Surgical Intervention with Expansion
June 30, 2023
In this stunning case, treated in collaboration with Dr. Gregg Kinzer, a patient's request for new crowns reveals a plethora of systemic issues from dentition and alignment to airway and beyond.
Dr. Rebecca Bockow is a dual-trained board-certified orthodontist and periodontist – one of only a handful in the country. She lectures nationally on periodontics, orthodontics, interdisciplinary orthodontics, airway, and skeletal growth and development.
"So we have a patient like this, and so her chief complaint was to her very savvy dentist. This was a case I had the honor and privilege of treating with Dr. Gregg Kinzer, and she said I just want new crowns and for those that know Dr. Kinzer, he's very airway-aware, and he said, “Yes, I can fix your crowns, but there's some other issues that we see here.” So if we do a deep dive, if we take a closer look here, we see that she has a double crossbite. You saw that she was gummy, and she's class two. So she has a deficient maxilla, she has a deficient mandible, there's issues in the transverse, in the vertical, and in the AP, so it's not just about replacing the crowns.
"So this kind of brings it full circle back to what we talked about at the very beginning. As a restorative dentist, yes, I could have helped with the crowns, everyone watching today. Yes, we can... we know how to make those crowns prettier. But how do we get these patients healthier? And I think that was Dr. Kinzer's vision.
"So the treatment plan becomes: align the gingival margins, line up the teeth, and then double jaw surgery. And so I want to show you here as we bring the mandible forward, we have to widen the maxilla. So we had to achieve 12.5 millimeters of maxillary expansion to get the mandible to fit with the maxilla.
"And so here she is before and after. This, of course, she's cheating in this image, but it just gives us an illustration of how much more tongue space we were able to achieve so, before and after.
"But here she is, and so this is after ortho and surgery, and we're able to widen the maxilla - surgically widen in the maxilla. This is with a multi-segment Le Fort surgery, and this is before the crowns were replaced. So all I've done orthodontically is align gingival margins and align the incisal edges.
"But I want to show you the width. So this is about supporting the soft tissue, supporting the airway supporting the lips, giving these patients a wider smile, and just a full rehabilitation. So here she is after jaw surgery after the restorative treatment. And just bringing everything all together. So this is the beautiful, beautiful restorative work of Dr. Gregg Kinzer.
"And just seeing here that nice width gain bringing the mandible forward, and so here she is pre-treatment, after surgery, and then here after the final restorations. So having a global understanding of the transverse dimension, the vertical dimension, the AP dimension in the complex treatment planning.”
Dr. Bockow loves to create beautiful smiles for her patients, setting them up for a lifetime of dental and airway health.
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