What are the surgical risks and 2-year stability of mandibular anterior subapical osteotomy in the treatment of dentoalveolar protrusion?

Abstract

To investigate the stability and complications of mandibular anterior subapical osteotomy (ASO) in the treatment of bimaxillary dentoalveolar protrusion by way of a retrospective study. One hundred and twenty patients who received orthognathic surgery at a single center between 2008 and 2017 were included. Relapse was assessed by serial tracings of lateral cephalograms which were obtained pre-operatively (T1), within 6weeks after surgery (T2) and at 2years after surgery. The changes between T2 and T3 represented stability and were tested using the paired t test. The relationship between the extents of surgical repositioning (T2-T1) and relapse (T3-T2) was investigated using the Pearson correlation coefficient. The associations between the variables and the occurrence of relapse and complications identified the risk factors and were evaluated using the χ2 test or Fisher's exact test. When r > 0.80, clinical correlation was considered significant; and statistical significance was set at P < 0.05, while confidence interval was set at 95%. There was a mean uprighting of L1-MP by 12.7°. At 2years after surgery, 96.7% of the patients experienced a mean relapse of L1-MP by 2.9°. The extent of surgical repositioning was only weakly correlated with that of relapse and no specific factor that increased the risk of relapse could be identified. The most frequent complications were blood loss requiring transfusion, wound dehiscence or infection, gingival recession, and periodontal bone loss, involving 25.8 to 43.3% of the patients. The remaining complications included tooth root damage, fixation hardware exposure or infection, lingual mucosal laceration, and tooth devitalization. There were no cases of avascular necrosis or nonunion. Although relapse occurred in most of the patients after 2years, the actual extent was small (2.9°) which was not likely to be clinically significant. HKUCTR-2964 CLINICAL RELEVANCE: Although ASO may be valuable in correcting mandibular dentoalveolar protrusion, the procedure brings with it risks and complications and should be reserved for severe deformities.