Orthognathic Surgery Research Articles

Can the Upper Vermilion and the Nasolabial Fold Be Changed With Orthognathic Surgery?

BackgroundRetrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support. PurposeA study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles. Study design, setting, sampleA retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial aesthetic procedures, and dental rehabilitations involving lip changes, were excluded. Predictor variableThe predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (one month after surgery), and T2 (after one year of follow-up). Main outcome variableThe outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL. CovariatesThe covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements. AnalysesDescriptive and inferential analyses were performed based on analysis of variance (ANOVA), the Bonferroni test, Pearson’s linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for p < 0.05. ResultsThe sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6º was recorded (p < 0.001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (p=0.019). An increase in upper lip concavity angle of 14.4 ± 12º was recorded (p < 0.001), along with a vermilion lengthening of 1.6 ± 1.3 mm (p < 0.001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (p=0.001), indicating a more projected and everted upper vermilion. Conclusions and relevanceWhen adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted.

Three-dimensional assessment of root changes after Le Fort I osteotomy

The study aim was to assess the volumetric, linear, and morphological changes of the maxillary incisor, canine, and premolar roots following Le Fort I osteotomy. Sixty patients (585 teeth) were included retrospectively from among individuals who underwent combined orthodontics and orthognathic surgery. The study group comprised 30 patients who underwent orthodontics and one-piece Le Fort I osteotomy, while the control group consisted of 30 patients who underwent orthodontics and bilateral sagittal split osteotomy but no maxillary surgery. CBCT scans were obtained at four time points: preoperative, 6 months, 1 year, and 2 years postoperative. A fully automated three-dimensional evaluation protocol was utilized to assess root changes of the maxillary teeth. Significant differences in the apical and middle parts of the teeth were observed between the study and control groups at 1 and 2 years postoperative, with greater percentage changes in the study group (all P < 0.05). Greater root remodelling in the canines, first and second premolars was observed in the study group (all P < 0.005). Spearman correlation analysis indicated a positive relationship between root remodelling and maxillary advancement, with larger advancements contributing to increased root remodelling in the apical and middle root parts (both P < 0.05). These findings can be valuable for surgeons and orthodontists in evaluating root changes.

Management of Gummy Smile Using Esthetic Crown Lengthening Technique

Abstract Excessive gingival display is a major concern for a large number of patients visiting the dentist. It is a multifactorial condition that needs to be managed in a sequential manner in order to reach proper treatment technique that targets and resolves the underlying etiologies. There are different etiologies of a gummy smile, such as vertical maxillary excess, short and hyperactive upper lip, altered passive eruption, anterior dentoalveolar extrusion, or a combination of these causes. Many techniques have been used to restore the dentogingival relation for the management of gummy smile. The various treatment modalities for Excessive Gingival Display includes gingivectomy, modified lip repositioning, orthognathic surgery, orthodontic therapy, hyaluronic acid infiltration, botulin toxin injections. This case report deals with the correction of Excessive Gingival Display using conventional gingivectomy.

Mandibular Contouring in Subjects With Class II or Class III Dentofacial Deformities and Treatment Needs

Facial contouring relates to hard and soft structures that make up the face. Skeletal class II and III subjects present bone structure and position changes, significantly impacting the soft tissues. This study aims to analyze the morphology of the mandible at mandibular ramus and angle level in subjects with skeletal facial deformity class II and III who are candidates for orthognathic surgery and to define implications in facial contour. A cross-sectional study used cone beam computed tomography to compare the mandibular contour (mandibular angle and ramus region) in orthognathic surgery candidates. One hundred sixty orthognathic surgery candidates were analyzed, ranging in age from 18 to 58 years (31.29 ± 11.97). Regarding the skeletal class, 95 (59.37%) were skeletal class II, and 65 (40.62%) were skeletal class III. Class II subjects had a larger antegonial notch than class III subjects. Concerning the mandibular contour, class II subjects presented less vertical distance than class III subjects, but both presented similar gonial angles. Concerning the ideas to assess the need for mandibular contouring surgery, the 2 proposals to determine the need for mandibular contouring surgery in class II and III subjects present a similar distribution. The mandibular notch is an objective element and is commonly present in subjects with a class II facial pattern; this element can be used in contour analysis to define expected facial characteristics, including the patient’s facial sex, in the decision of surgical techniques for lower facial contour augmentation or reduction.

Do Regional Nerve Blocks During Bimaxillary Surgery Decrease Postoperative Pain and Vomiting Compared With Patient-Controlled Analgesia?

Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting. The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA). This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded. The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA. The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents. The study covariates included demographic, surgical, and anesthesia characteristics. Statistical analyses were conducted using an unpaired t-test, χ2 test, or Fisher's exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P<.05. 354 participants were included in the study (262 in the nerve block group, mean age 22.5±4.0years; 92 in the PCA group, mean age 22.6±4.4years; P=.81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P=.18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio=0.67, 95% confidence interval: 0.22-2.01, P=.48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio=0.34, 95% confidence interval: 0.18-0.65, P=.001). For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a low POV risk.

Discrepancy index, treatment complexity index and objective Grading system: correlation between parameters, indices and implications for treatment

Abstract Objectives An assessment of orthodontic treatment duration and results allows for measurable outcomes, goal-setting, and the establishment of patient management standards. It is important information that can be utilised for educational purposes in an orthodontic postgraduate program. The aim of this study was to determine correlations of the parameters within and between the Objective Grading System (OGS), Discrepancy Index (DI) and Treatment Complexity Index (TCI) and identify those factors associated with treatment outcomes and duration. Materials and methods This retrospective cohort study involved a consecutive sampling of 242 pre- and post-treatment patient records from the postgraduate orthodontic clinic between 2013 and 2017. The cases were assessed using the DI, OGS, and TCI pre-treatment. Treatment outcomes were assessed using the OGS. Spearman’s Rank Correlation Coefficients were computed within and between the indices. Multiple and logistic regressions were used to evaluate associations between treatment outcomes and duration, respectively. Results Within DI, significant correlations (p &lt; 0.05) were observed between overjet-overbite, overjet-occlusal relationship, overjet-crowding, overbite-anterior open bite, overbite-crowding, anterior open bite-lateral open bite, anterior open bite-crowding, lingual posterior cross bite-crowding. Within pre-OGS, significant correlations (p &lt; 0.05) were observed between alignment-marginal ridge, alignment-occlusal relationship, alignment-root angulation, overjet-interproximal contact, marginal ridge-buccolingual inclination, marginal ridge-overjet, marginal ridge-occlusal contact, marginal ridge-occlusal relationship, overjet-occlusal contact, overjet-occlusal relationship, overjet-root angulation, occlusal relationship-root angulation, interproximal contact-root angulation. Within TCI, functional appliance correlated with orthognathic surgery (p &lt; 0.001), rapid palatal expansion (RPE) (p = 0.005) and multidisciplinary collaboration (p = 0.001). Pre-OGS correlated with DI (p &lt; 0.001) and TCI (p = 0.026). Cephalometric (p = 0.002) and other conditions (p = 0.031) were associated with treatment outcomes. RPE was associated with extended treatment duration (p = 0.014). Conclusions DI, OGS, and TCI exhibited weak correlations within and between indices. Cephalometric values, clinical conditions, and RPE use should be carefully considered during treatment planning.

Can ChatGPT-4o provide new systematic review ideas to oral and maxillofacial surgeons?

ObjectiveThis study aims to evaluate the capacity of ChatGPT-4o to generate new systematic review ideas in the field of oral and maxillofacial surgery. The data obtained from this study will provide evidence-based information to oral and maxillofacial surgeons regarding the academic use of GPT-4o. Materials and methodsChatGPT-4o was asked to provide four previously unpublished systematic review ideas each for the topics of impacted third molars, dental implants, orthognathic surgery, and temporomandibular disorders. A literature search was conducted in the PubMed database to check if the ideas generated by GPT-4o had been previously published, and the search results were compared with the ideas generated by the AI. ResultsThe PubMed database search resulted in a total of 871 publications, with 37 publications found to be related to the topics generated by GPT-4o after the first and second screening. Out of the 16 publication ideas generated by GPT-4o, 9 (56.25 %) were determined to be previously unexplored according to the PubMed database search. There was no statistically significant relationship between the presence of ChatGPT's suggestions in PubMed and the subject areas of the studies. ConclusionChatGPT-4o has a high potential to be used as a valuable tool for suggesting systematic review topics in oral and maxillofacial surgery. Additionally, this tool can assist researchers not only in proposing publication ideas but also in developing the methodology of the study.

Treatment acceptance in adult patients with anterior open bite: A National Dental Practice-Based Research Network study

Orthodontists have many techniques to treat anterior open bites and must involve patients in making treatment decisions. This study aimed to investigate orthodontic treatment plan acceptance by United States adults with anterior open bites and to identify associations between treatment acceptance and patient demographics and dentofacial characteristics. A prospective, observational cohort study enrolled the patients of 91 orthodontic providers. A total of 345 adults were included in the sample. Provider personal and practice demographics were captured. Patient demographics, treatment goals, dentofacial characteristics, and reasons for not accepting the recommended plans were recorded. Adjusted regression models were used to identify associations between patient characteristics and the likelihood of accepting the most highly recommended plan. Approximately 78% of patients accepted the most highly recommended treatment plan. 60% of the patients who were recommended surgical plans accepted them. Patients with a history of orthodontics and a concave profile were more likely to accept the most highly recommended plan. Insurance coverage for orthognathic surgery was associated with a higher acceptance rate for surgery. Severe crowding was associated with a lower acceptance of surgery. The most common reasons for declining the recommended plan were not wanting jaw surgery and considering the treatment to be too invasive, risky, and/or costly. Patient acceptance is less common at higher levels of invasiveness of treatment. Prior orthodontic treatment, concave profile, and insurance coverage for surgery were associated with accepting treatment. Most patients accepted a surgical plan when it was the most recommended option.

Establishment of Cephalometric Hard Tissue Profile among Bengali and Caucasian Populations for Orthognathic Surgery

ABSTRACT The study aimed to compare cephalometric hard tissue profile values and analysis between Bengali and Caucasian populations. The study included 100 individuals (50 males, 50 females) aged 18–35. Subjects having class I molar occlusions and well-balanced facial profiles were included in the study. Lateral cephalograms were taken with consent, and a prestructured proforma recorded relevant information and cephalometric measurements. Our study found increased posterior cranial base length in Bengali males and increased anterior cranial base length in both sexes. Bengali males had a less convex profile, while females had a more convex profile compared to Caucasians with similar mandibular features. Increased maxillary and mandibular incisor proclination was observed. Our findings indicate the necessity for separate norms for orthognathic surgery in normal ethnic Bengali adults.

Evolution of Virtual Surgical Planning Use Among Craniofacial Surgeons

Virtual surgical planning (VSP) has benefits in craniofacial surgery with growing popularity. However, while specific use cases are highlighted in the literature, no studies exist providing an overview of VSP use among craniofacial surgeons, and little is known about the extent of exposure to VSP during plastic surgery training. This study surveyed members of The American Society of Maxillofacial Surgeons (ASMS) to better characterize both the landscape of VSP use among practicing craniofacial surgeons and the extent of exposure to VSP throughout surgical training. An electronic survey was administered in the fall of 2023. Response data included surgeon demographics, VSP usage, including the use in residency/fellowship, procedures for which VSP is used, and assessment of VSP’s impact on the surgeon’s practice. Demographics and VSP use were analyzed using descriptive statistics, while categorical and continuous variables were analyzed using χ2 tests and t-tests, respectively. Of the 44 respondents, 40 (90.9%) completed a craniofacial surgery fellowship, and 18 (40.9%) utilized VSP in either residency or fellowship. In respondents’ current practice, VSP is utilized most commonly for orthognathic surgery (n=32, 91.4%), postablative reconstruction (n=23, 82.1%), and facial feminization (n=11, 73.3%). Shorter operative time and improved esthetic outcomes were frequently reported as benefits derived from VSP use. Finally, surgeons in practice for less than 10 years were significantly more likely to have used VSP in both residency (OR=20.3, P&lt;0.01) and in fellowship (OR=40.6, P&lt;0.01) than those practicing for more than 10 years. These findings suggest that craniofacial surgeons apply VSP more commonly for certain procedure types. Our results additionally suggest that incorporation of VSP into residency and fellowship training has become significantly more common over time, with a pivot towards integration in the last decade.

Guided versus non-guided chin repositioning: a retrospective study on accuracy

Genioplasty is a widely used surgical approach to address chin deformities by performing an osteotomy on the inferior border of the mandible to allow for comprehensive repositioning of the chin. This study aimed to compare the accuracy of freehand chin repositioning with a guided technique that employed specialised surgical guides. For this retrospective study, data from 30 adult patients who underwent orthognathic surgery to correct dentofacial deformities were analysed. All patients underwent virtual planning before surgery, with half of them treated using freehand chin repositioning and the other half using the guided technique. The surgical outcomes were measured and compared with the virtual plan to assess the positional and rotational accuracy of the techniques. In terms of translational assessment, noteworthy values that exceeded clinically acceptable limits were observed only in sagittal movement in the freehand group (0.97 mm, interquartile range (IQR) 0.73–2.29 mm). Regarding rotational accuracy, both groups exhibited an IQR that surpassed acceptable limits for pitch (3.26°, IQR 2.06–5.20 for the guided group and 2.57°, IQR 1.63–4.24° for the freehand group). The Mann-Whitney test indicated no statistical differences between the groups in any translational or rotational assessment. In conclusion, although there was no statistical difference, the guided technique proved effective in achieving clinically acceptable accuracy in all positions and almost all rotations, displaying superior results in sagittal positioning compared with the freehand technique. To fully harness the advantages of guides and to guarantee accuracy in all rotations, we recommend further research involving guides made of more rigid materials, and customised implants.

Does the Sequence of Bimaxillary Orthognathic Surgery Affect Accuracy in Skeletal Class III Patients?

BackgroundIt is necessary to determine whether the sequence of maxillary and mandibular surgeries in bimaxillary orthognathic surgery affects the accuracy of surgical outcomes. PurposeThe study aimed to measure and compare the accuracy among patients who underwent maxilla-first versus mandible-first bimaxillary surgery to correct a class III skeletal pattern. Study designThis retrospective cohort study included consecutive patients treated by a single surgeon at one center using Le Fort I and bilateral sagittal split osteotomy surgery. Exclusions included patients scheduled for one-jaw or maxilla-segmental surgery and those with craniofacial syndromes, such as clefts. Predictor variableThe predictor variable was operative sequence for bimaxillary operations, divided into maxilla- or mandible-first groups. Outcome variableThe outcome variable was accuracy, measured using linear discrepancies between landmarks in the virtual plan and actual operative outcomes. The measurement of linear discrepancy that was closer to 0 was considered the more accurate result. CovariatesSex, age, maxilla sagittal rotation degree, amount of posterior maxilla impaction, mandibular autorotation (°), and intermediate splint thickness (mm) were the covariates. AnalysesStatistical analysis was performed using Student’s t-test and Pearson’s correlation, with statistical significance set at P < 0.05. ResultsThe sample comprised 60 patients with a mean age of 22.8 ± 3.7 years, of whom 36 (60%) were male. In the maxilla-first group, there were 30 subjects (60% male; mean age: 23.1 ± 4.2 years), with a mean mandibular autorotation of 0.41° (range: 0°–2.5°). The mandible-first group comprised 30 patients (60% male; mean age: 22.6 ± 3.3 years), with a mean mandibular autorotation of 5.46° (range: 1.9°–9.2°). The linear discrepancies for all landmarks did not significantly differ between mandible- and maxilla-first groups (P > 0.18). The mean 3D discrepancies for all landmarks in maxilla-first group was 1.23 ± 0.5 mm and 1.23 ± 0.33 mm in mandible-first group, with no significant difference observed between the groups (P > 0.98). The amount of mandibular autorotation for intermediate splint application showed no significant correlation with the linear discrepancies (P > 0.58). ConclusionsIn patients with skeletal class III malocclusion, mandible-first surgery in bimaxillary orthognathic surgery demonstrates accurate outcomes comparable to maxilla-first surgery.

Evaluation of Soft Tissue Changes Following Orthognathic Surgery Using Virtual Surgical Planning Software.

Orthognathic surgery brings about a harmonious relationship between jaws, resulting in improved facial aesthetics. It is key to analyze if satisfactory results can be attained by using virtual surgical planning for orthognathic procedures so as to recommend it for routine clinical practice. The aims of this study were to evaluate the various soft tissue changes that take place following orthognathic surgery using three-dimensional (3D) imaging and virtual surgical planning software and quantify the accuracy of virtual surgical planning software on patients undergoing orthognathic surgery. This is an observational prospective study with a sample size of 12. In this prospective study, 12 patients undergoing orthognathic surgery were included following the inclusion and exclusion criteria. A usual pre-surgical work-up was done and a 3D replica of the facial skeleton was formulated using the software with the DICOM data acquired from the patient i.e., CT and scans of patient's dentition. Virtual surgical planning was done and splints were manufactured according to the desired newly achieved position. Patients were operated following the virtual surgical plan guided by the computer-aided design and computer-aided manufacturing (CAD-CAM) splints. Post-operative evaluation was done. As the study is more of a descriptive study to obtain detailed knowledge of a new procedure, only one group is being studied and hence there is no statistical testing included in this study. The mean discrepancy noticed after superimposition of soft tissue points was 0.92 with a standard deviation of 0.3. 3D CT virtual surgical planning is a reliable tool to achieve predictable and reliable post-operative results in orthognathic surgical cases.

A 3D-CBCT Volumetric Analysis of Cervical Vertebrae Angulation and Airway Dimensions

Aim: To evaluate the relationship between airway dimensions and cervical vertebrae angulations in dental patients using three-dimensional cone beam computed tomography (3D-CBCT) technology. Materials and Methods: Pre-treatment CBCT scans and cephalometric radiographs were measured for 59 patients (mean age 22±2.3yrs.) using the Dolphin3D software system (version 11.7; Dolphin Imaging &amp; Management Solutions, Chatworth, CA) to record airway dimensions and cervical vertebral angulations. All CBCT images were acquired using the same standard protocol for collection using the iCAT CBCT Unit (Imaging Sciences International, Hatfield, PA): 13cm field of view, 0.4mm voxel size, 8.9sec scan time. Intraclass Correlations (ICC) were performed on duplicate measurements of 10 CBCT scans after a two-week interval to assess reliability. P-value and Pearson correlation coefficients were used to statistically assess the relationship between vertebral angulations and airway dimensions. Results: ICC values from the reliability assessment were &gt;0.90. Pearson correlation coefficients were categorized based on confidence level as follows: high (&gt;0.75 or &lt;-0.75), moderate (0.5 to 0.74 or -0.5 to -0.74), or weak (0.3 to 0.49 or -0.3 to -0.49). No high/moderate correlations were observed. Weak correlations (p&lt;0.05) were observed between the nasopharyngeal volume and the soft tissue thickness at CV1(-0.47) and CV2(-0.34). A weak correlation was observed between the nasal cavity volume and S-N (+0.41) as well as ANS-PNS(+0.38). A weak correlation was observed between the total airway volume and the soft tissue thickness at CV2(-0.34). Conclusion: The soft tissue thickness of the posterior wall of the airway at the level of cervical vertebrae-2 appears to have a weak, negative correlation with several upper airway parameters and total airway volume. Soft tissue thickness of the posterior pharyngeal wall is crucial for dental clinicians to analyze prior to some procedures such as orthognathic surgery and orthodontic treatment that involve growth modification and jaw positioning, as it may have an association with decreased airway volume. Clinical Significance: The relationship between cervical vertebrae angulation, airway, and craniofacial morphology is a complex aspect of human anatomy. In dentistry, it is crucial that clinicians recognize the vital role cervical vertebrae angulation and airway interact in relation to craniofacial morphology. Knowledge of these interconnections will significantly inform treatment planning for multiple oral health conditions such as malocclusions, jaw discrepancies, and temporomandibular joint disorders.

Pre- and Post-Operative Cone Beam Computed Tomography Assessment of the Temporomandibular Joint in Patients with Orthognathic Surgery.

This study aimed to compare the pre- and post-operative temporomandibular joint (TMJ) condylar position in dentofacial deformity (DFD) patients who had orthognathic surgeries using cone beam computed tomography (CBCT). A retrospective study evaluating the pre- and post-operative CBCT for 79 DFD patients (equivalent to 158 TMJs) (mean age = 26.62 ± 9.5 years) with a bilateral sagittal split osteotomy with or without Le Fort I surgeries (n = 29 Class II DFD, n = 50 Class III DFD) was performed. This included the compartmental measurement of TMJ spaces, in addition to the measurement of intercondylar distances and angles. Condylar position centricity was assessed using the Pullinger and Hollender formula. Clinical data were analysed for DFD class, the type of surgery and post-operative CBCT timing. Pre- and post-operative measurements were compared statistically using a paired t-test, Wilcoxon signed-rank test, and Stuart-Maxwell test. TMJ condyles tended to relocate post-operatively in a posterosuperior position with internal rotation in Class II DFD and a superior position with internal rotation in Class III DFD. However, the overall changes were within <0.5 mm translation and <4° rotation and the number of concentrically positioned condyles (according to the Pullinger and Hollender formula) did not change significantly. Orthognathic surgery is associated with minor post-operative translational and rotational condylar positional changes in Class II and III DFDs.

Exploring patient perspectives: orthognathic surgery outcomes and experiences assessed by patient-reported outcome measures and patient-reported experience measures

Evaluating the effectiveness of orthognathic treatment can be difficult. To address this issue, patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) have been proposed as valuable instruments for understanding the quality of healthcare from the patients’ standpoint. Therefore, the aim of this project was to employ PROMs and PREMs questionnaires to capture the patients’ perspectives regarding their experience during the orthognathic treatment process, as well as their perception of their postoperative state. Preoperative and postoperative questionnaires were offered to patients at consenting appointment and at various timepoints after the surgery. The assessment of statistical relationships was carried out by means of Fisher’s exact test. A total of 64 preoperative and 126 postoperative responses were received. The primary motivators for pursuing the surgery were the improvement of facial and dental aesthetics, as well as increased satisfaction with photographic and video appearances. These three factors were also cited as the most important postoperative benefits. Of the respondents, 58% reported experiencing altered sensation to the lower lip at the 24-month follow up (p = 0.02); however, the affected patients reported that this did not have an impact on their daily activities. The use of PROMs and PREMs to appraise the quality of life constitutes a valuable method for surgeons to gauge their treatment efficacy. Above all, such tools are particularly useful for evaluating patient satisfaction, which is the ultimate objective of any treatment.

A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery.

In this study, a new methodology for designing and creating a custom-made template for maxillofacial surgery has been developed. The custom-made template can be used both for cutting and repositioning of the mandible arches for executing a BSSO (bilateral sagittal split osteotomy) treatment. The idea was developed in order to give the possibility of using a custom-made template with standard plates, thus reducing long times, high costs and low availability of custom-made plates; this represents the proof of novelty of the proposed template, based on a well-established methodology. The methodology was completely developed in the CAD virtual environment and, after the surgeons' assessment, an in-vitro experiment by a maxillofacial surgeon was performed in order to check the usability and the versatility of the system, thanks to the use of additive manufacturing technologies. When computer-aided technologies are used for orthognathic surgery, there are significant time and cost savings that can be realised, as well as improved performance. The cost of the whole operation is lower than the standard one, thanks to the use of standard plates. To carry out the procedures, the proposed methodology allows for inexpensive physical mock-ups that enable the BSSO procedure to be performed.

Bilateral alloplastic temporomandibular joint reconstruction with orthognathic surgery: a case report of idiopathic condylar resorption

Idiopathic condylar resorption (ICR) also known as cheerleader’s syndrome, progressive condylar resorption, idiopathic condylysis, and condylar atrophy can be defined as chronic ongoing changes of condylar shape and decrease in mass. It is characterized by an excessive physical stress to the articular structures of the temporomandibular joint (TMJ) that exceeds the normal adaptive capacity. Consequently, leading to decrease condylar head volume, decrease ramus height, progressive mandibular retrusion in adults, or decreased growth rate in adolescents. A case report of a 30-year-old female based on the history, clinical, and radiographic examination has class II skeletal relationship secondary to bilateral ICR, receded chin, vertical maxillary excess (VME) and canting. Surgical treatment plan was established using 3D Systems, Inc., (“3DS”) VSP® and case was managed by bilateral total alloplastic temporomandibular joint reconstruction (BATMJR) with orthognathic surgery to do LeFort I, bilateral condylectomy, genioplasty, and inferior border osteotomy. The case report includes one-year follow-up which shows stable outcome, emphasizing long-term success of comprehensive treatment strategy in addressing skeletal class II malocclusion associated with ICR.

Treatment of Class III Malocclusion with Open Bite and Macroglossia Using an Anterior Loop

General Background: Class III malocclusion is a prevalent dental anomaly characterized by the anterior positioning of the mandible relative to the maxilla, posing functional and aesthetic challenges. Specific Background: This condition may present with additional complexities such as dental crowding, open bite, and macroglossia, complicating the orthodontic treatment approach. Knowledge Gap: While conventional treatment modalities include orthognathic surgery and growth modification, there is limited documentation on the efficacy of orthodontic camouflage in non-surgical settings, particularly in adults with completed growth. Aims: This study aims to evaluate the effectiveness of orthodontic camouflage using anterior stainless steel loops in managing dentoskeletal Class III malocclusion accompanied by anterior open bite and macroglossia, without premolar extraction. Results: Over a 7-month treatment period, significant corrections in overjet, overbite, and molar relationship were achieved, demonstrating the potential of this approach as a non-surgical alternative. Novelty: This research introduces a modified technique involving stainless steel wire with specific loop placements, contributing to the orthodontic management strategies for complex Class III cases. Implications: The findings support the broader application of camouflage techniques in orthodontic practice, offering a viable option for patients opting out of surgery and highlight the need for further studies to optimize and validate such approaches.Highlights: Efficiency of Camouflage: Shows how orthodontic camouflage can effectively treat complex Class III malocclusion without surgery. Novel Technique: Introduces a new method using stainless steel loops in wires to enhance treatment outcomes. Clinical Implications: Expands non-surgical treatment options in orthodontics, offering viable alternatives to surgery. Keywords: Class III Malocclusion, Orthodontic Camouflage, Open Bite, Macroglossia

Metamorphosis of a Tall and Ugly Woman Through Plastic Surgery During a 7-Year Period: An Analysis of The Life and Loves of a She-Devil.

The aim of this study is to analyze the process of metamorphosis of a tall and ugly woman through plastic surgery as depicted in The Life and Loves of a She-Devil (1983) of Fay Weldon. The process of plastic surgeries and the psychology of the protagonist of this novel were analyzed. A highly unattractive woman (Ruth, 185cm) takes revenge on her husband (Bobbo, 175cm) and his attractive lover (Mary Fisher, 160cm). To transform her appearance, Ruth remodels her jaw, has her teeth extracted (2-jaw surgery or facial contouring surgery), straightens and trims her nose (corrective rhinoplasty), flattens her cheekbones (reduction malarplasty), reduces her breast size (reduction mammoplasty), and shortens both her arms and legs (limb reduction surgery). Following the series of surgeries, Ruth ultimately made herself look identical to Mary Fisher, her husband's lover. She believes her inadequacies stem from her body's failure to meet societal beauty standards, prompting her decision to "remake" herself. She declares, "I will be what I want, not what God ordained." Ruth's aspiration is not to acquire a new face but to attain the face of Mary Fisher. When confronted with pain and harm, Ruth does not waver but acknowledges it. "Of course it hurts. Andersen's little mermaid wanted legs instead of a tail. And, like her, I welcome it. I don't complain." In this study, we derived insights into why patients who want to change their entire bodies undergo plastic surgery, what these patients really want, and patients' attitudes toward the pain caused by surgical procedures.