Juvenile Rheumatoid Arthritic Condylar Degeneration

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Original Article
Published on 15-12-00

Surgical Adult
Class II Case Report

A 36 year old woman presented with a chief complaint of ” I do not like my chin and would like to have lower jaw extended and upper teeth brought back to straight position” . She was referred by our head and neck surgeon, having been referred there by a plastic surgeon whom she consulted for a chin implant. The plastic surgeon realized this was not a simple small bony chin process, but a major dentofacial skeletal deformity.

Juvenile Rheumatoid Arthritic
Condylar Degeneration

Medical History: systemic juvenile rheumatoid arthritis. Previous orthodontic (“camouflage”) treatment (4 years) in another state as a teenager. Xerostomia. Taking methotrexate 7.5mg, prednisone 4mg for
arthritis, and doxepin 35mg for fibromyalgia and sleep.

Orthodontic preparation for orthognathic surgery usually involves removing dental compensations for the skeletal deformity. Usually, this means advancing or tipping upper incisors forward, and uprighting and leveling the lower arch. If previous orthodontic treatment has increased compensations
in an attempt to camouflage the skeletal misfit, as was the case here, the job is harder.

Initial records are shown (0)

At six months, the patient was ready for orthognathic surgery, which was done by Bryce Potter DMD MD. Note how we send a centric registration with models to the surgeon so a stint is made to guide the mandible into the best possible postoperative occlusion.

It is also possible to see here how large the overjet is when teeth have been positioned favorably on each bone.
That allows greater mandibular advancement.

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“The orthodontist aligns teeth on the separate
bones, the surgeon aligns the bones”

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Arthroplasties were done bilaterally, the mandible advanced -bilateral sagittal ramus osteotomies (BSRO) – and the chin augmented. Surgery usually takes two hours or less if only a jaw lengthening is done, perhaps three hours for more complex cases such as this. Most people go home after surgery, which today is usually done on an outpatient basis. Dr Potter has a state approved outpatient surgical center. Most patients heal rapidly and can work in a week.
Jaws are NOT wired shut- it is possible to move the jaw immediately because fixation is internal, in the bone, similar to dental implants.Cost for simple mandibular surgery (jaw lengthening or shortening) are approximately $6000 including surgeon, anesthesiologist, surgical suite. We hear people say they have avoided seeking help in the past because they
were told either, (a ) it costs $20,000.00 or (b) you must have your jaw broken and wired shut. Both are false. In our considerable experience on over 600 surgical cases, the recovery is comparable to having impacted third molars removed. And since the spectre of hospitalization is usually not a factor, most former negatives have been removed from such surgery. And most medical plans participate with a gentle nudge from the doctors.

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So, here is a young woman
whose life has been changed in only one year.

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These are dentistry’s most appreciative patients. Many go on to have cosmetic dentistry, bleaching, complete restoration.

They are delighted with the change in facial appearance and happy to now receive the best the dentist has to offer.

Every practice has many people who would be delighted to have this service, but they won’t bring up the subject because the past responses have been negative.

You can change that, and help change their life.