Orthognathic Patient Research Articles

Mandibular lateral movements of orthognathic patient by Four-Dimensional JAW motion system

To compare the maximum lateral movements between the control group and group of patients before and after combined orthodontic and orthognathic treatment based on a four-dimensional jaw motion system. This study included ten patients before and after combined orthodontic and orthognathic surgery treatment and ten controls. The mandibular left and right lateral movements were tracked, visualized, and analyzed using Planmeca four-dimensional jaw motion system. A t-test was used to compare the means between the groups. The average maximum of lateral movement in the control group was on the left side 12.8 mm and on right 14.15 mm. The number of lateral movements in the orthognathic group was on the left side 9.24 mm and on right 8.44 mm before treatment and after treatment on the left side was 8.99 mm and on the right side was 8.26 mm. There was no statistical difference between groups at p<0.05; p=0.30. Only the right lateral movement was statistically significant (p=0.02) comparing the control to the orthognathic group before the surgery. This short research showed that there was a slight reduction in the lateral movements in the group of orthognathic patients after treatment but with no statistical difference. The statistically significant difference was of the right lateral movement comparing the control to the orthognathic group before the surgery. Further research is needed to demonstrate if there can be some improvement of lateral movements in the orthognathic patient after surgery.

Comprehensive virtual orthognathic planning concept in surgery-first patients

The surgery-first concept is becoming increasingly popular in orthognathic surgery since it offers major advantages such as a reduction of treatment duration and an increase in patient satisfaction by eliminating phases of presurgical orthodontic decompensation. Here, we present a novel interdisciplinary pathway of a fully virtual orthodontic-surgical planning concept in a surgery-first setting using a 3D-printed cutting guide and a customised maxillary implant for the Le Fort I osteotomy as well as a CAD/CAM-based stereolithographic final splint. Patient data from cone-beam computed tomography of the skull and a full arch dental scan were processed using the OnyxCeph3TM software (Image Instruments). A mutual computer-aided surgical simulation was conducted by the orthodontist and the oral and maxillofacial surgeon to determine the three-dimensional maxillary and mandibular movements. In a separate virtual planning session, the surgeon designed a customised maxillary guide and implant for precise intraoperative transfer (Geomagic Freeform Plus software, 3DSystems). A 3D-printed CAD/CAM-based final splint was fabricated by the orthodontist and used for accurate mandibular repositioning. We established a comprehensive virtual interdisciplinary orthognathic workflow and successfully applied this concept with a high level of accuracy in a series of surgery-first patients with different types of dentofacial anomalies. This novel fully computer-based pathway offers a high potential to improve the outcomes of orthognathic surgery and reduce total treatment time in the management of the orthognathic patient.

Pre and post operative orthodontics in orthognathic surgery

In the early 2l'st century, orthodontics differs from what was done previously. There is more emphasis now on dental and facial appearance reflecting awareness that parents and patients seek treatment largely because of concern about facial appearance and those psychosocial problems related to appearance. Second, patients now expect and are granted a greater degree of involvement in planning treatment. Last, Orthodontics now is offered much more frequently to older patients as part of a multidisciplinary treatment plan involving other dental and medical specialties. Orthognathic Surgery is mostly performed to correct developmental or acquired oral and maxillofacial skeletal deformities. The type of tooth movement and mechanics required for Orthognathic surgery is oftentimes different to standard Orthodontics. It is imperative that the treating Orthodontist is conversant with the principles and technical mechanical requirements in the management of the Orthognathic patient.

Facial profile study using 3-dimensional photographs to assess esthetic preferences of Hong Kong Chinese orthognathic patients and laypersons

This study was conducted to investigate and compare esthetic perceptions of different facial profiles among Hong Kong Chinese laypersons and patients scheduled for orthognathic treatment. Two sets of 3-dimensional facial photographs (1 male and 1 female) each comprised 7 images that showed different dentoskeletal relations (ie, Class I, bimaxillary protrusion, bimaxillary retrusion, maxillary protrusion, maxillary retrusion, mandibular protrusion, and mandibular retrusion). The sets of photographs were shown to 101 laypersons (age, 28.87±6.22years) and 60 patients seeking orthognathic treatment (age, 27.12±6.07years). They rated their esthetic perceptions of the photographs on the basis of a 100mm visual analog scale (VAS) from 0 (very unattractive) to 100 (very attractive). The dentoskeletal Class I facial profile was ranked as the most attractive profile. Female orthognathic judges selected the retrusive maxilla while male orthognathic judges and male and female laypersons ranked the mandibular protrusion profile as the least attractive profile for both females and males. A bimaxillary protrusive female profile was viewed as more attractive by the orthognathic male (P=0.006) and female (P=0.006) judges, compared with female layperson judges. After adjustment for age, no statistically significant interaction between sex and judges (P>0.10) for all VAS scores were detected. For the female bimaxillary protrusive profile, orthognathic patient judges assigned a mean VAS score of 9.174 points higher than layperson judges (95% confidence interval, 3.11-15.24; P=0.003). Dentoskeletal Class I facial profile was generally considered the most attractive profile in both sexes; male and female orthognathic patients preferred a bimaxillary protrusive female profile. A concave facial profile was perceived as least attractive in both sexes.

Orthognathic patient perception of 3D facial soft tissue prediction planning

The primary aim of this study was to explore patients’ perceptions regarding the impact of 3D prediction planning (3D PP) of facial soft tissue changes following orthognathic surgery.The study was carried out on 30 patients who were shown photorealistic 3D soft tissue prediction planning before undergoing orthognathic surgery to demonstrate the expected facial changes. Distraction osteogenesis and cleft deformities were excluded from the study before consenting to surgery. Following surgery, the included patients were asked to complete a standard questionnaire to explore their perceptions regarding the impact, accuracy, and value of 3D prediction planning.The majority of the 30 participants perceived 3D PP to be beneficial in reducing their presurgical anxiety, increasing their motivation to undergo surgery, improving the accuracy of their surgical expectations, and enhancing doctor–patient communication. Most of the patients perceived their surgical soft tissue changes to be better than the predictions. Significant positive correlations were detected between satisfaction with the delivered service and the facility of seeing 3D PP (rs = 0.4; p = 0.034). Similarly, 3D PP improved patients’ confidence in the surgical decision (rs = 0.4; p = 0.031), as well as increasing their motivation to undergo surgery (rs = 0.5; p = 0.010).3D PP was found to be effective in improving the quality of orthognathic surgical care.

Reprint of the role of total joint replacement surgery in the orthognathic patient

Alloplastic reconstruction of the temporomandibular joint, commonly referred to as total joint replacement, is used to treat end stage joint disease in a cohort of patients who present with a range of condylar pathology. In considering its role in the management of the orthognathic patient, it is helpful to categorize patients into those with primary pathology of the mandibular condyle or those with primary dentofacial deformity. The success of total joint replacement is predicated by the predictably stable results that are achieved when used in carefully selected clinical scenarios. In this article, we will discuss the role of total joint replacement surgery in the orthognathic patient and highlight its clinical impact by inclusion of a case study.

Development of a core outcome set for use in routine orthodontic clinical trials

A diverse range of outcomes is used in orthodontic research with a focus on measuring outcomes important to clinicians and little consistency in outcome selection and measurement. We aimed to develop a core outcome set for use in clinical trials of orthodontic treatment not involving cleft or orthognathic patient groups. A list of outcomes measured in previous orthodontic research was identified through a scoping literature review. Additional outcomes of importance to patients were obtained using qualitative interviews and focus groups with adolescents aged 10-16years. Rating of outcomes was carried out in a 2-round electronic Delphi process involving health care professionals and patients using a 9-point scale. A face-to-face meeting was subsequently held with stakeholders to discuss the results before refining the core outcome set. After triangulation, a final list of 34 outcomes grouped under 10 domains was obtained for rating in the e-Delphi surveys. Fifteen outcomes were voted "in" after the second Delphi round involving 274 participants with a further outcome being included after the consensus meeting. These were subsequently refined into a final set of 7 core outcomes, including the impact of self-perceived esthetics, alignment and/or occlusion, skeletal relationship, stability, patient-related adherence, breakages, and adverse effects on teeth or teeth-supporting structures. A bespoke orthodontic core outcome set encompassing both clinician- and patient-focused outcomes was developed. Incorporating this is the first step into providing a more holistic assessment of the impact of treatment while allowing for meaningful comparisons and synthesis of results from individual trials.

Assent for Orthognathic Surgery: Features, Challenges, and Benefits.

The ideal age to undergo orthognathic surgery approximates the age of majority, and as a result a considerable portion of the patient population undergoing orthognathic surgery are legal minors. When a patient cannot legally provide consent, assent is often sought. Assent for surgical orthodontics is complicated by particular changes in cognitive variables during adolescence, the multiphased and multi-provider treatment course, and the intervention's elective nature. Ultimately, inclusion of a high-quality assent process can help identify patients most likely to benefit from orthognathic surgery and increase patient satisfaction.

The role of total joint replacement surgery in the orthognathic patient

Alloplastic reconstruction of the temporomandibular joint, commonly referred to as total joint replacement, is used to treat end stage joint disease in a cohort of patients who present with a range of condylar pathology. In considering its role in the management of the orthognathic patient, it is helpful to categorize patients into those with primary pathology of the mandibular condyle or those with primary dentofacial deformity. The success of total joint replacement is predicated by the predictably stable results that are achieved when used in carefully selected clinical scenarios. In this article, we will discuss the role of total joint replacement surgery in the orthognathic patient and highlight its clinical impact by inclusion of a case study.

Numbness of the lower lip does not adversely affect quality of life or patients’ satisfaction after mandibular orthognathic surgery

Measures of patient-reported quality of life (QoL) are increasingly being used to tailor services that are funded by Clinical Commissioning Groups (CCG) in England. Mandibular osteotomies may result in altered sensation of the lower lip, but we know of limited evidence about the resulting effect on QoL. The modified Bristol orthognathic patient outcomes questionnaire was given to patients who had mandibular osteotomies at the Queen Elizabeth Hospital, Birmingham, between March 2006 and April 2016. Questionnaires were collected at the final orthognathic postoperative appointment. The significance of the difference in QoL between those who had altered sensation of the lower lip and those who did not was compared using a two-tailed t test. During this period 170 patients had mandibular orthognathic operations. Completed questionnaires were received from 117 of those patients (69%) during this period, after a follow up of about six months. We found no significant difference between the perceived benefits of treatment between the 41 who had altered sensation and the 74 who did not (p=0.30). Only 5/41 who reported residual numbness six months postoperatively stated that they would not choose to have the same treatment again. In conclusion, orthognathic surgery results in an appreciable improvement in QoL and should continue to be funded by CCG in England. Contrary to the perception of some clinicians, those patients with residual numbness of the lip did not have significantly poorer QoL. Future interpretation of the data will be improved if they are collected both before and after the operation.

Clinician, dental student, and orthognathic patient perception of black-and-white silhouette lateral profile dimensions of ideal chin position in a Chinese population

This study aimed to investigate differences in the influence of chin prominence and length on perception of facial aesthetics by Chinese dental clinicians, orthognathic patients, and dental students. Male and female silhouette lateral profiles were modified to obtain 28 facial profiles by altering chin prominence and length by 3 mm in the sagittal and vertical planes. Images were rated by 70 clinicians, 30 orthognathic patients, and 100 dental students on a 7-point Likert scale. Perceived attractiveness was highest when the male chin prominence (MCP) was -3 mm to 3 mm and the female chin prominence (FCP) was 3 mm. In contrast, male chin length (MCL) of 0 to 3 mm and female chin length (FCL) of 0 mm were considered the most attractive. In the sagittal and vertical profiles, MCP (-9 mm), FCP (-9 mm), FCL (-9 mm), and MCL (-9 mm) were ranked least attractive. The overall aesthetic opinions of orthognathic patients, clinicians, and dental students are similar. The greater the retrusion or protrusion of the chin and the shorter or longer the chin length, the lower were the rates of facial aesthetics and the greater were the desire for surgery.

Managing the Obese Orthognathic patient: Is it time for National Guidelines?

Managing the Obese Orthognathic patient: Is it time for National Guidelines?

Class III orthognathic surgical cases facilitated by accelerated osteogenic orthodontics: a preliminary report

Abstract Objectives To describe a multidisciplinary treatment approach that includes corticotomy, orthodontic force and orthognathic surgery for the management of skeletal Class III surgical cases. The main advantage of the combined techniques is a reduction in treatment time for young adult patients. Method Accelerated Osteogenic Orthodontics (AOO) was delivered to three young adult patients during their pre-surgical orthodontic treatment. After aligning and levelling the dental arches, a piezosurgicalcorticotomy was performed to the buccal aspect of the alveolar bone. Bone graft materials were used to cover the decorticated area and soft tissue flaps were replaced. Results The mean time for extraction space closure was 5.4 ± 1.3 months and the mean time for pre-surgical orthodontic treatment was 12.0 ± 0.9 months. The average total treatment time was 20.4 ± 2.4 months. A pre-existing bony fenestration in the buccal cortex adjacent to the right lateral incisor root apex of Case 1 was corrected. Conclusion The facial aesthetics of three patients improved following multidisciplinary treatment. This approach may be an efficient method for the orthognathic patient who desires a reduced treatment time, but further clinical research is required.

Measurement of soft tissue change using 3D scanner in orthognathic surgery patient

Measurement of soft tissue change using 3D scanner in orthognathic surgery patient

Comparison of the Accuracy of Voxel Based Registration and Surface Based Registration for 3D Assessment of Surgical Change following Orthognathic Surgery

PurposeSuperimposition of two dimensional preoperative and postoperative facial images, including radiographs and photographs, are used to evaluate the surgical changes after orthognathic surgery. Recently, three dimensional (3D) imaging has been introduced allowing more accurate analysis of surgical changes. Surface based registration and voxel based registration are commonly used methods for 3D superimposition. The aim of this study was to evaluate and compare the accuracy of the two methods.Materials and methodsPre-operative and 6 months post-operative cone beam CT scan (CBCT) images of 31 patients were randomly selected from the orthognathic patient database at the Dental Hospital and School, University of Glasgow, UK. Voxel based registration was performed on the DICOM images (Digital Imaging Communication in Medicine) using Maxilim software (Medicim-Medical Image Computing, Belgium). Surface based registration was performed on the soft and hard tissue 3D models using VRMesh (VirtualGrid, Bellevue City, WA). The accuracy of the superimposition was evaluated by measuring the mean value of the absolute distance between the two 3D image surfaces. The results were statistically analysed using a paired Student t-test, ANOVA with post-hoc Duncan test, a one sample t-test and Pearson correlation coefficient test.ResultsThe results showed no significant statistical difference between the two superimposition methods (p<0.05). However surface based registration showed a high variability in the mean distances between the corresponding surfaces compared to voxel based registration, especially for soft tissue. Within each method there was a significant difference between superimposition of the soft and hard tissue models.ConclusionsThere were no significant statistical differences between the two registration methods and it was unlikely to have any clinical significance. Voxel based registration was associated with less variability. Registering on the soft tissue in isolation from the hard tissue may not be a true reflection of the surgical change.

The Intraoperative Use of Multimodal Analgesia in Controlling Postoperative Pain in the Orthognathic Patient

Multimodal analgesia is becoming an increasingly popular approach in controlling postoperative pain in the ambulatory setting. It is an approach that involves administering a combination of opioid and non-opioid analgesics that act on different sites 1 Elvir-Lazo O.L. et al. The role of multimodal analgesia in pain management after ambulatory surgery. Current Opinion in Anesthesiology. 2010; 23: 697-703 Crossref PubMed Scopus (166) Google Scholar . The purpose of this retrospective study is to evaluate the intraoperative use of multimodal analgesia using dexmedetomidine (precedex) via intravenous (IV) infusion and an IV bolus of methadone 2 Gottschalk A. et al. Intraoperative Methadone Improves Postoperative Pain Control in Patients Undergoing Complex Spine Surgery. International Anesthesia Research Society. Jan 2011; 112: 218-223 Google Scholar , 3 Geoffrey G. et al. A Double-comparison of the Efficacy of Methadone and Morphine in Postoperative Pain Control. Anesthesiology. 1986; 64: 322-327 Crossref PubMed Scopus (120) Google Scholar and ketamine, and its effects on postoperative pain control in the orthognathic patient.

Orthognathic Surgery in Cleft Patients

After studying this article, the participant should be able to: 1. Identify the skeletal changes in the cleft patient that necessitate surgery. 2. Describe the orthodontic principles that precede surgical treatment. 3. Demonstrate the surgical principles involved in cleft orthognathic surgery and how to avoid common pitfalls particular to cleft orthognathic surgery. 4. Anticipate when dentoalveolar distraction can help in the treatment of problems not easily treated with conventional orthognathic techniques. This CME article covers the basic multidisciplinary approach to the treatment of patients requiring a combined orthodontic orthognathic approach to their skeletally based malocclusion. The dentoskeletal abnormalities are described for these patients, as are the fundamental orthodontic principles in the presurgical treatment of these patients. The basic surgical principles are discussed in general, and the reader is provided with advice on avoiding common pitfalls. Specific attention is given to the more recent advances in dentoalveolar distraction in cases of large defects that would have been difficult to treat using conventional orthognathic surgery. Videos are provided to illustrate the general principles in treating the cleft orthognathic patient and to illustrate the treatment of large defects using dentoalveolar distraction.

Assessing the influence of chin prominence on perceived attractiveness in the orthognathic patient, clinician and layperson

The purpose of this investigation was to undertake an objective and quantitative evaluation of how the degree of chin prominence influences perceived attractiveness. The chin prominence of an idealized profile image was altered in 2mm increments from −24 to 12mm, in order to represent retrusion and protrusion of the chin, respectively. These images were rated on a 7-point Likert scale by a pre-selected group of pre-treatment orthognathic patients, clinicians and laypeople. In treatment planning to alter the sagittal prominence of the chin in an individual with an otherwise normal soft tissue facial profile, an ‘ideal’ sagittal position with soft tissue pogonion on or just behind a true vertical line through subnasale may be used. Chin retrusion or protrusion up to 4mm is essentially unnoticeable. Surgery is desired for chin protrusions greater than 6mm and retrusions greater than 10mm. The overall direction of aesthetic opinion appears to be the same for all the observer groups; the greater the retrusion or prominence of the chin, the less the rating of the perceived attractiveness and the greater the desire for surgical correction.

Assessing the influence of lower facial profile convexity on perceived attractiveness in the orthognathic patient, clinician, and layperson

The aim was a quantitative evaluation of how the severity of lower facial profile convexity influences perceived attractiveness. The lower facial profile of an idealized image was altered incrementally between 14° to -16°. Images were rated on a Likert scale by orthognathic patients, laypeople, and clinicians. Attractiveness ratings were greater for straight profiles in relation to convex/concave, with no significant difference between convex and concave profiles. Ratings decreased by 0.23 of a level for every degree increase in the convexity angle. Class II/III patients gave significantly reduced ratings of attractiveness and had greater desire for surgery than class I. A straight profile is perceived as most attractive and greater degrees of convexity or concavity deemed progressively less attractive, but a range of 10° to -12° may be deemed acceptable; beyond these values surgical correction is desired. Patients are most critical, and clinicians are more critical than laypeople.

The aesthetic outcome in orthognathic surgery patient—a long-term follow up

The aesthetic outcome in orthognathic surgery patient—a long-term follow up