put them over the chin cup.  The socks are removed and washed daily to prevent bacterial growth.  We refrain from mentioning to the kids what A & D is generally used to cure.
Good Luck,
Bob Haeger
Kent, Washington

Date: Wed, 21 Jan 2004 15:28:47 +0530
From: "Dr, M.Jayaram" <>
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>
Subject: Irritation (skin) with chin cap
        There are two possible things: One is sensitive skin: Remedy: Ask the patient to use gauze/banian(hoseiry) material with talcum or baby powder sprinkled on it act as an interposing medium between skin and intetrior of chin cap.Or even tissuepaper might do.
Two: In our place with humidity and heat it becomes very difficult to wear chin caps in summer. Remedy: softer chin caps with holes (for aereation) may be better tolerated.(Formerly available from Orthoband Inc)
Bottom line: Ultimately, unless one can make them patient friendly, long term compliance/results are going to be bleak.
                                                                            Dr. M. Jayaram, "Anchorage", Kozhikode-673004. S.India.

Date: Thu, 22 Jan 2004 09:57:49 -0800 (PST)
From: "George Papanastasoulis" <>
Subject: Response Screw implants
Hi all,

We are presently using the palatal implant from
Straumann in our practice for Mx anchorage, with great
results (associated with TPA).

On the lower arch we have started using microscrews
(inserted by our periodontist) at the attached
gingival level.  In cases where we need to retract the
anterior segment (ie: recent case of Cl II div I,
surgical, patient had exo'd bombed out 37,47 and we
needed to retract the flared out lower anteriors
rather than exoing the 34,44.....38,48 were erupting
into position), we placed open coil between 36-35 and
46-45, and ligature tied the 35,45 to the microscrews
in order to prevent the flaring of the anterior
segment.  When the 6's were retracted, we simply
retied the ligature tie back to the 4's and proceeded
to distalize the 5's and so on.

Hope this is what you were looking for as an answer,
if not write back.

Thanks for listening to my two cents worth,
George Papanastasoulis
Monteal, Canada

Date: Thu, 22 Jan 2004 10:01:03 -0800 (PST)
From: "George Papanastasoulis" <>
Subject: Facemask on Down's Syndrome patient

Hi all,

Here is the dilemma.

Pt is 6.5 years old, Cl III (-2 OJ in CR, but patient
protrudes mandible to approximately -10 OJ when
speaking and chewing).  I see that there is no
stability in the posterior segments, and would like to
expand and protract the maxilla via facemask.

The questions are:
1) What kind of cooperation will I get.
2) Does anyone have experience treating such patients,
and would you know why she has a tendency to protract
the Md by 8 mm all the time????

Thanks in advance,
George Papanastasoulis
Montreal, Canada,

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