Surgical-orthodontic Correction Research Articles

Surgical Orthodontic Correction for Class III Skeletal Malocclusion: Case Report

Surgical Orthodontic Correction for Class III Skeletal Malocclusion: Case Report

Stabilita incizálního schůdku, hloubky skusu a horní mezimolárové šířky po segmentální osteotomii maxily

Aim: The aim is to assess stability of overjet, overbite, and upper intermolar width after the orthodontic-surgical correction of orthodontic anomaly with segmental H-osteotomy of the maxilla. Material and method: The retrospective study works with 40 patients who underwent the segmental osteotomy of the maxilla. Each patient had aɸcomplete orthodontic documentation before the therapy (T1), prior to the surgery (T2), after aɸcompletion of an orthodontic treatment (T3) and approx. 25 months after aɸremoval of fixed appliance, minimum of 1 year after the completed orthodontic treatment and at least 1.5 years after the orthognathic surgery (T4). In every time interval, aɸdigital model of aɸdentition was made to measure the overjet, the overbite and the upper intermolar width. Results: During aɸ long-term check-up the value of the overjet showed aɸ clinically and statistically insignificant decrease by 0.1 ± 0.5 mm. The overbite also showed aɸclinically insignificant decrease by 0.1 ±0.5 mm; in none of the cases there was aɸclinically significant bite opening. The average value of the upper intermolar width was 38.9 ±3.1 mm before the beginning of therapy, prior to orthognathic surgery the value increased due to orthodontic treatment by 0.5 ±1.7 mm. After the active therapy completion, the value increased by 0.9 ±1.7 mm, i.e. by 1.4 ± 2.6 mm compared to the initial condition. In aɸlong-term check up, the average loss of uper intermolar width by 0.4 ±0.7 mm was recorded.

Orthodontic-Surgical Correction of a Skeletal Class III Malocclusion: Case Report

Introduction: Class III malocclusions and anterior crossbites are disturbing for patients because they are very apparent and often cause aesthetic and functional damage. Description: The clinical case describes a 19-year-old patient in good general health attended the dento-facial orthopedics service at the Rabat Hospital Center for Dental Consultation and Treatment presenting an anterior crossbite. The clinical examination and the cephalometric analysis showed that the patient had a Class III malocclusion of maxillary and mandibular origin with hyperdivergent facial type. An orthodontic-surgical treatment was well indicated for correction of the skeletal discrepancy in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. Results: In reviewing the patient’s final records, the major goals set at the beginning of treatment were successfully achieved; the facial profile and proportion were significantly improved with solid functional occlusion Conclusion: In class III malocclusion when facial aesthetics is altered, the surgical-orthodontic treatment is the most indicated for patients who do not present facial growth.

Impact of dentofacial deformity on the chance of being hired for a job.

This study aimed to determine the impact of dentofacial deformity on an individual's chances of being hired for a hypothetical job involving customer service. Face photographs (frontal and lateral) of 15 patients with moderate to severe dentofacial deformity, taken before and after orthodontic-surgical correction, were selected and randomized between two different questionnaires. In addition, five patients without dentofacial deformity were used as controls in both questionnaires. These questionnaires were taken by adults responsible for hiring personnel to work in commerce and business activities, graduates or postgraduates in business administration, with experience in recruiting and hiring personnel. The evaluation took place using a Likert scale with values ranging from 0 to 10 (in which 0 corresponded to complete disagreement and 10 to complete agreement), considering the following variables in a first impression judgment: honesty, intelligence, productivity at work, and hiring chance. Data were tabulated and statistical analysis was performed using a linear regression model for the explanatory variables that showed statistical significance in the analysis of variance (ANOVA). Effect size through Cohen's d has been corrected for all comparisons performed. All re-examined domains demonstrated statistical differences even when included in a multivariate model (p < 0.05), with lower mean values for those requiring pre-treatment (presenting deformity), although the effect size was small for all comparisons. Dentofacial deformity influenced the hiring chance, although not appearing to be a preponderant factor for hiring, acting as a tiebreaker among the candidates adopted.

Surgical-orthodontic Correction of Skeletal Class III Anterior Open Bite with Facial Asymmetry

Surgical-orthodontic Correction of Skeletal Class III Anterior Open Bite with Facial Asymmetry

Management of Class III malocclusion by orthodontic clockwise rotation of maxillo-mandibular complex – A case report

Severe Skeletal Class III malocclusions in adult patients are managed by surgical orthodontic correction and orthodontic camouflage especially in borderline cases. An orthodontic camouflage is best opted in situations where the patient is either reluctant to have an invasive procedure or mitigate other ways to obtain an ideal interincisal relation, best esthetic outcome and function. There are many ways suggested to treat Class III malocclusions non-surgically like fixed appliance with class III intermaxillary elastics, extraction of mandibular first bicuspids, extraction of mandibular first and maxillary second bicuspids and enmasse distalization of mandibular arch using temporary anchorage devices. Clockwise rotation of maxillo-mandibular occlusal complex gives promising treatment outcome in selected cases with extrusion of upper arch and possible clockwise rotation of the mandible for improving mandibular prognathism. This case report aims to illustrate a Class III non-growing patient treated by clockwise rotation of maxillo-mandibular occlusal complex for achieving optimum facial esthetics and function.

Outcome of surgical-orthodontic treatment in hemifacial microsomia with and without early mandibular distraction osteogenesis

The aim of this study was to compare the outcomes of surgical-orthodontic treatment between hemifacial microsomia (HFM) patients who had and had not undergone early mandibular distraction osteogenesis (DO). Twenty adult unilateral HFM patients were included, seven who had undergone early mandibular DO (DO group) and 13 who had not (NDO group). All patients were type IIB, except for one type IIA patient in the NDO group. Mean age at definitive surgery was 20.72±2.96 years. Linear, cross-sectional, and volumetric measurements were obtained from serial cone beam computed tomography scans. Data were obtained pre-surgery (T0), 1 week after surgery (T1), and at treatment completion (T2) to determine surgical movement, post-surgical stability, and net gain movement. Surgical and ultimate outcomes did not differ significantly between the groups. The overall surgical movement among all patients was as follows (mean values): maxillomandibular complex (MMC) symmetry was achieved by Le Fort I differential roll movement (3.78mm extrusion on the affected side, 4.28mm impaction on the non-affected side), a combination of medial movement and yaw rotation of MMC, and genioplasty. Upper and lower dental midlines and deviated menton were shifted by 5.73mm, 5.08mm, and 12.38mm, respectively. Anterior impaction and advancement with counterclockwise rotation of MMC were also performed. Menton was advanced by 6.14mm and lower facial height was increased by 3.55mm. Neither group exhibited a significant difference in stability. Relapse at the maxilla was <1mm and relapse at the mandible was <1.5mm. The results suggest that early DO had limited beneficial effects on the definitive correction outcome. HFM patients achieved acceptable symmetry and a stable surgical outcome, regardless of early DO, following surgical-orthodontic correction at skeletal maturity with three-dimensional surgical simulation.

English

English

Trends in surgical-orthodontic management of Class III malocclusions in Western Australia

Abstract Aim The aim of this retrospective cohort study was to identify trends in the surgical-orthodontic management of skeletal Class III malocclusions in Western Australia between 1985 and 2016. Methods The records of 225 patients (132 females, 93 males) who received combined surgical-orthodontic correction of their Class III malocclusion between 1985 and 2016 were retrospectively assessed. The subjects were divided into three groups according to surgery type: Group (1) maxillary advancement only; Group (2) mandibular setback only; Group (3) two-jaw surgery. Results A trend towards two-jaw surgery for Class III correction was observed. Between 1985 and 2016, 123 patients (55%) were treated via two-jaw surgery; 97 patients (43%) were treated via maxillary advancement alone and five patients (2%) were treated via mandibular setback alone. Between 2011 and 2016, 61% were treated via two-jaw surgery; 37% were treated via maxillary advancement surgery; 2% were treated via mandibular setback surgery. Gender affected surgery type: two-jaw surgery (60% female); maxillary advancement (62% female); mandibular setback (17% female). A greater proportion of females received Class III surgical management in comparison with males (59:41). Conclusion Two-jaw surgery is the most common procedure for the surgical correction of skeletal Class III malocclusions in Western Australia. Of the single jaw procedures, isolated maxillary advancement surgery is more common than mandibular setback procedures.

Is skeletal stability after bimaxillary surgery for skeletal class III deformity related to surgical occlusal contact?

A stable occlusion at the time of surgery is considered important for post-surgical stability after orthognathic surgery. The aim of this study was to determine whether skeletal stability after bimaxillary surgery using a surgery-first approach for skeletal class III deformity is related to the surgical occlusal contact or surgical change. Forty-two adult patients with a skeletal class III deformity corrected by Le Fort I osteotomy and bilateral sagittal split osteotomy with a surgery-first approach were studied. Dental models were set and used to measure the surgical occlusal contact, including contact distribution, contact number, and contact area. Cone beam computed tomography was used to measure the surgical change (amount and rotation) and post-surgical skeletal stability. The relationship between skeletal stability and surgical occlusal contact or surgical change was evaluated. No relationship was found between maxillary or mandibular stability and surgical occlusal contact. However, a significant relationship was found between maxillary and mandibular stability and the amount and rotation of surgical change. The results suggest that in the surgical-orthodontic correction of skeletal class III deformity with a surgery-first approach, the post-surgical skeletal stability is not related to the surgical occlusal contact but is related to the surgical change.

Surgical Orthodontic Correction of a Skeletal Class Ⅲ Case Treated by Dental Decompensation Using Anchor Screws

Surgical Orthodontic Correction of a Skeletal Class Ⅲ Case Treated by Dental Decompensation Using Anchor Screws

Factors affecting treatment duration of labial inversely impacted maxillary central incisors.

A labial inversely impacted maxillary central incisor is a relatively rare occurrence. The crown of the tooth is directed upward, and its palatal aspect is facing labially. This typical orientation can be the result of trauma to the deciduous incisor transmitted to the palatal side of the crown of the permanent incisor. Labial inversely impacted maxillary central incisors are most commonly combined with labial-lingual root dilacerations. The aim of this study was to examine factors that affect the surgical-orthodontic treatment duration of labial inversely impacted maxillary central incisors. The records of 35 consecutively treated patients were retrospectively evaluated. Cone-beam computed tomography images were taken before treatment, and factors affecting treatment time, including age, length, crown-root angle, crown height and depth, angle of inversion, rotation to axial plane, and distance and angle to midline, were measured using Dolphin Imaging software (version 11.8; Patterson Supply, St Paul, Minn). Treatment duration was evaluated for each patient, and logistic regression analyses were applied. The 15 boys and 20 girls had a mean age 8.36±1.36years. The mean orthodontic traction duration was 11.28±3.08months. Multiple regression analyses indicated that factors resulting in a longer duration were age (β=0.779; P=0.043), crown height (β=0.344; P=0.007), crown-root angle (β=-0.037; P=0.018), and tooth length (β=-0.623; P=0.038). Surgical-orthodontic correction of labial inversely impacted maxillary incisors requires an average of 1year. Assessments of age, crown height, root dilaceration, and length of incisor can help the orthodontist to better predict treatment duration during consultations with patients and parents.

Orthodontic-surgical correction of a class III malocclusion through a surgery-first protocol: case report

Dentomaxillofacial deformities are conditions that lead to a disharmony between the maxilla and mandible seriously affecting facial appearance and masticatory function. Sometimes the orthodontist requires the collaboration of a maxillofacial surgeon specially. Ever since interventions and osteotomies became more complex an interdisciplinary relationship was established between both specialties. This case report presents a 13-year-old patient with a skeletal class III accompanied by maxillary hypoplasia and mandibular anterior displacement causing an anterior and posterior crossbite. Presurgical orthodontics was performed with 0.022” slot Roth appliances. Once the arches were coordinated, the patient was refered for a surgical assessment. Orthognathic surgery was performed: a LeFort I maxillary advancement with a mandibular ramus segmental surgerywas performed to reposition the jaw and treatment was finished with orthodontics to settle the bite. An occlusal adjustment was performed for obtaining the right mandibular movements and appliances were removed having achieved the desired objectives. It is important to make a proper diagnosis to define treatment objectives for each patient in order to improve aesthetics and function.

Three-dimensional regional displacement after surgical-orthodontic correction of Class III malocclusion

Three-dimensional regional displacement after surgical-orthodontic correction of Class III malocclusion

Three-dimensional regional displacement after surgical-orthodontic correction of Class III malocclusion.

To investigate how displacements of maxillo-mandibular structures are associated with each other at splint removal and 1 year post-surgery following 1-jaw and 2-jaw surgeries for correction of Class III malocclusion. Fifty patients who underwent surgical correction with maxillary advancement only (n = 25) or combined with mandibular setback (n = 25) were prospectively enrolled in this study. Cone-beam computed tomographies were taken pre-surgery, at splint removal and at 1 year post-surgery. Three-dimensional cranial base superimpositions and shape correspondence were used to measure the outcomes from pre-surgery to splint removal (surgical changes) and splint removal to 1 year post-surgery (post-surgical adaptations). Pearson's correlation coefficients were used to evaluate the association between the regional displacements. Both surgery groups presented mandibular clockwise rotation with surgery and post-surgical adaptive counterclockwise rotation. In patients treated with maxillary advancement only, the surgical changes of the maxilla were significantly correlated with chin changes. The amount and direction of chin autorotation were significantly correlated with right and left ramus autorotation. Right and left condylar displacements were significantly correlated. One year post-surgery, adaptive displacements and bone remodeling of both rami were correlated with the chin and condylar changes. For the 2-jaw group, the few correlations between the positional and remodeling changes in the anatomic regions of interest observed due to the surgery were different than those observed after post-surgical adaptations, suggesting that these changes occurred independently. Our results indicate that surgical displacements and post-surgical adaptations are often correlated in one-jaw surgery and are, in general, independent in two-jaw surgery.

Orthodontic-surgical correction with a bilateral mandibular ramus sagittal osteotomy of a skeletal Class III maloclussion

A case of a male patient of 19 years 3 months of age is reported. The chief complaint was having discomfort in the jaw. The diagnosis was a hyperdivergent skeletal class III, bilateral molar and canine class III with proclined upper incisors, bilateral anterior and posterior cross-bite, upper and lower crowding with a lower dental midline deviation. The patient also had a maxillary collapse. The patient did not refer any habit. Treatment was conducted in three phases: a pre-surgical phase: alignment, leveling, dental decompensation, tripodism (occlusal stability), transverse expansion. Surgical Phase: Mandibular LeFort I Surgery: 5mm advancement. Post-surgical phase: Detailing, retention. Active treatment time was 4 years 4 months. Removable upper and lower Hawley retainers and fi xed canine to canine both in the upper and lower arch were used. Treatment outcome was successful, obtaining bilateral canine and molar Class I, normal overjet and overbite, coincident midlines, adequate intercuspation and a harmonic facial profi le.Key words: Anterior and posterior crossbite, mandibular advancement.

A more accurate soft-tissue prediction model for Class III 2-jaw surgeries

The use of bimaxillary surgeries to treat Class III malocclusions makes the results of the surgeries more complicated to estimate accurately. Therefore, our objective was to develop an accurate soft-tissue prediction model that can be universally applied to Class III surgical-orthodontic patients regardless of the type of surgical correction: maxillary or mandibular surgery with or without genioplasty. The subjects of this study consisted of 204 mandibular setback patients who had undergone the combined surgical-orthodontic correction of severe skeletal Class III malocclusions. Among them, 133 patients had maxillary surgeries, and 81 patients received genioplasties. The prediction model included 226 independent and 64 dependent variables. Two prediction methods, the conventional ordinary least squares method and the partial least squares (PLS) method, were compared. When evaluating the prediction methods, the actual surgical outcome was the gold standard. After fitting the equations, test errors were calculated in absolute values and root mean square values through the leave-1-out cross-validation method. The validation result demonstrated that the multivariate PLS prediction model with 30 orthogonal components showed the best prediction quality among others. With the PLS method, the pattern of prediction errors between 1-jaw and 2-jaw surgeries did not show a significantly difference. The multivariate PLS prediction model based on about 30 latent variables might provide an improved algorithm in predicting surgical outcomes after 1-jaw and 2-jaw surgical corrections for Class III patients.

Perceived changes by peer group of social impact associated with combined orthodontic-surgical correction of class III malocclusion

ObjectivesWhereas the psychosocial benefits of orthognathic treatment for the individual patient are established, there is little data relating to social perceptions in relation to changes in facial appearance as a result of combined orthodontic and orthognathic treatment. This study aimed to investigate the social impact of combined orthodontic–orthognathic surgical correction for class III malocclusion in Caucasian subjects. MethodsThis cross-sectional study compared perceptions of facial appearance prior to and after orthognathic correction of class III malocclusion. Eighty undergraduate students were shown photographs of four Caucasian subjects (2 male and 2 female) pre- and post-orthognathic class III correction. Observers were asked to rate these subjects in relation to four different outcomes: (i) social competence (SC); (ii) intellectual ability (IA); (iii) psychological adjustment (PA); (iv) attractiveness. A mixed-model analysis of variance (ANOVA) was calculated to determine the effect of each variable. ResultsStatistically significant differences were found in ratings of the same face before and after treatment. After treatment, faces were rated as more psychologically adjusted, more sociable, more likely to be successful and more attractive; with the mean psychological adjustment rating being associated with the most change (before treatment=8.06 [SD 2.30]; after treatment=6.64 [SD 2.03], t=2.04, p<0.001). ConclusionsAfter combined orthodontic–orthognathic correction of class III malocclusion in Caucasians, individuals are rated by young adults as being better adjusted both psychologically and socially, more likely to be successful and more attractive.

Dental transposition of canine and lateral incisor and impacted central incisor treatment: A case report

IntroductionDental transposition and impaction are disorders related to ectopic eruption or failure in tooth eruption, which can affect child physical, mental and social development and may be difficult to be clinically solved. MethodsWe describe a case of transposition between the upper left canine and lateral incisor associated with impaction of the central incisor on the same side, in a 12-year-old patient. Conservative treatment involving surgical-orthodontic correction of transposed teeth and traction of the central incisor was conducted. ConclusionThe option of correcting transposition and orthodontic traction by means of the segmented arch technique with devices such as cantilever and TMA rectangular wire loops, although a complex alternative, was proved to be esthetically and functionally effective.

Rapid correction of dento-facial deformities combining accelerated osteogenic orthodontics (AOO) and orthognathic surgery

Background and objectives: Heinrich Kole first introduced the corticotomy procedure to accelerate tooth movements, 1 Kole H. Surgical operations of the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Path. 1959; 12: 515 Abstract Full Text PDF PubMed Scopus (186) Google Scholar Epker 2 Epker B.N. Paulus P.J. Surgical orthodontic correction of adult malocclusions: single tooth dento-osseous osteotomies. Am J Orthod. 1978; 74: 551-563 Abstract Full Text PDF PubMed Scopus (22) Google Scholar and others 3 Generson R.M. Porter J.M. Zell A. Stratigus G.T. Combined surgical and orthodontic management of anterior open bite using corticotomy. J Oral Surg. 1978; 34: 216 Google Scholar modified the technique but corticotomy surgery has gained little acceptance in the modern era of orthognathic surgery. Wilcko et al. 4 Wilcko M.T. Wilcko W.M. Pulver J.J. Bissada N.F. Bouquet J.E. Accelerated osteogenic orthodontics: a 1-stage surgically facilitated rapid orthodontic technique with alveolar augmentation. J Oral Max Fac Surg. 2009; 67: 2149-2159 Abstract Full Text Full Text PDF PubMed Scopus (208) Google Scholar introduced a technique combining coorticotomies, stippling and alveolar ridge grafting. The technique termed AOO or Wilckodontics has been shown to be very successful in correcting dental malocclusions. 5 Hasse C.D. Aesthetic benefits of orthognathic surgery in Cosmesis of the Mouth Face and Jaws. Wiley-Blackwell, Oxford2012: 301-304 Google Scholar The purpose of this paper is to report the author's results combining AOO and orthognathic surgery.