Ortho-surgical treatment in Class II skeletal patients with mandibular retrognathism: a concise systematic review

Abstract

Introduction: In the setting of class II malocclusion corrections, the union of orthodontic and surgical procedures was developed. Bilateral sagittal split osteotomy is standard protocol for correcting mandibular retrognathism. Class II dental malocclusion with deep bite needs to be treated early by orthodontics. Thus, the commonly used technique combines BSSO for mandibular advancement and recoil genioplasty to correct the resulting chin protrusion. Objective: To carry out a systematic review of the main considerations of ortho-surgical treatments in class II patients with mandibular retrognathism. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 128 articles was found involving class II malocclusion and ortho-surgical treatments. After, a total of 64 articles were fully evaluated and 24 were included and discussed in this study. A meta-analysis study evaluated the best functional appliance improving mandibular length in individuals with retrognathism. Sander Bite Jumping reported the greatest increase in mandibular length, with 3.40 mm. Another meta-analysis study compared dental, skeletal, and aesthetic outcomes between orthodontic camouflage and orthodontic-surgical treatment in patients with Class II skeletal malocclusion and retrognathic mandible with anterior growth. The difference between treatments was not statistically significant regarding SNA angle, linear measure of the lower lip to the Ricketts aesthetic line, convexity of the skeletal profile or soft tissue profile excluding the nose. In contrast, orthodontic-surgical treatment was more effective to the ANB, SNB and ML/NSL angles and the soft tissue profile including the nose.