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Dorian: Face too long, desolate and deseased teeth

Facial diagnosis

  • Receding lower jaw
  • Too long lower jaw
  • Too long upper jaw
  • Open bite

Dental diagnosis

  • Class II division 1

Treatment jaw surgery

  • Advancement lower jaw (BSSO)
  • Shortening upper jaw (intrusion upper jaw - Le Fort I)
  • Chin surgery (Sliding genioplasty)

Treatment dental implants

  • Implant supported bridge (fixed denture) upper jaw
  • Implant supported bridge (fixed denture) lower jaw
  • Implants with osteotomy
  • Implants with bone graft

Treatment aesthetic surgery

  • Cheek augmentation
  • Jaw angle augmentation
  • High cheekbone augmentation

About this case

Dorian is in his early thirties. He has a rather exceptional disease on his teeth (amelogenesis imperfecta). The enamel of his teeth is not well developed. Provisional crowns were made since many years. He had a huge open bite often concomitatn with this desease. Dorian was treated already elsewhere with a Le Fort I osteotomy (posterior impaction) and a genioplasty. But he was left with so many unanswered questions, he felt abandoned by the medical team, and felt deeply depressed. He realised that he was already 18 years under dental treatment and nobody could even tell him where his story would end. He wanted to start his live just as anybody else. Dorian saw my website and came on consultation several times. We talked many hours together. Finally we agreed to the following treatment plan, endorsed by our residents and some of my colleagues: Le Fort I impaction advancement, lower jaw advancement, chin advancement, cheekbone augmentation with hydroxyapatite granules and human glue directly applied on the high cheekbones, total teeth extraction in upper and lower jaw, implants in upper and lower jaw, and finally impression taking for the laboratory. He was operated on Monday. At the end of the week, Friday, his implant retained dentition was placed (provisional chrome cobalt -resin). Six months later two gonial angles (medpor implants) were added to his healed BSSO angle region. The aim was to give him -as he requested- more body in that region with better defined gonial contours. Needless to say Dorian’s live took another fantastic turn. He left behind almost two decades of unsatisfactory dental treatment, isolation and frustration. It once more highlight the importance of treating a patient in a holistic way, even if it means thinking out of the box but always caring with ultimate realistic goals.