In the September issue, “Surgical orthodontic treatment for a patient with advanced periodontal disease: Evaluation with electromyography and 3-dimensional cone-beam computed tomography” (Nakajima K, Yamaguchi T, Maki K. Am J Orthod Dentofacial Orthop 2009;136:450-9), is an extensive case report assessing various parameters: periodontal health, muscle activity, and orthognathic surgery outcome. The authors painstakingly detailed every aspect of their treatment and produced wonderful results. Poor periodontal health is every orthodontist’s nightmare, and they did not allow it to be an impediment but, rather, accepted it as a challenge.

The posttreatment photographs (frontal and oblique views) show a hyperactive mentalis with resultant puckering in the rest position compared with the pretreatment photographs. Can this be attributed to the setback of the mandible that has rotated clockwise and in turn affected lip competency in a patient with a high angle at the outset? A reference to the superimposed (pretreatment and posttreatment) tracings validates this.