Evaluation of alveolar bone changes around mandibular incisors during surgical orthodontic treatment of patients with mandibular prognathism: Surgery-first approach vs conventional orthognathic surgery

Abstract

This retrospective study aimed to investigate the alveolar bone changes around mandibular incisors in patients with skeletal Class III malocclusion treated with surgery-first orthognathic approach (SFA) and conventional orthognathic surgery (COS) using cone-beam computed tomography scans. Sixty-four patients were divided into 2 groups according to the inclusion of presurgical orthodontic treatment; the SFA group included 32 patients treated without presurgical orthodontic treatment, and the COS group included 32 patients treated with presurgical orthodontic treatment. Cone-beam computed tomography scans were obtained before treatment, after presurgical orthodontic treatment, and after treatment for the COS group and were obtained before and after treatment for the SFA group. The measurements of vertical alveolar bone height and horizontal bone thickness at 4 levels and the alveolar bone area surrounding the mandibular incisors were compared according to the treatment progress and groups. The vertical bone levels and horizontal bone thickness of the labial and lingual sides and the area of the alveolar bone around the mandibular incisors were reduced after treatment in both SFA and COS groups. Vertical bone loss was more prominent than horizontal bone loss after treatment in both groups, and alveolar bone loss was greater on the lingual side than on the labial side. There were no significant differences in alveolar bone changes around the mandibular incisor between the SFA and COS groups. However, the alveolar bone was reduced more in the COS group than in the SFA group. The results indicate that SFA and COS may trigger degeneration of the alveolar bone around the mandibular incisors after treatment in patients with mandibular prognathism. Careful consideration is needed to avoid iatrogenic degeneration of the periodontal support around the incisors, particularly during presurgical orthodontic treatment.