Pulpal and Periodontal Tissues Changes Associated with Le Fort I and Sagittal Split Ramus Osteotomies: A review.

Konstantinos Lazaridis,Athanasios E Athanasiou,Maria Lazaridou

doi:10.2174/1874210601812010024

Abstract

Introduction:Le Fort I and sagittal split ramus osteotomies are the most commonly performed orthognathic surgery procedures on the maxilla and mandible, respectively.Techniques: Despite progress in the techniques, these procedures may still be associated with morbidity, expressed as inflammation, inadequate bony union, periodontal damages or in extreme cases even total bone loss.Discussion: Through a comprehensive review of the literature, the influences of maxillary and mandibular surgery on Pulpal Blood Flow (PBF), pulp sensitivity and pulp vitality are examined. Moreover, adverse effects of maxillary surgery on tooth color and periodontal tissues are also reported. The effects had a variety of expression. Concerning maxillary surgery, some studies showed an initial increase in PBF followed by a decrease to the baseline or even lower levels after 1-3 months. Other studies found an initial decrease in PBF followed by an increase soon after. There were also studies that showed no significant PBF changes, in contrast.Conclusion: Concerning mandibular surgery, a recent study showed a decrease in PBF immediately after sagittal split ramus osteotomy. Some authors detected tooth discoloration of maxillary teeth after Le Fort I osteotomy. Root resorption and root injury were also detected, but were of minor significance. Usually, these adverse effects derive from injury of the vessels of the palatal pedicle. This pedicle should be maintained intact for the avoidance of blood flow impairments. In addition, the descending palatine artery should be protected during maxillary surgery procedures in order to maintain the highest possible blood flow on the maxillary teeth.

Highlights

Le Fort I and sagittal split ramus osteotomies are the most commonly performed orthognathic surgery procedures on the maxilla and mandible, respectively.Techniques: Despite progress in the techniques, these procedures may still be associated with morbidity, expressed as inflammation, inadequate bony union, periodontal damages or in extreme cases even total bone loss
With the use of Laser Doppler Flowmetry (LDF), Chen et al (2011) reported a decrease in Pulpal Blood Flow (PBF) after Sagittal Split Ramus Osteotomy (SSRO), which started to recover after 18-28 weeks, never reached preoperative levels
The authors concluded that the decrease in PBF that is associated with single-segment Le Fort I osteotomy, may affect pulp sensibility in the short term after surgery [20]

Summary

Introduction

Techniques: Despite progress in the techniques, these procedures may still be associated with morbidity, expressed as inflammation, inadequate bony union, periodontal damages or in extreme cases even total bone loss. Through a comprehensive review of the literature, this article addresses possible adverse effects of these surgical procedures on pulp and periodontal tissues as well as the methods applied to measure their severity. Articles were searched with the following terms: “blood-flow and Le Fort I osteotomy,” “blood-flow and orthognathic surgery,” “vascular impairments and orthognathic surgery,” “effects of Le Fort I osteotomy,” and “effects of orthognathic surgery.”. Abstracts and their original articles were selected for review from the available titles. Bibliographies of included articles were subsequently reviewed for additional publications

Results

Discussion

Conclusion