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Dr. Brad Fulton (General Dentist) Dr. Jeff Shirck (Orthodontist) Dr. Dave Smeltzer (OMFS) May 7th, 2015 40 yo Male Chief Complaint: “I keep breaking my teeth” • Mandible 5mm left of MSP • Decreased incisal display on smile • Right gonion 7mm sub left gonion • Missing #1/2/16 • Crown #7 with endo treatment • Multiple anterior composite restorations • Discoloration #8 • Maxillary crowding • Narrow maxillary arch • • • • • Crown #19 Fractured #25 Endo treated #26 Mandibular crowding #17/#32 present • Class III malocclusion right and left • Crossbite #8-#15 • Mandibular midline 4mm left MSP 1. 2. 3. 4. 5. Extract #17, 25, 32 Comprehensive orthodontics (Estimated treatment time 18 months) Orthognathic Surgery approximately 12 months into treatment (Asymmetric BSSO to rotate mandible back to the right to get chinpoint onto face and a 2-piece Lefort with downgraft)Goal will be to get middle of lower incisor on to the midpoint of face Post-surgical orthodontics Restorative work on #7-10 (discussed whitening and crowns/veneers) 6/12/13: Orthodontic treatment started 10/13/14: Surgical hooks placed for orthognathic surgery 11/25/14: Three weeks post orthognathic surgery 3/18/15: Day of debond