Norul and Her New ‘Fixed-Smile’: Dr Mawarni


Norul works as a secretary in a law firm company. Her profession requires her to speak often in front of an audience in meetings and she felt quite conscious with her smile. She had been wearing a removable partial denture to replace her four missing front teeth for twelve years! She had lost her teeth due to an accident many years back.

Her intention was to correct her smile and get something fixed to replace her missing teeth. She had done some research on the treatment options. Hence, she was familiar with the terms implant and bridge. She found out about our clinic via our clinic blog.

What is different about Norul compared to most people is that she has a class III skeletal pattern and malocclusion. She also has a huge anterior open bite. What’s that you may ask! Well a Class III skeletal pattern is a condition whereby the lower jaw or mandible is too far forward than the upper jaw. An anterior open bite is a condition where the front upper teeth are not biting with the lower front teeth.

Ideally, the best treatment for her is to do orthognathic surgery first to correct her jaw and malocclusion (anterior open bite closure and reverse overjet) then replacement of the missing teeth.

Orthognathic surgery is a jaw correction surgery. It is indicated in extreme skeletal pattern abnormality such as severe class III. In the surgery, the jaw bone will be sliced and fixed to the ideal class I skeletal pattern. Orthognathic surgery can only be done by oral maxillofacial surgeon in operation theatre as it will be done under general anaesthesia and needs hospitalization. It is considered a major oral surgery and extreme make over.


After a thorough examination, I laid down some treatment options for her together. The limitation of the treatment outcome was also explained as she did not want to do the jaw correction surgery due to the limitation of the time and budget. She also did not want another removable partial denture. Without much hesitation, she agreed to do the 6-unit bridge option.

After the bridge was made, she was happy with the result. Although it is not perfect due to the limitation of the Class III skeletal pattern, it surely makes a lot of different than wearing her old uncomfortable denture.

“Thanks a lot doctor,” she said grinning widely. I am pretty sure she will be more confident with her new smile ;).

I walked her to the door and bid her farewell. Seeing her happy makes me even happier!

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