Case Study BT

Mr. BT presented to my office for consultation to advance his lower jaw in 1998. He reported a previous history of orthodontics but was unsatisfied with the results.

On examination I noted that Mr. BT had a 13 mm discrepancy between his upper and lower front teeth (overjet), congenitally missing maxillary lateral incisors, and a poorly positioned third molar on the lower right.

I discussed the various options with him and due to the fact that the amount of forward movement of his mandible was severe (13mm) I felt distraction osteogenesis surgery would be the best option for him as distraction surgery typically is less invasive, produces less likelihood of nerve injury, and is more stable than traditional orthognathic surgery in cases such as his.

Mr. BT underwent the surgery as planned and after a one week latency period to permit soft tissue healing we began distracting his lower jaw forward at a rate of 1mm per day. In approximately 14 days BT’s mandible was positioned forward in the proper relationship with respect to his upper jaw. Four months later the distraction devices were removed.

Mr. BT finished his second round of orthodontics about a year later and he is currently over 5 years out from his surgery and doing well.

Fig 1 a: Pre-distraction panorex	Fig 1 b: Pre-distraction cephalometric x-ray
Fig 1 c: Pre-distraction profile	Fig 1 d: Pre-distraction occlusion
Fig 2 a: 2 years after distraction panorex (#31 extracted)	Fig 2 b: 2 year after distraction cephalometirc x-ray
Fig 2 c: 2 year after distraction profile	Fig 2 d: 2 year after distraction occlusion