I'm working on a new site and could use some help.

My WP Version is 3.5.1
Montezuma is 1.1.9

BEFORE is modified the icons in Montezuma Options all of the icons in the upper right menu area were stars. The mouseover effect works.

My Permalinks were set to default, now set to Post Name. - I have tried both.

Here is the custom CSS I want to use:

/* Part 1- for default state: */
#menu1 .about-dr-overturf > a > i { background-position: 0px -1080px; }
#menu1 .contact > a > i { background-position: 0px -1008px; }
#menu1 .new-patients > a > i { background-position: 0px -2064px; }
#menu1 .posts > a > i { background-position: 0px -72px; }
#menu1 .welcome > a > i { background-position: 0px -96px; }
/* Part 2 - for hover state: */
#menu1 .about-dr-overturf:hover > a > i, #menu1 .about-dr-overturf.active > a > i { background-position: -24px -1080px; }
#menu1 .contact:hover > a > i, #menu1 .contact.active > a > i { background-position: -24px -1008px; }
#menu1 .new-patients:hover > a > i, #menu1 .new-patients.active > a > i { background-position: -24px -2064px; }
#menu1 .posts:hover > a > i, #menu1 .posts.active > a > i { background-position: -24px -72px; }
#menu1 .welcome:hover > a > i, #menu1 .welcome.active > a > i { background-position: -24px -96px; }

The site is www.nacortho.com

I've tried looking at it with several different browsers.

Please help!

After reading your post, I'm unclear as to what the problem is. I see the stars on all the menu items.

Now I see. If you cahange your permalinks, you have to change the css to reflect the new format of the permalinks. So set your permalink then check what the CSS should be and what you have and change it to agree.