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.
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
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
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.
“The orthodontist aligns teeth on the separate
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.
So, here is a young woman
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.
|To cite this article please write:
Carter R.N. Juvenile Rheumatoid Arthritic Condylar Degeneration. Virtual Journal of Orthodontics [serial online] 2000 Dec 15; 3(3):[3
screens] Available from URL:https://vjo.it/jracd-2/