Abstract
BackgroundOrthognathic surgery can be carried out using isolated mandibular or maxillary movement and bimaxillary procedures. In cases of moderate skeletal malocclusion, camouflage treatment by premolar extraction is another treatment option. All these surgical procedures can have a different impact on the soft tissue profile.MethodsThe changes in the soft tissue profile of 187 patients (Class II: 53, Class III: 134) were investigated. The treatment approaches were differentiated as follows: Class II: mandible advancement (MnA), bimaxillary surgery (MxS/MnA), upper extraction (UpEX), or Class III: maxillary advancement (MxA), mandible setback (MnS), bimaxillary surgery (MxA/MnS), and lower extraction (LowEX) as well as the extent of skeletal deviation (moderate Wits appraisal: − 7 mm to 7 mm, pronounced: Wits <− 7 mm, > 7 mm, respectively). This resulted in five groups for Class II treatment and seven groups for Class III treatment.ResultsIn the Class II patients, a statistically significant difference (p ≤ 0.05) between UpEX and moderate MnA was found for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), and mentolabial angle (Pog’-B′-Li). In the Class III patients, a statistically significant differences (p ≤ 0.05) occurred between LowEX and moderate MxA for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), upper and lower lip distacne to esthetic line (Ls/Li-E-line), and lower lip length (Sto-Gn’). Only isolated significant differences (p < 0.05) were recognized between the moderate surgical Class II and III treatments as well between the pronounced Class III surgeries. No statistical differences were noticed between moderate and pronounced orthognathic surgery.ConclusionsWhen surgery is required, the influence of orthognathic surgical techniques on the profile seems to be less significant. However, it must be carefully considered if orthognathic or camouflage treatment should be done in moderate malocclusions as a moderate mandibular advancement in Class II therapy will straighten the soft tissue profile much more by increasing the facial and soft tissue profile angle and reducing the mentolabial angle than camouflage treatment. In contrast, moderate maxillary advancement in Class III therapy led to a significantly more convex facial and soft tissue profile by decreasing distances of the lips to the E-Line as well as the lower lip length.
Highlights
Severe dentofacial skeletal malocclusions can usually be treated using a combined orthodontic and orthognathic treatment approach
When surgery is required, the influence of orthognathic surgical techniques on the profile seems to be less significant. It must be carefully considered if orthognathic or camouflage treatment should be done in moderate malocclusions as a moderate mandibular advancement in Class II therapy will straighten the soft tissue profile much more by increasing the facial and soft tissue profile angle and reducing the mentolabial angle than camouflage treatment
These mean values and standard deviation (SD) of the measured parameters depending on the main surgical techniques regardless of the amount of displacement but with gender related corresponding p-values are shown in Table S1 (Supplementary materials)
Summary
Severe dentofacial skeletal malocclusions can usually be treated using a combined orthodontic and orthognathic treatment approach. The objective of orthognathic surgery is to correct these deformities to achieve an adequate occlusion in patients with severe skeletal Class II or Class III discrepancy after completion of development of the dentition by repositioning the maxilla, the mandible, or both. In cases of moderate skeletal malocclusions, orthodontic treatment options are available that include extraction of the premolars for dental compensation in borderline cases of Class II or Class III patients that do not want surgery [4]. In cases of moderate skeletal malocclusion, camouflage treatment by premolar extraction is another treatment option. All these surgical procedures can have a different impact on the soft tissue profile
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