North Texas Dentistry Volume 4 Issue 4 - Page 17

Treatment plan Collaboration with patient’s dentist to address oral hygiene and plaque control, removal of the over-retained deciduous maxillary molar, and dental clearance to begin orthodontic treatment. An ENT specialist referral was made, and the enlarged tonsils were removed. In addition to a thorough patient and parental education regarding severity of skeletal Class III malocclusion requiring orthodontic-surgical treatment was done, early oral and maxillofacial surgery referral was made for 3rd molar extraction and consultation for orthognathic surgery. The 3rd molars in all four quadrants were removed at least six months prior to surgery to allow for adequate healing and bone-fill of the extraction sockets. Maxillary transverse deficiency was addressed with a rapid palatal expander, upper and lower crowding resolved, teeth leveled, aligned, and upper and lower arches coordinated. Ideal dental movements were facilitated with the use of the SureSmile system of computer generated 3D treatment simulation and robotically generated arch wires. Case workup included a focus on TM joint status, and any internal or condylar concerns were ruled out. The reverse overjet was monitored during pre-surgical orthodontic phase; it increased mildly due to incisor decompensation and residual growth of the mandible. Surgical plans were made after 6-9 months of stable anterior overjet. Pre-operative planning was done, and with model surgery, it was determined that the best solution to obtain a stable and esthetic result was a 2-jaw surgery procedure that included a 3-piece maxillary Le Fort I advancement, and a mandibular BSSRO with setback. Post-surgery orthodontic finishing included supplemental arch wires and heavy interarch elastics. Orthodontic appliances were removed about eight months post-surgery, and retention was established with a mandibular fixed lingual retainer bonded from left to right canine, and a maxillary removable This case was treated in collaboration with Dr. Julie Stelly (general dentist, Plano, TX) and Dr. O’Dell Marshall Hawley retainer. (oral & maxillofacial surgeon at Medical City Dallas Hospital). Deji V. Fashemo, DDS, MPH A 1992 dental graduate of the University of Ibadan School of Dentistry in Ibadan, Nigeria, Dr. Fashemo began his orthodontic specialty training at the Lagos University Teaching Hospital. When he moved to the United States, he trained in comprehensive dentistry at the University of Rochester Eastman Dental Center, Rochester, N.Y. In Rochester, Dr. Fashemo continued his clinical training with a residency in orthodontics, and earned the degree of Master of Public Health (MPH) in clinical research. He subsequently completed a yearlong clinical hospital fellowship in craniofacial / cleft, surgical & special care orthodontics at the Indiana University School of Dentistry. In 2004, Dr. Fashemo joined Driscoll Children’s Hospital, Corpus Christi, TX to pioneer a hospitalbased craniofacial / cleft orthodontic program; he ran that program for five years. In 2009, he was recruited to the Dallas area by Medical City Dallas Hospital where he established Fourth Dimension Orthodontics & Craniofacial Orthopedics, a unique private orthodontic practice to cater to general orthodontic patients while supporting the craniofacial anomalies program within Medical City Children’s Hospital. He serves as the medical director of craniofacial orthodontics for the hospital. Dr. Fashemo is actively involved in clinical outcomes and healthcare access research initiatives, and gives invited lectures at national and international meetings. He serves on several professional association committees, including as a director of the Texas Association of Orthodontists, and is a reviewer for the Cleft Palate-Craniofacial Journal. When not fixing teeth, jaws and faces with braces, Dr. Fashemo enjoys playing soccer and spending time traveling with his wife and four daughters. Results Patient’s anterior crossbite and open bite were corrected; she has a Class I dental occlusion with ideal overjet and overbite relationship and a pleasing smile. Functionally, the patient breathes better, has good energy, and snoring is eliminated. Follow up Patient was recalled and long-term retention records obtained about 1 year 8 months after orthognathic surgery, and one year following removal of orthodontic appliances. Her smile and bite remain in excellent shape, and dental and periodontal health is optimal. Also significant, patient and parental satisfaction remain at a very high level. 7777 Forest Lane, Ste. C-770 Dallas, TX 75230 (972) 566-3100 | NORTH TEXAS DENTISTRY 17