PMC3881376_01
Pretreatment face: (a) frontal, (b) profile, and (c) smile.
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fig1
An adult female patient with a chronological age of 19 years and 4 months and an ectomorphic body type reported to the Department of Orthodontics, Pushpagiri College of Dental Sciences, with the chief concern of unattractive facial appearance due to forwardly placed lower jaw and teeth. (Figures 1-4).
Pretreatment face: (a) oblique, and (b) vertical proportions and symmetry.
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fig2
An adult female patient with a chronological age of 19 years and 4 months and an ectomorphic body type reported to the Department of Orthodontics, Pushpagiri College of Dental Sciences, with the chief concern of unattractive facial appearance due to forwardly placed lower jaw and teeth. (Figures 1-4). Examination of vertical facial proportions (Figure 2) revealed that both her midfacial and lower anterior facial heights were increased which corroborates an increased display of teeth and gingiva.
Pretreatment occlusion: (a) right, (b) left, and (c) front.
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fig3
An adult female patient with a chronological age of 19 years and 4 months and an ectomorphic body type reported to the Department of Orthodontics, Pushpagiri College of Dental Sciences, with the chief concern of unattractive facial appearance due to forwardly placed lower jaw and teeth. (Figures 1-4). Intraorally, the molar relationship was Class III with a complete anterior crossbite, along with a reverse overjet of 2 mm (Figure 3).
Pretreatment: (a) upper, and (b) lower arch.
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fig4
An adult female patient with a chronological age of 19 years and 4 months and an ectomorphic body type reported to the Department of Orthodontics, Pushpagiri College of Dental Sciences, with the chief concern of unattractive facial appearance due to forwardly placed lower jaw and teeth. (Figures 1-4).
Pretreatment: (a) lateral, and (b) PA cephalograms.
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fig5
Pretreatment radiographic records included lateral and posteroanterior (PA) cephalograms and orthopantomogram (OPG) (Figures 5-6).
Pretreatment orthopantomogram (OPG).
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fig6
Pretreatment radiographic records included lateral and posteroanterior (PA) cephalograms and orthopantomogram (OPG) (Figures 5-6).
Presurgical face: (a) frontal, (b) profile, and (c) smile.
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fig7
Maxillary and mandibular arches were aligned up to 0.021'' x 0.025'' stainless steel wire and arch compatibility was established between upper and lower arches (Figures 7, 8, 9, and 10).
Presurgical face: (a) oblique, and (b) vertical proportions and symmetry.
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fig8
Maxillary and mandibular arches were aligned up to 0.021'' x 0.025'' stainless steel wire and arch compatibility was established between upper and lower arches (Figures 7, 8, 9, and 10).
Presurgical occlusion, (a) right, (b) left, and (c) front.
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fig9
Maxillary and mandibular arches were aligned up to 0.021'' x 0.025'' stainless steel wire and arch compatibility was established between upper and lower arches (Figures 7, 8, 9, and 10).
Presurgical: (a) upper, and (b) lower arch.
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fig10
Maxillary and mandibular arches were aligned up to 0.021'' x 0.025'' stainless steel wire and arch compatibility was established between upper and lower arches (Figures 7, 8, 9, and 10).
Presurgical: (a) lateral, and (b) PA cephalograms.
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fig11
At the end of the presurgical phase radiographic records were repeated and compared (Figures 11 and 12).
Presurgical orthopantomogram (OPG).
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fig12
At the end of the presurgical phase radiographic records were repeated and compared (Figures 11 and 12).
(a) Digital simulation of intended jaw movements (blue) and (b) predicted photo.
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fig13
The obtained data was incorporated into prediction algorithms to provide single-line profile drawings predicting the final treatment goal (Figure 13).
(a) facebow transfer and model surgery with (b) intermediate and (c) final occlusal splints.
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fig14
Since both jaws were to be repositioned, the maxillary and mandibular dental casts were mounted on a semiadjustable articulator with the aid of facebow transfer (Figure 14(a)) and bite registration taken with the patient's jaws in the retruded contact position or centric relation. An intermediate acrylic occlusal splint was fabricated after the maxillary cast was repositioned on the articulator (Figure 14(b)). Based on this position the final occlusal splint was then fabricated (Figure 14(c)).
PMC3881376_02
(a) Le Fort I maxillary osteotomy, (b) rigid fixation with bone plates and intermediate occlusal splint, and (c) BSSO with mandibular setback and final occlusal splint.
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fig15
The maxilla was repositioned 5 mm superiorly and 3 mm anteriorly (Figure 15(a)). Bilateral sagittal split osteotomy with short lingual split was carried out using surgical saws, and the mandible was set back by 8 mm (Figure 15(c)) after compensating for the mild autorotation due to maxillary impaction. Rigid type fixations were used in both jaws using four-hole miniplates and screw on both sides (Figure 15(b)).