| Orthognathic Surgery Alternative |
Avoiding the Unwanted
Traditional Orthodontics
This male patient wore orthodontics for several years as a child to treat a particular bite problem. After the orthodontic treatment was completed and the braces were removed (when he was approxmiately 14 years old), his facial bones continued to grow.
He subsequently developed a Class III Open Bite. His upper and lower teeth touched only on the molars, with a half centimeter gap between the upper and lower teeth everywhere else. Our patient eventually developed a prognathic condition, where his jaws projected forward.
Double Jaw Orthognathic Surgery
Later, while a college student, the patient underwent double jaw orthognathic surgery to correct the open bite issue. His maxilla (upper jaw bone structure) was rotated forward and his mandible (lower jaw) was shifted back by removing a small amount of bone. The surgery was coordinated with a second round of orthodontic treatment.
By the time 15 years rolled by, the patient had suffered moderate relapse with occlusion that was far from perfect. A noticeable cross bite developed on both sides, and his upper jaw (maxilla) had recessed such that, even when smiling, he barely showed his upper teeth. The adjacent before photo shows the cross bite
Bite - Malocclusion causes Trauma
His bite was unstable and the two front teeth made contact before the molars. This premature contact created trauma to the front teeth which caused mobility.
The diagnosis was a Class III Occlusion with an anterior edge to edge bite as well as a bilateral posterior cross bite.
The patient had been told the best way to fix the problem was doing surgery again. He refused to go thru that again and wanted an alternative.
Occlusal Diagnostic Impressions
Diagnostic photos and models were made as well as a mounted diagnostic wax-up of a proposed solution. The patient's functional issues are clearly represented and were useful for the patient to select a variety of reconstructive components required for creating the outcomes he wanted.
The second impression photo reflects the cosmetic and functional changes the patient wanted based on the application of certain procedures that addressed the specific interests of the patient.
Restorative - Reconstructive Components
The cosmetic and functional outcome sought by the patient, for his particular jaw structure, figuratively bent some of the rules or standards in restorative and reconstructive dentistry.
Under the patient's instruction, custom fabricated enlarged porcelain fused to high noble metal (PFM) crowns for the posterior teeth which exceeded the normal envelope of function for those teeth in order to correct the posterior cross bite.
The upper front (anterior) teeth were lengthened to approximately 13 mm with Empress veneers, which is beyond the average tooth length of 10.5 mm, and brought forward to overlap the lower incisors. This specification was required by the patient so he could display teeth when smiling.
The use of veneer technologies and custom porcelain components provided additional occlusal equilibration (selective alterations to biting surfaces) to transition the front teeth out of traumatic occlusion.
The lower bicuspids were prepared for Wolceram crowns. The upper posterior teeth were prepared for porcelain fused to high noble metal crowns which were built out buccally (towards the cheek) to correct the posterior cross-bite.
Considering the gum recession that was present as well as the loss of bone, there was clearly some risk of jeopardizing the health of those teeth; thus special attention was given to the balancing of the patient's bite.
An occlusal guard was designed to prevent the occurence of eccentric forces from clenching or grinding his teeth which was important for maintaining optimal oral health but also for promoting long term endurance of the reconstructive treatments and dental components.
Going beyond the limits of traditional cosmetic and functional makeover dentistry is possible for some patients who are proactive in seeking alternatives.
Boca Raton Cosmetic Dentist
Mitchell Pohl, DDS
2900 N. Military Trail, Suite 105
Boca Raton Florida FL 33431
(561) 368-3440
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