Biography Sylvain Chamberland - AAO · PDF fileBiography Sylvain Chamberland ... AJODO 2011 Long-term dental ... help to achieve counterclockwise rotation of the mandible ©sylvainchamberland.com

©sylvainchamberland.com

Biography Sylvain Chamberland

•D.M.D. (Docteur en Médecine Dentaire), University Laval, 1983

•Private practice, general dentistry 1983-1988

•Certificate in Orthodontics, University of Montreal, 1990

•M.Sc. in dental science, University Laval, 2008

•Private practice in orthodontics since 1990

•Publications

✦ Closer look at SARPE, JOMS 2008

✦ Short-term and long-term stability of SARPE revisited, AJODO 2011

✦ Long-term dental and skeletal changes following SARPE, letter to editor, OOOO 2013

✦ Functional genioplasty in growing patients, AO 2015

•Lecturer in several graduate program and scientific meeting in USA, Canada, Europe

Vertical dimension and facial aestheticsAAO 117th Annual SessionSan Diego, California, USA


AllthatismissingisYou!

•Introduced in 2009, the DOS program provides access to care for children in need. Access to quality orthodontic care is missing in many children’s lives. The AAO DOS program mission is to serve indigent children without insurance coverage or that do not qualify for other assistance in their state of residence.

•The program has expanded and offers care to children nationwide in addition to the recognized state programs in Illinois, Indiana, Kansas, Michigan, New Jersey, North Carolina, Rhode Island, Tennessee, Texas and Virginia.

•In order to expand further, we need you to help us by volunteering to serve as a provider orthodontist or help identify orthodontists willing to lead efforts to establish a DOS chapter in your state.

•Stop by the DOS booth here in San Diego to learn more about the program or contact Ann Sebaugh at [email protected] with questions.

AAO Donated Orthodontic Services (DOS) Program


Conflict of Interest Declaration

•I declare that neither I nor any member of my family have a financial arrangement or affiliation with any corporate organization offering financial support or grant monies for this continuing education presentation, nor do I have a financial interest in any commercial product(s) or services I will discuss in this presentation

©sylvainchamberland.comAugust 19, 2017, Pier-Eric’s wedding

In MemoriamCapt. Vanessa Chamberland

June 25,1989 - November 14, 2016

Vanessa lived 10 000 days. It seemed like a moment. The next 10 000 days that I, Carole, Pier-Eric and Richard will live will be an eternity.


Hyperdivergent tendency•Morphological characteristics

✦Excessive anterior and posterior dentoalveolar height

✦Open bite

✦ Increased lower facial heights

✦Steeper mandibular plane

✦ Larger gonial angleBuschang, Peter H, Roberto Carrillo, and P Emile Rossouw. "Orthopedic Correction of Growing Hyperdivergent, Retrognathic Patients with Miniscrew Implants." Journal of oral and maxillofacial surgery : JOMS 69:754-762, 2011


Long Face• Vertical proportion

✦Excessive lower facial third

✓Ratio closer to ¼ to ¾ rather than ⅓ to ⅔


Long Face•Traditionally, long face were normalized via orthognathic surgery

•Nowadays, mini-implant provide adequate skeletal anchorage for molar intrusion

✦Can be considered a reasonable alternative to orthognathic surgery for AOB

Hart TR, Cousley RJ, Fishman LS, and Tallents RH. Dentoskeletal changes following mini-implant molar intrusion in anterior open bite patients. The Angle Orthodontist: November 2015, Vol. 85, No. 6, pp. 941-948. Man-Suk Baek et al, Long-term stability of anterior open-bite treatment by intrusion of maxillary posterior teeth, AJODO 2010;138:396.e1-396.e9Scheffler, N.R., Proffit,WR, Phillips C. Outcomes and Stability in Patients with Anterior Open Bite and Long Anterior Face Height Treated with Temporary Anchorage Devices and a Maxillary Intrusion Splint. AJODO 2014; 146:594-602


Short Face•Vertical proportion

✦ Vertical maxillary deficiency

✦ Shorter lower facial third

✓ Ratio closer to 1:1rather than ⅓ to ⅔


Short Face•Short face need to be elongated via orthognathic surgery

✦ Inferior repositioning of the maxilla

✦Clockwise rotation of the occlusal plan

✦Genioplasty to increase the height of the symphysis


How Can We Intrude Molars?•Many gizmos have been proposed

Hart RH, AO 2015

Scheffer NR, AJODO 2014

Marzouk ES, AJODO 2016

Man-Suk Baek, AJODO 2010 Cope J, clinical case report 10004

Wilmes B et al Aust Orthod J 2015


What does literature say?•Most of these studies reports effective maxillary molar intrusion of 2

to 5 mm

•None of these studies address mandibular molar intrusion at the same time

•Sheffler & Proffit reports lower molar extrusion of 2 to >4 mm in 10% of the patients

✦ They also report that full coverage posterior bite plane impede eruption of the lower molars


Can We Intrude Lower and Upper Molars?

•Palatal Tad + TPA

•Buccal Tad between /6-7 + lingual arch

✦ Intrusion of both Mx (1,8 mm) & Md molars (1,2 mm) to increase OB by 4,2 mm on average

Chunlei Xun, Xianglong Zeng, and Xing Wang (2007) Microscrew Anchorage in Skeletal Anterior Open-bite Treatment. The Angle Orthodontist: January 2007, Vol. 77, No. 1, pp. 47-56.


What is the Orthopedic Effect of Upper and Lower Molar Intrusion?

•Forward rotation of the mandible

✦ Mandibular plane decrease

✦ Chin move forward

•Segmented approach help to prevent extrusion of anterior teeth

•Once intrusion is achieved, ligature tie is used to maintain intrusion

Buschang, P H, Carrillo R, and Rossouw PE. "Orthopedic Correction of Growing Hyperdivergent, Retrognathic Patients with Miniscrew Implants." Journal of oral and maxillofacial surgery : JOMS 69:754-762, 2011


So, Can we Close an Open Bite with TADs?

•Intrusion of the maxillary posterior teeth can give satisfactory correction of moderately severe anterior open bites, with elimination of 5 to 6 mm of open bite, but 0.5 to 1.5 mm of reeruption of these teeth is likely to occur.

•Controlling the vertical position of the mandibular molars so that they do not erupt as the maxillary teeth are intruded is important in obtaining a decrease in face height.

Scheffler, Nicole R. et al. Outcomes and stability in patients with anterior open bite and long anterior face height treated with temporary anchorage devices and a maxillary intrusion splint, AJODO, Volume 146 , Issue 5 , 594 - 602


% with Change in the Maxillary 1st Molar distance from the palatal plane

•Mx: 60% of the patients had the molar intruded 2 to 4 mm T1-T2

•Re-eruption of 2-4 mm occurred during post treatment in 16% of the patient

✦ During tx (T2-T3), changes was largely re-eruption of intruded molars

✦ After tx (T3-T4-T5), vertical growth in younger patients was a major contributor to the change



% with Change in the Mandibular 1st Molar distance from the mandibular plane.

•During splint therapy

✦ Extrusion of 2 to > 4 mm occurs in ~10 % of the patients

•During post-intrusion orthodontics

✦ 17% of the patients had 2-4 mm extrusion

•During posttreatment

✦ 19% of the patients had 2-4 mm extrusion



Vertical Change of the Incisors

•Mx incisors extrude ~ 1 to 1,5 mm (Sheffler AJODO 2014. Baek AJODO 2010, Chunlei AO2007)

•Md incisors extrude ~ 1,3 mm and retroclined 1,4° (Chunlei AO2007)



Is Invisalign more effective for Open Bite Treatment?

•32 consecutive patients treated at U of Pacific

✦ Treatment times comparable to fixed appliances

✦Open bite closes effectively to establish contact of anterior teeth

✦During the 1 to 9 years post retention study period, there was less than 1 mm relapse

Boyd Robert, Comparison of Invisalign with Conventional Ortho Treatment for Anterior Open Bite . Online video Invisalign website.


The Good Question Is:• Is Invisalign therapy effective to intrude posterior teeth and

decrease vertical dimension?

•No study has shown changes in the skeletal vertical dimension following aligner therapy


Expert Opinion Conclude

•“Micro implants, plates or surgery may be needed in addition to Invisalign for more posterior intrusion for severe open bite treatment.”

•…!


• No changes in vertical dimensions

• Lips are still incompetent at repose

• Profile did not improve

Courtesy of Dr Louis Dorval

Initial Final Follow up 2 years


•No change in vertical dimension

•Extrusion of U & L incisors


About Aligner Therapy•“My” expert opinion:

✦Aligners therapy may be effective to close an open bite by dental movement.

✦Aligners therapy is not effective to change the skeletal vertical dimension

✦ There is no study that shows molars intrusion with only aligners therapy


Where is the Best Place for Palatal Miniscrew

•Optimal bone thickness 8-9 mm apical to contact point of 1st molar and 2nd premolar useful in supporting posterior intrusion

•Insertion above 8-11 mm from the bone crest should be avoid because of the sinus and thinner BL bone depth

• Poggio, PM, C Incorvati, S Velo, and A Carano. "‘‘Safe Zones’’- A Guide for Miniscrew Positioning in the Maxillary and Mandibular Arch." Angle Orthod 2006;76:191–197

• Ludwig et al JCO 2011



•Optimal bone thickness 8-9 mm apical to contact point of 1st molar and 2nd premolar useful in supporting posterior intrusion

•Both TAD were stable during intrusionLeft TAD was not as solid as right TAD



•Insertion above 8-11 mm from the bone crest should be avoid because of the sinus and thinner BL bone depth

•Left TAD was not as solid as right TAD

✦Sinus pneumatization



•Insertion near or at midpalatal suture


Where is the Best Place for Buccal Miniscrew

• Mx

✦Greatest amount of MD bone is between 1st and 2nd premolars and canine-1st premolar,

✦5 to 8 mm above the alveolar crest, which mean TAD will be above the mucogingival jct

• Md

✦Greatest amount MD : between 1st - 2nd premolar

✦Greatest amount BL : between 1st - 2nd molar


What happens if you pull from Mx buccal TAD

•Buccal tipping of molars

AnGr 080310

AnGr 131009


Initial

• Class II div 1

• Hyperdivergent

• Anterior open bite

• Tx exo ⅘ & microimplants

AnGr 0609, 14a 4 m


Tx Goal

•Reduce dentoalveolar height

•Reduce LAFH

•Increase chin projection


Final

• Profile improved

• Lip competency achieved

• Class I occlusion

• Surgery avoidedAnGr 0911, 16a 10 m


•Significant condylar & Mx growth and minimal dentoalveolar growth help to achieve counterclockwise rotation of the mandible


What Happens if You Pull From Mx Palatal TAD

•1st molar intrude more vertically

•2nd molar tip buccally as intrusion occurs

•Pulling from 2nd molar permits intrusion of the palatal cusp

NdaLi 20-4-15 NdaLi 20-4-15

NdaLi 09-06-15 NdaLi 23-11-15

Courtesy Jason Cope


Can we Close an Open Bite by Lower Molar Intrusion Only?

•Yes, we can

•Average intrusion 1,7±,91 mm and 2,8 ±1,05 mm for the1st and 2nd molar respectively

•Average relapse ~30%

•Relative position of crestal bone to CEJ was stable during treatmentSugawara J et al, Treatment and posttreatment dentoalveolar changes following intrusion of mandibular molars with application of a skeletal anchorage system (SAS) for open bite correction, Int J Adult Orthod Orthognath Surg 2002;17:243–253

Initial & 1 y follow up


TADs & Posterior Intrusion

•Selective intrusion of buccal segmentsJuBo231111

JuBo250511

JuBo310512


TADs & Posterior Intrusion

•At debond, positive overbite obtained

JuBo250511

JuBo220812


•Tracing superposition shows

✦Posterior intrusion

✦Counterclockwise Md rotation

✦Positive Overbite

JuBo310512JuBo250511


✦Post genioplastyJuBo220812JuBo250511 JuBo081112

JuBo081112 JuBo081112

JuBo250511

JuBo250511


JuBo020511

JuBo220812

•Significant molar intrusion

•Crestal bone stable



•Class I, open bite

•Severe ALD

•Bimaxillary protrusion

PaPl150512


• Lip incompetency at repose

• Gummy smile at full smile

• ~Normal incisor showing at repose


Tx plan

•Extraction?

•Orthognathic surgery?

•Or ??


At 13 weeks•Tx initiated Feb.2013. TADs placed 6 weeks later.

•TPA .032 x .032 SS + paramedian TADs (Elinks)

•Buccal TADs between 15-16, 25-26 (EC)

•Buccal TADs between 36-37, 46-47 (lig. tie)

PaPl 160513


At 40 weeks•At 25 weeks the TPA was replaced because it impinged into

the palate

•At 22 weeks: Bonded .032 x .032 SS lingual arch

✦Posterior inferior teeth are intruded with ∆ EC

•At 40 weeks, buccal EC is removed

PaPl 211113 .Md:020 x.025 SW

.Mx:020 x.025 SW


At 48 weeks•Posterior openbite is obtained

•Incisors retraction is going on with maximum anchorage

•Note the absence of the lingual arch which will cause expansion of the molars (adverse side effect)

PaPl 160114

Courtesy Jason Cope


At 54 weeks•TADs placed anteriorly to intrude upper incisors

•Palatal lingual ligature to maintain intrusion

•Lower incisors are still retracting

•Mx midline need shifting to the left

PaPl 270214


Repose Smile


At 71 weeks•20x25sw U & L

•Stop intruding lower teeth

•Continue upper intrusion

PaPl 230614


At 86 weeks•Removal of the TPA and intrusive links

•2 TADs were lost or removed

•Angulation of 7s/ normalized by intrusion from lingual cups to the palatal TADs

PaPl 091014


• TAD between 46-47 failed because it was to high.


•At 88 weeks

•At 93 weeks

✦ Finishing

PaPl080115

PaPl151214


Outcome

•Positive overbite is achieved

PaPl310415

PaPl150512



•FMA decreased by 2,2°

•ANS-Me decreased by 4 mm

•Upper and lower molars intruded

•1/s intruded

PaPl310415


Initial Follow up

PaPl310415PaPl150515

PaPl210116

Final


Vertical proportion•Normalized vertical

proportion

•Lip competency at repose

•Anterior lower facial height

✦ Ratio close ⅓ to ⅔


•Li.Nda.

Col de Laurichard


•Class I, open bite

LiNda 040214


• Severe bimaxillary protrusion

• Anterior vertical excess

• Lip incompetency

• Lower incisor display on smiling


At 13 weeks• Tx initiated February 25

✦ Mx: 3 segments

• At 13 weeks

✦ Mx:Tomas Pin EP 8 mm + .020x.020 CuNiti

✦ Md: Tomas Pin EP 6 mm + .020x.020 CuNiti

LiNda 270514

Courtesy Jason Cope


At 19 weeks

•Mx: .020x.020 CuNiti

•Md: .020 x .025 SS

✦ Retighten lower right pin

LiNda 270514

LiNda080714

Retighten


At 25 weeks

•Mx: .021x.021x.020x55 mm + Elinks #4 6-P

•Md: .021x.021x.020x58 mm + E #4

✦ Replaced lower right pin

LiNda080714

LiNda190814


At 31 weeks

• Mx: ∆ Elinks #4 6-P et E3 to palatal TADs

• Md: E5 attached to /7s

✦ LR pin loose, lig. tie on both lower pin

• Note posterior open bite

LiNda190814

LiNda290914


LiNda290914

At 37 weeks

• Mx: ∆ Elinks #4 6-P

• Md: E5 attached to /7s

✦ Retight right inf TAD, E4 TAD-2ePmI

• Note posterior open bite

LiNda121114


At 42 weeks

• Mx: ∆ Elinks #5 7-P

• Md: ∆ E5 to /7s

LiNda121114

LiNda171214


• Maximum anchorage + anterior retraction

• Posterior intrusion

• Note buccal tipping of 7s/…

LaMaNda260115



• TPA removed, E-links removed•E-links attached to 7s/ to correct buccal tipping

LiNda09-06-15

LiNda26-08-15

LiNda09-06-15

LiNda26-08-15


•Patient left the country for 5 months, came back late June

•Mx and Md buccal TADs removed

LiMaNda23-11-2015

LiMaNda05-01-2016

91 weeks

97 weeks


Initial

97 w91 w


•FMA decrease 2°

•ANS-Me decrease 3,8 mm

• /1-MP decrease 105° to 91°

•Upper & lower molars intruded

•Slight intrusion of 1/s


Final

•Tx time 130 weeks (include 5 months no show)

LiMaNda22-08-2016




Final Follow up 6 mInitial


Vertical proportion• Normalized vertical

proportion

• Lip competency at repose

• Anterior lower facial height

✦Ratio close ⅓ to ⅔

©sylvainchamberland.com Le Grand Lac, Alpe du Lauzet


•Class I

•Anterior openbite

•Mandibular incisor crowding

ChOlGa220514


• Skeletal Hyperdivergent

• Short ramus

• Bimaxillary dentoalveolar protrusion

• Lip incompetency at repose


• Concavity of right TMJ anterosuperior surface, flattening on the left joint

• Condylar resorption or arthrosis

• Patient at risk…


ChOlGa030914

Mx: 3 segments .020x.020 cnt. Tomas Pin SD 6 mm, Elinks E3 P-4Md: 2 segments .020x.020 cnt. Tomas Pin EP 6 mm, Hamac elastic

ChOlGa221014

Mx: 3 segments .020x.025niti. ∆ E3 P-4.Md: ∆ Hamac

7 weeks later


•Vector TAS 6 & 8 mm paramedian (out of stock of Tomas Pin)

•TPA .032x.032SS. E-links E6. Md: lingual arch .032x.032TMA

ChOlGa030914

ChOlGa221014

•∆ E links E6. ∆ Hamac

Courtesy Jason Cope


•Improvement of lip seal

•Counterclockwise rotation of occlusal plane

•Bimax protusion:

✦ I decided to extract all 5s

January 2015 January 2015

May 2014March 2015

May 2014


• Intrusion of Mx and Md buccal segment

•Counterclockwise rotation of mandibular plane


ChOlGa310315

ChOlGa12051ChOlGa22061ChOlGa140915

ChOlGa071215


At 104 weeks•Class I occlusion

•Positive OJ + OB

•Space closed

ChOlGa13-07-1216


• FMA decrease 0,5°

• ANS-Me decrease 5,5 mm

• /1-MP decrease 99° to 87°ChOlGa13-07-1216


•Significant intrusion

✦Mx + Md molars

•Retraction of 1/ & /1


Outcome•Tx time 117 weeks

ChOlGa13-10-1216


ChOlGa13-10-1216


Initial May 2014 Pre genio July. 2016ChOlGa13-07-1216 ChOlGa13-10-1216

Final Oct. 2016ChOlGa22-05-1214


Vertical proportion• Normalized vertical proportion

• Lip competency at repose

• Anterior lower facial height

✦Ratio close ⅓ to ⅔


Do you have a non extraction Open Bite Case

•The previous cases had both vertical excess and bimax protrusion

•If one want to address the vertical dimension and not the protrusion, don’t extract

✦Chances are that profile will not improve that much


• Class I, anterior open bite

• Md deviation to the right (midline to right)

• Normal facial proportion

AA.St.Tr. 130711, 22ans

Symptoms began at age 19TMJ pain, difficulty eating hard foodStarted contraceptive pills at 19 or 19½


• Concavity on the superior surface of the right condyle

• Flatness of the anterior surface of the left condyleRheumato: Ø17β-estradiol: 84 pmol/L début cycle (n=180-550)

<73 pmol/L mid cycle (n= 110-1470)ANF: positive, moucheté, titre1:80 (normal)Scinti Tc99: Slight increased intake left TMJBlood test: normalRh factor: negative


•Mx: Posterosuperior traction vector

•Posterior openbite & normal OB

AA St-O 211111

AA St-O 150212

AA St-O 100512


•Mx: Midline correction

•At 57 weeks into tx: Ready for finishing and detailing

AA St-O 100512

AA St-O 130812

AA St-O 100912


•TPA To derotate 6’s/

•LLA to avoid expansionAA St-O 150212

AA St-O 100512

AA St-O 211111


•Md forward rotation occured

•/1-MP change from 88° to 95°


• Monitor root resorption

• If superimpositions are accurate

✦ lower dentition intrude & advance

✦ Mx dentition:

✓ no posterior intrusion, no anterior extrusion


•Tx time: 66 weeksAA St-O 271112, 14 days post debonding

AA.St.Tr. 130711, 22ans

©Dr Sylvain Chamberland

• Stability...

• Time will tell

Initial


• Initial

• Follow up14 m in retention

• Follow up 23 m in rétention

AA St-O 080813, 8

AA.St.Tr. 130711, 22ans

AA St-O 100214, 14 mois post-tx

AA St-O 061114, 23 mois post-tx

Patiente asymptomatique

Short face Syndrome Syndrome de la Face

Courte


Occlusal Plane Alteration• Clockwise rotation

✦↑ occlusal plane angle

✦↑ FMA

✦Chin rotate posteriorly (less prominent)

✦↓ PFH

✦Perinasal structures advance

✦↓ ∠1/

✦↑ ∠/1 Wolford LM: J Oral Maxillofac Surg 1993

Reyneke JP: Essentials of orthognathic surgery 2003

Center of rotation at incisal edge

Courtesy Dr Dany Morais


Center of Rotation at ANS

•Similar to CR at incisal edge

✦Perinasal structures less affected

✦Chin rotates more posteriorly

✦ 1/ move posteriorly

✦Upper lip move posteriorlyWolford LM: J Oral Maxillofac Surg 1993

Reyneke JP: Essentials of orthognathic surgery 2003Courtesy Dr Dany Morais


Center of Rotation at PNS

•Similar to CR at ANS

✦ Increase AFH

✦ 1/ less affected

Wolford LM: J Oral Maxillofac Surg 1993

Reyneke JP: Essentials of orthognathic surgery 2003Courtesy Dr Dany Morais


Not Only Just a Matter of Occlusion

Jan 2007

Oct 2004


Surgery•Le Fort 1 advance +

Clockwise rotation

•CR at PNS

✦ Improve lip and paranasal support

✦Decrease chin projection

✦ Increase facial height

•Genio: set back




Improved Smile Display


Hike to lac Blanc & La Flegere, Chamonix


• Short face

• Hypodivergent

• Prominent chin

✦ Mandibular dentaolveolar retrusion


Class II div 1

NaPa081105


Tx plan• Presurgery

✦ Promote maximum extrusion of mandibular molar to level the curve of Spee

• Surgery

✦ Inferior repositionning of the maxilla

✦ Md advancement

✦ Genio set back + elongation


Mechanotherapy•Anterior bite plane

•Intrusive arch + lingual arch

NaPa010206

NP_3

NaPa010206

NaPa140306


•When posturing in class I a posterior open bite is created

•This allows clockwise rotation of the distal segment when the BSSO is done

•This reduces slightly the advancement of the chin


• Face height increased

• Class I relationship is achieved

• C/R at PNS

NaPa310507


Vertical proportion

•Normalized vertical proportion

✦ Increased LAFH

✦ Lower facial third

✓ Ratio closer to ⅓ to ⅔


Initial Final 2y follow up


CR close to PNS


2 y Follow up

•Incisor display improved

•Self esteem improved

NaPa030909


Hike to lac Cornu & lac Noir, Chamonix


•Class II div 1

•Deep overbite + deep curve of Spee

•Minor ALD

KiBr24092012


•Hypodivergent

•Short facial height

•Minimal smile display


Tx plan• Mx

✦ Advancement

✦ Inferior repositionning at ANS

✦ Impaction at PNS

✦ Clockwise rotation 3.6°

• Md

✦ BSSO

✦ Clockwise rotation of the distal segment


•1/-SN = 109°

•/1-PM = 114°


3D Tx Planning


3D Tx Planning

Preoperative Occlusal Angle = 7.7ᵒ Simulated Postoperative Occlusal Angle = 11.2ᵒ


Post-Surgical Orthodontic Phase Reprise en charge post chirurgicale

•Box elastics and Cl II elastics

✦ To obtain posterior occlusal setting

•Note screw orientation…

•Extra-oral incision + submandibular drainage + i.v. antibiotherapy

KiBr 30012014Abcès sous-mandibulaire droit


Outcome

• Improved LAFH

• CR near incisal edge

• Preop-Postop superposition match 3D planning

Before

After


Outcome•Increased facial height

improve facial 3rd ratio

©sylvainchamberland.com Chamonix


AnBella11-10-2012


•Pre surgical

•6 weeks post opAnBella21-01-2014 post op

AnBella21-08-2013 pre op


CR at or near PNSMx: Le Fort 1, advance 5 mm anterior inferior repositioning 3,5 mm, posterior 1,5 mm. Iliac bone grafting Md: BSSO advance 11 mm Genio: Vertical augmentation of 6 mm + iliac bone graft


•Final outcome

AnBella04-08-2014


Vertical proportion


✦ Increased LAFH

✦ Lower facial third

✓ Ratio closer to ⅓ to ⅔



Initial

Pre surgery

Final

Follow up 1 y


Conclusion

•Treatment planning should address not only dental occlusion

•Vertical dimension is an important characteristic of facial esthetics


To live is easy… To realize that life is fragile, to admit that it is given to us as a gift and not as a right, to accept that it proceeds from a random privilege which can be withdrawn without reason or warning and to understand that it obeys no rule of justice or individual merit; This is difficult …

Ben Nevis


To live is easy… To realize that life is fragile, to admit that it is given to us as a gift and not as a right, to accept that it proceeds from a random privilege which can be withdrawn without reason or warning and to understand that it obeys no rule of justice or individual merit; This is difficult …

Ben Nevis

Documents

Biography Sylvain Chamberland - AAO · PDF fileBiography Sylvain Chamberland ... AJODO 2011 Long-term dental ... help to achieve counterclockwise rotation of the mandible ©sylvainchamberland.com