Abstract
Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. However, controversy surrounds whether the maxilla- or mandible-first surgery approach leads to better surgical outcomes. In our previous study, we have shown that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. However, the post-operative stability of each approach has not been investigated. Therefore, this one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. In total, 106 patients who underwent bimaxillary surgery and had an individualized 3D virtual operation plans, received either maxilla-first (n = 53) or mandible-first (n = 53) surgery. 3D printed interocclusal splints were used during surgery to position the jaws. One year postoperatively a cone-beam computed tomography (CBCT) scan was made to assess the effects using the OrthoGnathicAnalyser. The mean sagittal, vertical and transverse relapse was less than 1.8 mm and no significant differences were found in relapse between the maxilla-first or the mandibular-first surgical procedure. Overall, this study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery.
Highlights
Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics
Significant controversy has surrounded the surgical approach taken during orthognathic surgery, in particular the sequencing of bimaxillary osteotomies
Bimaxillary surgery with either early, or late onset postoperative instability has been shown to obtaining satisfactory long-term results. This unintended surgical outcome may lead to postoperative changes both in terms of function and aesthetics and may significantly affect the patient’s overall quality of life
Summary
Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. The post-operative stability of each approach has not been investigated This one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. This study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery. Significant controversy has surrounded the surgical approach taken during orthognathic surgery (corrective jaw surgery), in particular the sequencing of bimaxillary osteotomies. To obtain a harmonious facial profile and a stable dental occlusion, there has been an increase in using computer-assisted virtual surgical planning software in order to improve the predictability of the postoperative outcomes in orthognathic surgery[6]. This study has evaluated the one-year postoperative skeletal stability of 3D planned bimaxillary osteotomies in patients who underwent either maxilla- or mandible-first surgical protocols
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