Influence of third molars in Le Fort 1 osteotomy

Abstract

Background:The influence of maxillary third molar (M3) on the outcomes of Le Fort 1 osteotomy is not deeply investigated.Aim:To investigate the influence of M3 on Le Fort 1 osteotomies.Setting:Tertiary Referral Center, operated by a single surgeon, prospective study.Period:January 2005 to December 2010.Patients:Consecutive Le Fort 1 osteotomy patients with both M3.Predictor Variable:Gender, position, M3 root morphology, and degree of impaction.Outcome Variable:Time taken after all osteotomy cuts to point of time when maxilla is placed in predetermined plane.Result:A total of 658 M3 in line of cut were studied. Of all M3, 312 were impacted, 28.9% were partially impacted and 23.7% were erupted. Of all the M3, 2.9% had their cuspal tips above the horizontal cut, 13.8% along the line of cut, and in 20.7% below the line but not erupted. Buccoverted tooth took shortest time (7.74 minutes), while palatoversion required more time (8.44 minutes) (P = 0.000). When the cuspal tip of M3 was located above the horizontal line of cut, the mean time required to achieve the planned position was 7 minutes, while the completely erupted teeth took a mean of 8.24 minutes (P = 0.000).Conclusion:When the M3 is placed higher, it takes lesser time to prepare basal bone to receive the maxilla at its predetermined level. Angulation of M3 influences the outcome. Deeply placed M3 reduces the manipulation of the greater pterygoid palatine vessels in the area thereby minimizing the bleeding in the surgical field.