CASE STUDY wires. The deep tunnel wire in the Tip-Edge Plus ® brack-ets act as a tipping spring to achieve a zero ‘slop’ bracket. This resuls in 100% bracket prescription. Asymmeticial elastic strengths are then being worn to try and improve the end-on Class II molars on his left side. After several months in Fig. 10 Stage 3 and some discussions on the merits of orthog-nathic surgery to improve the ‘gummy smile’, a surg-erical date was planned. Fig. 10 shows the excessive gummy smile. Figure 11 was taken just prior to the surgery. Note again the improved molar relationship with continous class 2 elatics and favorable growth. The orthognathic surgery consisted of bilateral sagittal osteotomies of the mandible with advance-ment, maxillary Lefort I osteotomy with a superior repositioning, and horizontal sliding osteotomy of the anteroinferior border of the mandible (chin advance-ment). The post surgerical panographic x-ray is found in Fig. 12. After 4 weeks of healing, Justin returned for final finishing. The braces were removed 3 months after surgery. See Fig.13 Extra-oral pre and post orthodontics photos are compaired in Fig. 14. Total treatment time was 2 years and 10 months. Post orthodontic cephalometric readings are found in Table 2. I believe the changes in Justin’s smile will give him an equal opportunity to succeed in life with someone Fig. 14 Dental Ī Ī Ī Ī Upper 1/1=125° Lower 1-MP=92° Upper to SN=95° Lower 1 to AP=+5mm Vertical Ī Y-Axis=74° Ī MP Plane= 46° Ī Inf.Border=+11 Anterior-Posterior Ī Ī Ī Ī Ī Wits=1mm SNA=80° SNB=76° PP=12 mm Por N/A/B=95/95/116mm Soft Tissue Ī E-Plane=-1/0mm Ī ANB=4 Ī Pog-NB=+2mm° Table 2 Fig. 11 who didn’t have Justin’s disfiguring smile to begin with. As I told Justin, the rest is up to him. Special thanks to the list below. Without their help Justin’s case and others like him would not have happened. 1. The Academy of Gp Orthodontics which gave me an education and had confidence in me to ask me to teach in their fine organization. Dr. Charles Mayo once said, “In order to be a teacher, a doctor must always be a student.” 2. The Oklahoma Health Care Authority-SoonerCare-Which allows trained general dentist which have met their requirements to treat kids like Justin. Oklahoma has a medicaid dental program to be proud of. 3. Dr. Ron Graves and Dr. Pat Wallace two of the finest oral surgeons I know. They never hisitated to work with me, a general dentist on orthognathnic cases. 4. My wife Sharion, who has always encouraged my mission in life and who endured many weekends with-out me. Fig. 12 Fig. 13 22 May/June 2012 JAOS
Journal of the American Orthodontic Society May-June 2012: Page 22
