Orthognathic Case Presentation State University of New York at Stony Brook

Department of Orthodontics
S. Mathew DDS
Resident-Orthodontics

Jeff Drayer DDS

Resident-Orthodontics

Jose Vicens DMD

Resident-Orthodontics Resident-

Benjamin Murray DMD

Resident-Orthodontics Resident-

Richard Faber DDS, MS

Director Advanced Education Program in Orthodontics

Salvatore Ruggerio DMD, MD

Associate Professor Oral and Maxillo-Facial Surgery Maxillo-

Patients History
Patient: J.O. Age: 13 y.o. (7/28/2000) Race/Ethnicity: Guatemalan CC: People make fun of my face PMH: non contributory, No meds, NKDA PDH: WNL, seeks regular care TMJ: WNL

Original Presentation

7/28/2000

Original Presentation

7/28/2000

Treatment
The patient was followed with serial lateral cephs and hand wrist films to evaluate growth cessation to begin pre-surgical orthodontics. The patient was also evaluated for partial glossectomy with an MRI by OMFS in 2001, and glossectomy was not performed. Pre treatment records taken in Nov. 2004 Pre-surgical orthodontics began in January 2005 Pre-surgical orthodontic records taken in 2006

Clinical Exam 11/10/04 Frontal View

ovoid, asymmetric facial form Chin deviates to the left Mesocephalic skull form 3mm interlabial gap -2mm incisal display

Clinical Exam Smile

On smile, shows 60% of clinical crown Maxillary midline is 1.5mm R of mid sagittal Tongue thrust upon smile

Clinical Exam Lateral View

Concave profile Acute nasolabial angle Slightly deep labiomental fold due to everted lower lip Mandibular prognathism

Intra-oral Examination
Permanent dentition Lower midline 1mm right of mid sagittal plane 4mm open bite with tongue thrust present Anterior crossbite

Interdigitation
Right Side (CR):
Canine : CL III Molar: CL III

Interdigitation
Left Side (CR):
-Canine: CL III -Molar CL III
Centric Occlusion

Maxillary Arch
Wide U-shaped. Symmetric mild spacing Intermolar width=48mm

Mandibular Arch
Wide U shaped symmetric arch Moderate spacing Intermolar width= 49mm Mild curve of Spee

Radiographic Analysis: Panoramic

All permanent teeth present, no evident pathology

11/9/04

PA Ceph

Asymmetric Skeleton, Dental: Mx midline 1.5mm R, Md midline 1mm R Apical bases: Mx midline 1.5mm R, Md midline 1mm R

11/9/04

Lateral Ceph

Skeletal Class III, ANB:-7, Wits:-15

11/9/04

Lateral Ceph
Cranial base: mildly decreased Maxilla: Normal size, Position WNL Mandible: Severely increased in size with severely increased ramus and normal body

11/9/04

Lateral Ceph
Gonial angle: Mildly increased Mandibular plane: WNL Y Axis: Mildly decreased Occlusal plane: WNL UFH: Moderately increased LFH Mildly increased
11/9/04

Lateral Ceph
Upper incisor: Flared and protrusive Lower incisor: slightly flared and protrusive Upper alveolus: Moderately decreased Lower alveolus: WNL

11/9/04

Lateral Ceph
Convexity: decreased NLA: decreased Incisor display: decreased Upper lip length: WNL Upper lip thickness: WNL Lower lip length: increased Lower lip thickness: WNL Chin thickness: WNL
11/9/04

Diagnosis
Skeletal Class III Dental Class III Normodivergent

Problem List
Skeletal Class III with large and protrusive mandible Dental Class III Anterior crossbite Anterior open bite Decreased OB and OJ Chin deviates to the left Large Tongue Mx and Md spacing

Objectives
Advance A point, retract B point surgically Obtain Class I Close open bite Close spaces Normalize OB / OJ Rotate mandible Coordinate midlines Improve facial profile

General Treatment Plan

Extract 8s Pre-surgical Orthodontics Differential IVRO Setbacks Le Fort 1,with posterior impaction Advancement Genioplasty Post- Surgical Orthodontics Retention, U/L Hawley with integrated tongue crib

Original VTO

Treatment sequence
Pt. banded and bonded 1/11/05 Progress records taken 12/13/05

Treatment sequence
Progress Radiographs 12/13/05

Treatment sequence
Pt. had all 8s removed under IV sedation 5/17/06 Post op radiograph below

6/2/06

Treatment sequence
May 2006 Obtained Surgical pre-approval Pre Surgical Records Taken 6/2/06

Treatment sequence
Pre-Surgical Radiographs 6/2/06

Treatment sequence
Pre-Surgical Radiographs 6/2/06 Hand Wrist SMI 11

Treatment sequence
Pre-Surgical Tracing 6/2/06

Model Surgery
pre-surgical VTO

Treatment sequence
Model Surgery

Mounted Models

6/10/06

Surgery
IVROs and LeFort 1

Surgery
Advancement Genioplasty

Post Surgical
2 weeks post-op

Post Surgical
2 weeks post-op

Final Records
Debonded 9/16/08

Final Records
Debonded 9/16/08

Ceph Superimposition

Treatment Changes

Pre Treatment

Post Treatment

Profile Change

Pre Treatment

Post Treatment

Orthognathic Case Presentation State University of New York at Stony Brook

Department of Orthodontics
S. Mathew DDS
Resident-Orthodontics

Jeff Drayer DDS

Resident-Orthodontics

Jose Vicens DMD

Resident-Orthodontics Resident-

Benjamin Murray DMD

Resident-Orthodontics Resident-

Richard Faber DDS, MS

Director Advanced Education Program in Orthodontics

Salvatore Ruggerio DMD, MD

Associate Professor Oral and Maxillo-Facial Surgery Maxillo-