Abstract
Aim:To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion.Methods:A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme.Results:The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias.Conclusion:This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.
Highlights
250,000 people in the UK have a severe enough malocclusion to justify orthognathic surgery (Kumar et al, 2008)
Oral health related quality of life (OHRQoL) has been defined as ‘the impact of oral disorders on aspects of everyday life that are important to patients and persons, with those impacts being of sufficient magnitude, whether in terms of severity, frequency or duration, to affect an individual’s perception of their life overall’ (Locker and Allen, 2007)
An improvement in OHRQoL after surgical-orthodontic management of severe malocclusion has been demonstrated by several longitudinal studies (Alanko et al, 2017; Hatch et al, 1998; Lee et al, 2008; Motegi et al, 2003; Nicodemo et al, 2008)
Summary
250,000 people in the UK have a severe enough malocclusion to justify orthognathic surgery (Kumar et al, 2008). Patient will benefit from treatment, professionally assessed existence of disease does not always align with the concept of illness and health from the patient’s perspective (Inglehart and Bagramian, 2002). Patients who, in the clinician’s opinion, have high levels of orthodontic need, may be submitted for orthognathic treatment despite possessing little desire to undergo invasive elective surgery. When exploring the various preoperative, intraoperative and postoperative complications associated with orthognathic surgery (Kim, 2017; Sousa and Turrini, 2012), clinicians may be asked, ‘What will happen if I don’t have surgery?’ Disappointingly, despite being presented in the 1980s, questions regarding the long-term effects of severe malocclusion on oral health, including whether surgical correction leads to an improvement, remain largely unanswered (Shaw et al, 1986). The critical informed consent process may rely more upon anecdote and the personal experience of the surgical team than the complete and methodical interpretation of the best of the available research evidence
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