Presurgical orthodontics for dentofacial deformities

Abstract

The approach to treatment planning for orthognathic surgery patients has continued to be refined with increasing clinical experience and research. The contemporary approach involves a team to ensure proper treatment objectives and results. The oral and maxillofacial surgeon will be provided with practical and applicable knowledge of definitive presurgical orthodontic planning. Salient aspects will be discussed as they apply to basic surgical approaches in the correction of dentofacial deformities. General Principles Start with a goal in mind Dependent upon surgical procedure(s) Prediction tracing Extractions Surgery is not to “rescue” the orthodontist Eliminate dental compensations Segmentalization When Why Level, align and coordinate arches or segments Surgery as early as possible Mandibular Advancement Anteroposterior Considerations Vertical Considerations Transverse Considerations Maxillary Superior Repositioning Anteroposterior Considerations Vertical Considerations Transverse Considerations Mandibular Setback or Maxillary Advancement Anteroposterior Considerations Function and esthetics are key factors necessary to insure beauty (harmony). Esthetic considerations are based upon individual proportionate relationships. Treatment planning decisions, staging secondary rhinoplastymalarplasty and cervical liposuction considerations will be presented. The ability to achieve function, stability and esthetic results in orthognathic deformities continues to be a formidable challenge for the surgeon. Decision making is based upon craniofacial growth factors, dynamic or orofacial muscle function, skeletal-dental stability and the concerns of the patient. Xavier de Callatay, Director of Studies at the New York Academy of Art noted that, “Artists and surgeons are building a new bridge between the disciplines of Art and Medicine for the sake of beauty. The Cosmetic surgeon enhances an individual’s natural appearance and the artist recreates the world to show its beauty. A beautiful portrait helps the ego and a constant good appearance is even more reassuring to one’s self and others.” As cosmetic surgeons, we have the ability to radically alter an individual and to cut some of the ties of natural evolution. Therefore, our responsibilities toward beauty are greater than in any other era. Katie Wood, Director of Ford Models, Inc. states that, “Faces of the 80’s and 90’s are considered beautiful when the forehead is broad and well shaped, eyes large and wide-set, a firm angular jaw line, full lips and a slim proportionate nose set in an oval face.” We must address the issue of beauty based upon the times and the goals of our patient’s within the parameters of function, stability and the concepts of aging. Complex Deformities: Bimaxillary Asymmetries