Patient Case Studies Group 2

TM-PROBLEM LIST

  • Underbite caused by a backwardly positioned upper jaw.
  • Gummy smile caused by the vertically excessive downward growth of the upper jaw.
  • Inflammation of the gum tissue of the upper front teeth which is caused by the chronic air exposure due to the vertically excessive downward growth of the upper jaw.
  • Upper jaw asymmetry with the upper jaw's dental midline deviated to the right.
  • Upper jaw cant (left side of the upper jaw is longer in the vertical plane than the right side).
  • Lower jaw asymmetry with deviation of the dental and facial midlines to the left.
  • Crossbite caused by the inadequate width of the upper jaw and lower jaw asymmetry.
  • Paranasal deficiency associated with a backwardly positioned upper jaw.

Pre-Op

Post-Op

PRE AND POST-SURGICAL ORTHODONTICS BY DR. CHARLES CAPPETTA

SURGICAL TREATMENT PLAN
  • Significant differential superior repositioning of the upper jaw to correct the vertically excessive downward growth of the upper jaw as well as the upper jaw cant.
  • Surgically widen the upper jaw to correct the inadequate upper jaw width to eliminate the crossbite.
  • Rotation of the upper jaw to the right to correct the maxillary dental midline.
  • Upper jaw advancement to correct a backwardly positioned small upper jaw and associated paranasal deficiency.
  • Forward autorotation of the lower jaw.
  • Lower jaw setback to compensate for the forward rotation of the lower jaw.
  • Rotation of the lower jaw to the right to correct the mandibular facial and dental midline asymmetry problem.
Pre-Op Facial showing "Gummy Smile"
4 weeks Post-Op

COMMENTS: The above pre-surgical frontal photo readily shows the clinical finding of a gummy smile caused by the excessive downward vertical growth of the upper jaw. This photo also demonstrates the upper jaw's asymmetry with the significant cant to the upper jaw (the orthodontic wire is inclined instead of horizontal) as well as the upper jaw's dental midline asymmetry. The four week post-surgical photos clearly show the correction of these problems. The upper jaw has been moved upward and the gums no longer show during smile. The horizontal pink line in the post-operative frontal photo is a stent which covers the tips of the upper and lower teeth during the 3-8 week initial healing phase.


SO-PROBLEM LIST

  • Underbite caused by a backward positioned small upper jaw.
  • Crossbite caused by a backward positioned small upper jaw and inadequate width of the upper jaw.
  • A moderate amount of vertically excessive downward growth of the upper jaw producing a long facial appearance.
  • Defect of gum tissue requiring pre-orthodontic gingival grafting.

Pre-Op

Post-Op

PRE AND POST-SURGICAL ORTHODONTICS BY DR. CHARLES CAPPETTA

SURGICAL TREATMENT PLAN
  • Upper jaw advancement to correct the underbite associated with a small backwardly positioned upper jaw.
  • Superiorly reposition the upper jaw to correct the vertically excessive downward growth of the upper jaw and diminish the long facial appearance.
  • Surgically widen the upper jaw to eliminate the crossbite associated with inadequate width of the upper jaw.
  • Lower jaw autorotation allowing the chin point to come forward.


AR-PROBLEM LIST

  • Underbite caused by a large forward positioned lower jaw.
  • Crossbite caused by a large forward positioned lower jaw.
  • Esthetic nasal-labial angle.

The Problem

The Correction

POST-SURGICAL ORTHODONTICS BY DR. GERALD FINKELSTEIN.

SURGICAL TREATMENT PLAN

  • Lower jaw setback to correct the underbite and crossbite associated with large forward positioned lower jaw.


NP-PROBLEM LIST

  • Open bite caused by the excessive vertical down growth of the upper jaw.
  • Long facial appearance caused by the excessive vertical down growth of the upper jaw.
  • Backward positioned lower jaw caused by maxillary vertical excess.
  • Lip incompetence and lip strain.
  • Vertically long chin appearance and absent mental-labial fold.
  • Paranasal deficiency caused by a backward positioned upper jaw.

Pre-OP
Excellent example of lip strain

Post-Op
incision line

PRE AND POST-SURGICAL ORTHODONTICS BY DR. JOHN ALIBERTI.

SURGICAL TREATMENT PLAN
  • Significant superior repositioning of the upper jaw to treat the excessive vertical down growth of the upper jaw, close the open bite, and reduce the lip incompetence.
  • Upper jaw advancement to correct paranasal deficiency associated with a backward positioned upper jaw.
  • Lower jaw autorotation forward.
  • Lower jaw setback procedure to compensate for the significant forward autorotation of the lower jaw.
  • Genioplasty with vertical reduction of chin height and advancement to reduce lip strain and create normal chin esthetics by creating a normal mental-labial fold.


FP-PROBLEM LIST

  • Small chin appearance.

Pre-Op

Post-Op
demonstrates how well the incision line heals

SURGICAL TREATMENT PLAN
  • Genioplasty to advance chin point and create better esthetics.


SM-PROBLEM LIST

  • Previous nonsurgical orthodontic attempt to close an open bite with relapse of the open bite.
  • Open bite caused by the vertically excessive downward growth of the back portion of the upper jaw.
  • Overbite caused by backward positioned small lower jaw.
  • Long facial appearance caused by the vertically excessive downward growth of the back portion of the upper jaw as well as a vertically long chin.
  • Lip incompetence and lip strain.
  • Paranasal deficiency caused by backward positioned small upper jaw.

Pre-Op Facial

Post-Op Facial Pre-Op Bite

Post-Op Bite

PRE AND POST-SURGICAL ORTHODONTICS BY DR. CHARLES CAPPETTA.

SURGICAL TREATMENT PLAN
  • Superiorly reposition the upper jaw to correct the vertically excessive downward growth of the back portion of the upper jaw.
  • Upper jaw advancement to treat the paranasal deficiency associated with a backward positioned small upper jaw.
  • Autorotation of the lower jaw forward to close the open bite.
  • Lower jaw advancement to correct the overbite associated with a backward positioned small lower jaw.
  • Genioplasty advancement and vertical reduction of chin height to reduce lip strain and create esthetic chin appearance by creating a normal mental-labial fold.