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.
www.northtexasdentistry.com
7777 Forest Lane, Ste. C-770
Dallas, TX 75230
(972) 566-3100
www.4dorthodontics.com
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NORTH TEXAS DENTISTRY
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