Anterior Segmental Osteotomy Research Articles

Orthodontic Treatment with Maxillary Anterior Segmental Osteotomy in Chronic Periodontitis Patients: 8-Year Follow-up

Orthodontic Treatment with Maxillary Anterior Segmental Osteotomy in Chronic Periodontitis Patients: 8-Year Follow-up

Orthognathic Surgery Trending: Retrospective Ten Years Cases Analysis in Nineveh Province, Iraq.

The study aimed at analyzing patient's case sheets in regard to the incidence of skeletal discrepancy present in cases and its relation with the demographic profile of the sample. All these are chronicled for more than 10 years periods. This is a retrospective study analysis of the orthognathic case sheets for more than 10 years period. The total numbers of patients are 678. Patient's case sheet was already prepared by the Multi-Disciplinary Team Orthognathic Surgery Clinic in Al-Salam Teaching Hospital, which is the only authorized committee in Nineveh Health Directorate. The highest age percentage is between (18 and 27y/76%). Angle class III cases are the uppermost cases (36%) from the total. A significant P value is clear at the level ≤0.05 and ≤0.01 between surgery type and discrepancy in anterior segmental osteotomies (upper and lower) which is performed in bi-maxillary protrusion cases and Angle class II cases (0.01**). Similarly, anterior segmental osteotomies (upper jaw only) which are indicated in both open bite and Angle Class II cases documented as a statistically significant P value (0.02*). The positive correlation is shown in all variables with the disharmony or facial discrepancies. Esthetic and beauty as causes for treatment recorded more than function in relation to time series. This study documents that patients with skeletal class III accounted for the largest percentage (64%) in the study group. A high increase in patients number seeking treatment for their discrepancy is obvious with time from 2009 till 2022.

Comparison of skeletal stability with rigid and wire fixation in patients who have undergone Le Fort I and Anterior Segmental Maxillary Osteotomy

ABSTRACT Background: Maxillary superior repositioning is widely regarded as the most stable procedure in orthognathic surgery, requiring minimal instruments for stabilization. Rigid fixation is considered the ideal method for long-term stability, leading to improved anatomic structures, enhanced recovery of bite forces, and better bite function. Objective: To compare the skeletal stability following Le Fort I and anterior maxillary osteotomy with wire osteosynthesis and rigid fixation. Materials and Methods: A total of 16 patients, including one male and 15 females, underwent Le Fort I and anterior segmental maxillary osteotomy along with fixation using either wire osteosynthesis or rigid fixation for correction of vertical and anteroposterior maxillary excess. Patients were assessed at preoperative, 1-week postoperative, and 6-month postoperative stages using a lateral cephalogram to evaluate skeletal stability. Results: The wire osteosynthesis group showed significant differences in posterior maxillary vertical measurements compared to the rigid fixation group. However, there was no significant difference in anterior vertical and anteroposterior skeletal measurements between the two groups. Conclusion: Wire osteosynthesis is a stable form of fixation for superior repositioning with segmentation of the maxilla for correction of vertical and antero-posterior excess.

Nasolabial soft tissue changes associated with posterior maxillary movement following anterior segmental osteotomy in skeletal Class II patients: A case series

ObjectiveThis study investigated the relationship between the external nasal morphology and hard tissue movement in patients who underwent anterior segmental maxillary osteotomy (ASMO) to correct maxillary protrusion correction. MethodsThe study enroled patients with an overjet ≥ 5 mm, and an ANB ≥ 2° who underwent ASMO with or without Le Fort I osteotomy. Linear and angular measurements were performed on computed tomography images obtained preoperatively and one year post-surgery. ResultsThe movement of the maxilla at U1 was 6.7 ± 2.9 mm backward and 1.9 ± 2.0 mm upward. Tooth axis inclination of U1 (∠U1 to FH) increased 5.5 ± 6.1°. The nasolabial angle significantly increased from 90.0 ± 16.8° to 101.0 ± 13.2°. No significant differences were observed in alar base width or nasal tip angles. The change of ∠U1 to FH and the backward movement of U1 were relevant factors influencing the change of nasolabial angle. ConclusionsThis study provides insights into the relationship between external nasal morphology and posterior movement of the anterior maxillary segment after ASMO surgery. These findings are significant for predicting post-operative patient profiles.

Soft-Tissue Response following Genioplasty Combined with Anterior Segmental Osteotomy.

The authors' main aim was to analyze soft-tissue response of the chin following genioplasty with anterior segmental osteotomy, which enables optimal surgical planning of genioplasty. Sixty-two patients who underwent genioplasty with concomitant anterior segmental osteotomy were divided into three groups depending on the direction of pogonion (Pog) movement: G1 (without sagittal change), G2 (advancement genioplasty), and G3 (setback genioplasty). All genioplasties included height reduction. Hard- and soft-tissue measurements with cephalometry were performed at T1 (before surgery), T2 (after surgery), and T3 (after orthodontic treatment) for the analysis of sagittal and vertical changes. Correlation and regression analyses were conducted to analyze soft- to hard -tissue movement and soft-tissue thickness changes. During the T1 to T2 period, the horizontal soft- to hard-tissue ratio at Pog was 0.85 in G2 and 0.80 in G3, and the vertical ratio at menton (Me) was 0.9 for all groups. The correlation coefficients were 0.64 (G2) and 0.83 (G3) at Pog and 0.9 (all), 0.85 (G1), 0.95 (G3) at Me. There was no significant correlation between initial soft-tissue thickness and soft-tissue response ratio. During the T2 to T3 period, no significant relapses were observed, which demonstrates the stability of anterior segmental osteotomy combined genioplasty. Clinically and statistically significant soft-tissue responses were demonstrated at Pog and Me. The higher values in G3 in particular suggest that setback genioplasty with anterior segmental osteotomy is an effective treatment alternative to conventional two-jaw surgery in some patients with bimaxillary prognathism with macrogenia. Therapeutic, IV.

Esthetic and functional advantages of subapical anterior segmental maxillary osteotomy in treatment of dentofacial deformity

Aim This study aims to investigate the effect of anterior segmental maxillary osteotomy in treatment of maxillary prognathism with good molars occlusion. Patients and methods This study includes 20 patients diagnosed with dentofacial deformities − maxillary prognathism visiting maxillofacial surgery outpatient clinic in Assiut University Hospitals during the period between January 2017 and December 2021. Results The common complications which occur is wound infection which occur in two (10%) cases, then postoperative relapse which occur in one (5%) case, palatal mucosal tear which occur in one (5%) case, and unfavorable nasolabial esthetic which occur in one (5%) case. Conclusion Anterior segmental maxillary osteotomy is a recommended treatment modality of choice in patients with maxillary and/or dentoalveolar protrusion.

The surgical outcomes of anterior segmental osteotomy in Asian skeletal class II patients.

Anterior segmental osteotomy (ASO) following the surgery-first approach is a long-established treatment modality to resolve lip protrusion in patients with skeletal class II patterns. However, the indications and effectiveness of ASO still remain uncertain. The objective of this study is to investigate the effectiveness of ASO in Asian skeletal class II patients by evaluating the skeletal and soft tissue changes and analyzing pre-treatment variables that determine successful outcomes in occlusal as well as esthetic aspects. The lateral cephalograms of 44 skeletal class II patients who underwent ASO and orthodontic treatment for resolving lip protrusion were retrospectively collected. Hard and soft tissue variables of two groups, normalized (NG) and unnormalized (UNG) ANB after treatment were compared and analyzed. The rotational effect of the anterior segment on the hard and soft tissue was also investigated. ASO was successful in correcting the skeletal class II relationship and lip protrusion (ΔANB - 2.3°, 4-5mm lips retraction) in most cases. However, for patients with severely camouflaged skeletal class II incisors involving a large ANB and SNA, a large ANB still remained post-treatment. The study also found that rotation of the upper and lower anterior segments further augmented the amount of lip retraction. ASO was found to successfully correct ANB of skeletal class II patients under the following conditions (ANB 5.3° ± 1.5°, SNB 77.3° ± 4.5°, U1 to FH 115° ± 7.5, L1 to FH 48.0° ± 4.6). However, patients with larger ANB and SNA values may require bi-maxillary surgery. In addition, ASO has limitations in correcting gummy smile in cases of extreme maxillary excess. For patients requiring a large amount of lip retraction, rotation of the anterior segment may be beneficial in conjunction with bi-maxillary surgery.

Anterior Maxillary Osteotomy Distraction Osteogenesis (Amodo) in the Treatment of Maxillary Hypoplasia in Unilateral Cleft Lip and Palate-A Case Report

Distraction osteogenesis defines a technique of bone generation by distraction of native bony segments. The technique offers a promising treatment alternative for patients with maxillary or midfacial hypolasia. In this case report, the various steps in the treatment of an 18 year old boy with premaxillary hypoplasia and anterior crossbite are described. Patient was treated with a distraction osteogenesis technique and premaxillary advancement was performed using individual tooth - borne distraction device. The surgical procedure involved an anterior segmental maxillary osteotomy respecting the palatal periosteum. Distractor was cemented in the mouth after the surgical procedures. The patient was observed during a seven day latency period after which the device was activated 0.4mm every 12 hours. The anterior crossbite was eliminated and the occlusal correction and settling was achieved with fixed orthodontic appliances.

Simultaneous Mandibular Anterior Segmental Osteotomy and Genioplasty: A Novel Technique.

The current standard approach to treat class II malocclusion is orthodontic preparation followed by a mandibular advancement through bilateral sagittal split osteotomy associated or not with a genioplasty. However, when a malocclusion with an important incisors' axis deviation is associated with a chin malposition, an alternative technique can be considered: simultaneous mandibular anterior segmental osteotomy and genioplasty. This technique is performed without a bony bridge between osteotomies. Care must be taken not to wound the lingual mucosa. If preserved, this technique is safe. The result is stable and predictable.

Soft and Hard Tissue Changes and Facial Rejuvenation of Anterior Maxillary Segmental Osteotomy: A Three-Dimensional Cephalometric Study.

To explore the efficacy of anterior maxillary segmental osteotomy (AMSO) in reliving maxillary protrusion and better analyze the three-dimensional (3D) morphological changes of the postoperative nasolabial region using computed tomography (CT) and evaluate the trend of facial rejuvenation. Forty-five patients who underwent AMSO from January 2017 to December 2021 were retrospectively included. CT and oriented photography were performed before and 10 months after the treatment. The mimics17.0 software was used to reconstruct the 3D CT scan results before and after the operation, measure the data of each anatomical index, and systematically evaluate the soft tissue changes in the nasolabial region. The patients themselves, the plastic surgeons, family members, or friends of patients use the Face-Q Age Appraisal Visual Analogue Scale (VAS) to evaluate the changes in patients' visual age before and after the operation. Forty-five cases of maxillary protrusion were alleviated.Seen from the side, the protruding degree of the upper lip is obviously reduced.In the front view,∠Cont-Sbal-F, the width of alar base, andalae nasi all increased significantly. Contrary to traditional perceptions, the protrusion and height of the nose tip actually increased rather than decreased after AMSO. The visual age score improved positively, and patients obtained facial rejuvenation. No serious complications occurred; after 10-month follow-up, we achieved a high degree of satisfaction. AMSO can significantly improve the maxillary protrusion, and it can increase the protrusion and height of the nose tip. Also, patients can get a younger appearance. Comprehensive preoperative evaluation and postoperative nasolabial morphology with maxillary protrusion patients are helpful for correct clinical decision-making. At the same time, the operation suggests a new choice of facial rejuvenation for patients with maxillary protrusion. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The role of anterior segmental osteotomies in orthognathic surgery for protrusive faces in a Southeast Asian population: 10-year retrospective data of 51 patients treated in a single centre

Bimaxillary protrusion is a dentofacial deformity common in the East Asian population. It is often difficult to decide between orthodontic and surgical retraction to treat patients with bimaxillary protrusion, especially if surgery to correct skeletal base discrepancies is also required. The objective of this study was to investigate the treatment outcomes of surgical versus orthodontic retraction in patients with bimaxillary protrusion undergoing orthognathic surgery. A retrospective cohort study was conducted, where the medical records and radiographs of 51 patients with bimaxillary protrusion who had an anterior segmental osteotomy concomitant with orthognathic surgery were examined. Patients who had bimaxillary anterior segmental osteotomies were more likely to achieve an inter-incisal angle of 135 ± 5° at the end of treatment, when compared to patients who had orthodontic retraction (P < 0.01). The total treatment duration of patients who had bimaxillary anterior segmental osteotomies was significantly shorter as compared to that of the patients who only had these osteotomies in the maxilla (P < 0.001) or mandible (P = 0.012). Complications and permanent long-term sequelae following anterior segmental osteotomies were uncommon. It is concluded that bimaxillary anterior segmental osteotomies are a viable alternative for patients with concomitant bimaxillary protrusion and skeletal base discrepancies. This allows for a significantly shorter treatment time and greater correction of inter-incisal angles, without a significant increase in complications.

Modified Cupar's method for immediate diastema closure

Anterior maxillary osteotomy or ostectomy (AMO) is a safe, reliable, and easily adaptable procedure routinely performed in orthognathic surgery for the management of the dentoalveolar segment of the anterior maxilla. The anterior segmental maxillary osteotomy was first performed in 1921 by Cohn-Stock. Several modifications were done regarding approaches for AMO; however, Cupar's method is the most preferred approach by the surgeons and in practice since several decades. A novel midline split osteotomy is performed in combination with Cupar's method for superior and posterior repositioning of anterior maxillary segment in combination with immediate closure of diastema in this case report.

Arch Bar versus Titanium Mini-Plate Fixation in Anterior Segmental Osteotomy / Orthognathic Surgery (Cohort Clinical Study)

Aims and objectives: To compare the efficacy and outcome of arch bar versus plating fixation on the integrity of the osteomised segment. Materials And Methods: The study involved a total of 43 patients (86 jaws) undergoing upper (Wassmund) and lower (Kole) anterior segmental osteotomy from (2006-2013) in the Maxillofacial Department in Al-Salam Teaching Hospital/Mosul. The sample was divided into two groups, group A (43 jaws), the osteotomized segments fixed with the arch bar, while group B (43 jaws) fixed with mini-plates. The clinical evaluation includes the following criteria: pain, swelling, bleeding, wound healing, oral hygiene ,integrity of stabilization, relapse rate and duration of operation. Results: Clinical parameters as pain, swelling, and wound healing show no significant differences between groups; on the contrary, the bleeding scale and gingival health scale show very high significant differences in p-value. The integrity of stabilization immediately in operation reveals stable surgical correction in both groups. Still, one jaw from each group develops significant mobility (grade II) that necessitate the use of additional local types of fixation. Duration of operation: this manure could be operator skill dependent, in that most cases managed clinically in teaching hospitals necessitating some delayed time in operative work, but as a mean time overall patients in group A was 90 minutes, while in group B was 77 minutes. Conclusions: According to this study, we prefer to use an arch bar rather than manipulates for fixation of anterior segmental osteotomies. Key words: Arch Bar, Complication, Fixation, Miniplate, Osteotomy.

Cleft Lip and Palate Midfacial Hypoplasia: Criteria to Choose the Treatment.

A series of skeletal and dentoalveolar/occlusal criteria were proposed for choosing the treatment modality for the management of midface hypoplasia in cleft lip/palate patients, focusing on functional improvement, aesthetics, and minimizing the risk of recurrence and secondary alterations. For which, 42 patients with nonsyndromic cleft lip/palate, all with previous primary lip/palate surgeries and without previous osteotomies, were analyzed. Orthognathic surgery (OS) (n = 24) and maxillary distraction osteogenesis (n = 18) with anterior segmental osteotomies (segmental distraction osteogenesis [SD]), alveolar transport disc (TD), and midface total distraction osteogenesis (TDO) by modified Le Fort III osteotomy was done.The average of maxillary advancement for OS was 5.58 ± 0.83 mm, for SD 9.4 ± 0.89 mm, for TD 8.00 ± 1.00 mm, and for TDO was 8.13 ± 1.55 mm.In the presence of infraorbital and/or zygomatic hypoplasia, TDO was performed using skeletal anchorage, with the requirement of occlusal stability in dental cast in occlusion. In short maxillary arch without dental cast feasibility in occlusion, hypodontia/agenesis or absence of premaxilla, TD and SD was performed. There was only 1 mm of recurrence in 1 patient of each group. Changes in speech were detected in 2 patients in the OS group (8.3%). Orthognathic surgery can be indicated for advancements ≤7 mm not requiring orbito-zygomatic advancement, whereas distraction osteogenesis can be indicated for advances >8 mm with or without the need for orbito-zygomatic advancement, in addition with other dentoalveolar factors and velopharyngeal function.

Feasibility of Correcting Dentoalveolar Abnormalities with Anterior Segmental Osteotomies without Orthodontics

We designed this study to see the potency and stability of an-terior segmental osteotomies (ASO) while not dental orthopaedics for numerous dentofacial deformities. Records of patients treated with jaw or articulator ASO, or both, while not dental orthopaedics within the past fifteen years were analyzed. The assessment enclosed surgical analysis of patients’ aesthetics and purposeful satisfaction employing a form and grading (score zero - 4) system, and also the quantity of relapse calculated from 12-month surgical cephalograms. A complete of twenty six ASO subjects (age vary 13- thirty one years) were studied (14 jaw, 2 articulator, and ten bimaxillary). Semi-permanent stability was acceptable altogether cases with no important relapse (p>0.05). No major complications were encountered. All patients reportable smart to glorious (score=3 to 4) satisfaction following surgery. victimization meticulous designing and a careful surgical technique, ASO while not dental orthopaedics may be a straightforward, quick, safe, and stable possibility for the correction of dentofacial deformities.

Study of soft tissue changes in the upper lip and nose after backward movement of the maxilla in orthognathic surgery.

ObjectivesThis study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy.Materials and MethodsAll 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively.ResultsCluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for Aʼ/ANS and Ls/Is (P<0.001) was significant; Aʼ/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation.ConclusionThe ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.

Cirugía Ortognática con osteotomía segmentaria anterior como alternativa De Tratamiento En Pacientes con deformidades dento esqueletales (DDE) Clases III por deficiencia AP maxilar compensados dentalmente: Caso clínico

Introduction: Orthognathic surgery is a routine procedure carried out by maxillofacial surgeons in patients with dento-skeletal deformations (DSD) with the objective of achieving functional and esthetical satisfactory results. However, some in cases, due to the decision of the patient or the orthodontic team, the occlusion is tried to be compensated with the intention of avoiding surgery, without optimal results. As a consequence, some extra procedures are required in the surgery to correct and obtain better results. Objective: The aim of this case is to propose the anterior segmental osteotomy (ASO) as alternative of treatment in patients with dento-skeletal deformity class III with maxillary and para-nasal deficiency which have been orthodontically compensated. Material and methods: A 18 years old female with DED Class III due anterior-posterior (AP) maxillary and paranasal deficiency and AP mandibular excess. The surgery was carried out through Le Fort I osteotomy in combination with a segmentary osteotomy at the expense of first premolars and bilateral setback sagittal split osteotomy (BSSO). Clinical and imageology post operatory controls were made during the first 6 months and at two years. Results: Through the realization of the anterior segmental osteotomy the correction of occlusal and transversal alterations of the patient maxilla were performed and additionally favorable facial changes were obtained. Conclusion: The initial orthodontic management of patients with DSD will influence the surgical procedures and the achievement of a balance between esthetics and function. This illustrates why the treatment of these patients must be multidisciplinary; the treatment that was chosen in this case was innovative and could be an alternative for the treatments of patients with DED Class III.

One-piece Lefort osteotomy versus segmental procedure for maxillary skeletal deformities - A retrospective study

Maxillary skeletal deformities can occur in all three planes and are corrected by orthognathic surgery. Osteotomies form the basis for orthognathic surgeries. One of the most commonly used osteotomy techniques for maxillary skeletal deformities is the LeFort osteotomy. The aim of this study was to compare the application of One Piece LeFort Osteotomy and Segmental Osteotomy procedures in the treatment of maxillary skeletal deformities. The institutional study involved analysis of case sheets of patients who underwent surgical correction of maxillary skeletal deformities in the stipulated time frame and assessment based on the parameters: Demographic data, type of cephalometric analysis, cephalometric values, type of skeletal deformity, and technique of Osteotomy. Statistical analysis was calculated by chi-square test. A p-value&lt;0.05 was considered significant. Maxillary skeletal deformities were more prevalent among females (60%) than males (40%). Anterior maxillary segmental osteotomies were more commonly performed (60%), followed by LeFort 1 osteotomy (26.7%). The prevalence of posterior osteotomy technique was 13.3%. A statistically significant association was revealed between the type of skeletal malocclusion and technique of Osteotomy used, with a p-value of 0.008&lt;0.05. The type of malocclusion dictates the technique of Osteotomy is used. In a skeletal Class II, segmental malocclusion procedure was more preferred for maxillary deformities.

The Surgery-first Approach to Orthognathic Surgery.

The purpose of this study was to compare the outcomes between the conventional surgical approach (CSA) and the surgery-first approach (SFA) for both traditional orthognathic osteotomies (LeFort/BSSO) and anterior segmental osteotomies (ASO). This was a retrospective cohort study of patients treated at the Hanoi Plastic Surgery Center from January 2000 to December 2012. The study predictors were the type (LeFort/BSSO or ASO) and timing (CSA or SFA) of surgery. The study outcomes were total treatment time and the rates of complication and relapse. 146 patients were included in the study, of whom 99 (67.8%) were treated with traditional osteotomies and 47 (32.2%) were treated with ASO. In the traditional osteotomy group, there were no significant differences in complication (P = 0.84) or relapse (P = 0.77) rates between CSA and SFA. There were no complications or relapses in the ASO group. Total treatment time was significantly decreased when using the SFA for both orthognathic osteotomies (-3.9 months, P < 0.01) and ASO (-3.3 months, P < 0.01). Our results showed that the SFA was able to achieve similar clinical outcomes to CSA but in a shorter treatment time. The SFA was effective for not only traditional orthognathic osteotomies but also ASO.

Anterior segmental osteotomies without orthodontics: practicability of the correction of dentoalveolar deformities

We designed this study to determine the efficiency and stability of anterior segmental osteotomies (ASO) without orthodontics for various dentofacial deformities. Records of patients treated with maxillary or mandibular ASO, or both, without orthodontics in the past 15 years were analysed. The assessment included postoperative analysis of patients’ aesthetics and functional satisfaction using a questionnaire and grading (score 0 - 4) system, and the amount of relapse calculated from 12-month postoperative cephalograms. A total of 26 ASO subjects (age range 13- 31 years) were studied (14 maxillary, two mandibular, and 10 bimaxillary). Long-term stability was acceptable in all cases with no significant relapse (p>0.05). No major complications were encountered. All patients reported good to excellent (score=3 to 4) satisfaction following surgery. Using meticulous planning and a careful surgical technique, ASO without orthodontics is a simple, quick, safe, and stable option for the correction of dentofacial deformities.