Orthognathic Surgical Treatment Research Articles

A better way to perform orthognathic surgery in partially edentulous patients: A novel modified wafer design

Introduction: Orthognathic surgery in the partially edentulous population presents multiple challenges. This case series aims to evaluate the success a novel modified wafer in orthognathic surgery for partially edentulous patients. Methods: Six partially edentulous patients eligible for orthognathic surgical treatment are included in this study; including one who had a fully edentulous maxilla. In two cases, the indication for surgery was to replace defective TMJ prostheses. 3-dimensional surgical planning was undertaken with computerised software. Three patients had bimaxillary osteotomies and one had a bilateral sagittal split osteotomy of the mandible. New prosthetic TMJs were placed in two cases in addition to orthognathic movements. Novel modified wafers and intermaxillary fixation screws were used intra-operatively in all cases. Results: All patients had good functional outcomes from surgery. Long-term occlusal stability was achieved with acrylic dentures. Mean age of the cohort was 55.8 years. The post-operative length of stay in hospital is comparable to the literature. Two patients had fixation plates removed after surgery. Conclusions: Using novel modified wafers, and intermaxillary fixation screws, in orthognathic surgery is safe and effective for partially edentulous patients. This technique has proven effective in both orthognathic and TMJ replacement surgery. Introduction: Orthognathic surgery in the partially edentulous population presents multiple challenges. This case series aims to evaluate the success a novel modified wafer in orthognathic surgery for partially edentulous patients. Methods: Six partially edentulous patients eligible for orthognathic surgical treatment are included in this study; including one who had a fully edentulous maxilla. In two cases, the indication for surgery was to replace defective TMJ prostheses. 3-dimensional surgical planning was undertaken with computerised software. Three patients had bimaxillary osteotomies and one had a bilateral sagittal split osteotomy of the mandible. New prosthetic TMJs were placed in two cases in addition to orthognathic movements. Novel modified wafers and intermaxillary fixation screws were used intra-operatively in all cases. Results: All patients had good functional outcomes from surgery. Long-term occlusal stability was achieved with acrylic dentures. Mean age of the cohort was 55.8 years. The post-operative length of stay in hospital is comparable to the literature. Two patients had fixation plates removed after surgery. Conclusions: Using novel modified wafers, and intermaxillary fixation screws, in orthognathic surgery is safe and effective for partially edentulous patients. This technique has proven effective in both orthognathic and TMJ replacement surgery.

Operator Performance of the Digital Setup Fabrication for Orthodontic-Orthognathic Treatment: An Explorative Study.

The purpose of this study was to explore the operator performance of the fabrication of digital orthodontic setups integrated into cone beam computed tomography (CBCT) scans. Fifteen patients who underwent a combined orthodontic–orthognathic surgical treatment were included. The pre-treatment digital dental models and CBCT scans were fused, and four operators made virtual setups twice for all patients. Differences between the virtual setups were calculated by recording tooth crown movement from the pre-treatment model to the virtual setup. To examine performance, Pearson’s correlation coefficients, duplicate measurement errors, and inter-operator differences were calculated. For intra-operator performance, correlation values varied among tooth types, with mean correlation values from 0.66 to 0.83 for the maxilla and 0.70 to 0.83 for the mandible. For inter-operator performance, mean correlation values varied from 0.40 to 0.87 for the maxilla and from 0.44 to 0.80 for the mandible. Rotational mean differences exceeded the range of clinical acceptance (>2 degrees) at 18% for the maxilla and 20.8% for the mandible, and translational mean differences exceeded the range of clinical acceptance (0.6 mm) at 9.7% and 26% for the maxilla and mandible, respectively. The intra- and inter-operator performance of digital orthodontic setup construction for virtual three-dimensional orthognathic planning shows significant errors.

Qualitative and quantitative assessment of condylar displacement after orthognathic surgery: A voxel-based three-dimensional analysis

PurposeThis study aimed to evaluate the morphometric changes in the position of the mandibular condyles before and after orthognathic surgery. MethodsA retrospective single-center cohort study was conducted and included patients with a presurgical (T1) and postsurgical (T2) Cone Beam computed tomography (CBCT). The primary predictor variable was the orthognathic surgical treatment. Pre-operative and post-operative CBCT scans were superimposed using voxel-based registration. Semitransparent overlays of the models of condylar regions at T1 and T2 were created for the qualitative analysis. The primary outcome variable was the quantitative displacement of condyles (CoR; CoL) analyzed in X, Y, Z axis and the 3D distances. Descriptive and bivariate statistical analysis was performed, setting α=0.05. ResultsThe study sample included 33 patients (mean age: 25.33±2.49 years) affected by skeletal class III malocclusion with or without skeletal asymmetry. The X-axis showed a mean movement of 0.25 ± 0.17 mm for CoR, and 0.52 ± 0.51 mm for CoL. The Y-axis showed a mean movement of 0.29 ± 0.2 mm for CoR, and 0.51 ± 0.8 mm for CoL. The Z-axis was 0.33 ± 0.2 mm for CoR, and 0.5 ± 0.49 mm for CoL. No statistically significant difference was calculated comparing the movement of condylar surface between asymmetric and not asymmetric patients (p = 0.26 for CoR; p = 0.13 for CoL). No statistically significant difference was found in intercondylar distance between T1 and T2 (p = 0.39). ConclusionNo statistically nor clinically significant condylar displacement are recorded in orthognathic surgery patients at 12 to 18 months of follow-up.

Orthognathic Surgical Treatment and Its Effect on Soft Tissues

Büyüme gelişimini tamamlamış hastalarda tek başına ortodontik düzeltimin kapasitesini aşan şiddetli iskeletsel uyumsuzlukların tedavisinde kullanılan ortodontik ve cerrahi prosedürler ortognatik cerrahi olarak adlandırılmaktadır. Bu tedavinin sonucunda kabul edilebilir ve dengeli bir yüz görünümüne, çiğneme ve konuşma fonksiyonlarına kavuşulması ve hastanın esas şikâyetlerinin çözülmesi amaçlanmalıdır. Yüzün yumuşak doku hatları, altta yatan yüz iskeletini yansıtmaktadır, bu nedenle iskeletsel uyumsuzluklar kaçınılmaz olarak yüzün yumuşak dokularını etkilemektedir. Ortodontinin uzmanlık alanı olarak ilk kurulduğu 1900’lu yıllarda, tedaviler ‘Angle’ın sert doku paradigması’na göre, öncelikli olarak okluzyonun ideale getirilmesi şeklinde planlanmaktaydı; ancak son yıllarda, ortodonti ve ortognatik cerrahi tedavide, dentofasiyal problemlerin yüzün yumuşak dokularındaki tedavisine odaklanan ‘yumuşak doku paradigması’ kabul görmeye başlamıştır. Bu yaklaşımda tedavinin sonunda, öncelikli olarak olarak yüz yumuşak dokularının adaptasyonu ve dengesi amaçlanmaktadır. Bu makalede, ortognatik cerrahi tedavinin endikasyonları, hareket kapasitesi ve yumuşak dokular üzerindeki etkilerini ele alan bir literatür derlemesi sunulmuştur.

Cephalometric for Orthognathic Surgery (COGS) Analysis for Saudi Population

Objective: T o establish the cephalometric (Ceph.) norm by Ceph. for orthognathic surgery (COGS) analysis for Saudi population . Material and Methods: 500 adult Saudi samples (250 males and 250 females) with the age range of 18-30 years old were selected for this study. The selections of samples were based on a normal occlusal relationship, no history of facial trauma and no previous orthodontic treatment. Lateral Ceph. radiographs were tracing by CASSOS software and analyzed by SPSS software according to COGS analysis. Results: Signi fi cant differences were showed between the Saudi males and females on most of the Ceph. parameters. The Saudi males had a convex facial profile with chin prominent and more bimaxillary protrusion, upper and lower lip protrusion than the Saudi females . Conclusion: This study evaluated the craniofacial morphological difference between the male and the female population in Saudi Arabia by using COGS analysis. The finding of this study will help for better diagnosis of orthodontic and orthognathic surgical treatment planning and identify the morphological facial characteristics of Saudi patients.

Long-term dental stability after orthognathic surgery: a systematic review

Long-term dental stability is one of the main objectives following combined orthodontic and orthognathic surgical treatment. It is influenced by multiple factors such as surgical, patient-related, and orthodontic aspects. While recent reviews mainly focus on short-term dental changes (0.5-2 years), longer follow-up dental stability remains hardly reviewed. The aim of this study was to evaluate long-term stability of dental and dentolabial changes following combined orthodontic and orthognathic surgical treatment with a minimum follow-up period of 5 years. A systematic search was conducted up to December 2019 using Pubmed, Embase, Web of Science, and Cochrane Central. Randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case series with a minimum of 10 patients, which reported long-term dental stability following combined orthodontic and orthognathic treatment, were included. Long-term changes were assessed for overjet, overbite, maxillary, and mandibular incisors' position and relationship of lip position to maxillary and mandibular incisors. Risk of bias was assessed according to the Cochrane Handbook. Following the screening of 3178 articles, 11 studies were included (2 RCT, 9 retrospective) with a postoperative follow-up period ranging from 5 to 15 years. A decrease in overjet was observed for patients with skeletal class III malocclusion, whereas overjet increased in class II patients at long-term follow-up. Overbite increased in class II patients, whereas class III showed variable results. The lower incisor position was more stable vertically than horizontally; the latter showing more outcome variability. Dentolabial changes corresponded to the normal ageing process and results were not clinically significant after long-term follow-up. Current evidence suggests variability of dental and dentolabial stability in both skeletal class II and III patients. Further prospective studies are required to develop guidelines for long-term follow-up assessment using computer tomography or cone-beam computed tomography imaging, before final conclusions can be drawn. The protocol for this systematic review (CRD42020133844) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).

Orthodontic Strategy for Patients with Cleft Lip and Palate in Orthognathic Surgical Treatment

Orthodontic Strategy for Patients with Cleft Lip and Palate in Orthognathic Surgical Treatment

Digital Workflow for Combined Orthodontics and Orthognathic Surgery.

This article provides an overview of the digital workflow process for Combined orthodontics and Orthognathic surgery treatment starting from data acquisition (3-dimensional scanning, cone-beam computed tomography), data preparation, processing and Creation of a three-dimensional virtual augmented model of the head. Establishing a Proper Diagnosis and Quantification of the Dentofacial Deformity using 3D diagnostic model. Furthermore, performance of 3-dimensional Virtual orthognathic surgical treatment, and the construction of a surgical splint (via 3-dimensional printing) to allow transfer of the treatment plan to the actual patient during surgery.

Quality of Life Assessment for Elderly Patients Treated With Orthognathic Surgery.

The purpose of the present study was to evaluate the impact of orthognathic surgery on quality of life (QoL) in elderly patients. Twenty patients who underwent orthognathic surgery to correct Angle Class I, II e, III relations were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ) and generic oral health-related QoL through a 14-item short-form Oral Health Impact Profile (OHIP-14) were assessed. A statistically significant reduction (P < 0.001) in the average overall score was detected between the presurgical and postsurgical assessments. Male group showed significant improvement in physical pain (P = 0.047) and psychological discomfort (P = 0.039). No difference was found between the OHIP-14 (P = 0.582) and OQLQ (P = 0.525) total scores for the type of surgery (mono-maxillary or bimaxillary). Orthognathic surgical treatment had a positive impact on oral health-related QoL in the patients evaluated. The results of this study emphasize the concept that dental esthetics influence patients' oral health-related QoL.

Orthognathic surgical treatment of secondary maxillary deformities following the cleft lip and palate repair

Background: There are still some challenges in the corrective jaw surgery regarding the maxillary deformity secondary to cleft lip and palate repair.

Dentofacial Deformities and Implications on Quality of Life: A Presurgical Multifactorial Analysis in Patients Seeking Orthognathic Surgical Treatment

The purpose was to perform a quality-of-life survey in patients with skeletal malocclusion before undergoing orthognathic surgery, as well as delineate the sociodemographic profile and detect factors that may alter the quality of life. This cross-sectional study was carried out in patients who sought care at the Hospital das Clínicas of the University of São Paulo Medical School (N=106; average age, 27.2years). Participants answered the Oral Health Impact Profile 14 (OHIP-14) questionnaire and Orthognathic Quality of Life Questionnaire (OQLQ). The χ2 or Fisher test was used to verify the association between impact and sociodemographic variables. On the Oral Health Impact Profile 14 (OHIP-14) questionnaire, the "psychological incapacity" dimension (64.15%) presented a higher prevalence of impact. The marital status of the interviewees had a statistically significant effect on the impact of quality of life (P=.0119). On the Orthognathic Quality of Life Questionnaire (OQLQ), the "facial esthetics" dimension represented 81.13% in the prevalence of impact on quality of life. The "gender" variable had a statistically significant effect on the quality of life of the respondents (P=.0005), with women having an 11.78 times greater chance of having this impact. In this study, psychological factors and esthetics exerted a strong influence on the quality of life of patients with dentofacial deformities, overlapping with functional aspects.

Can we justify combined orthodontic and orthognathic surgery treatment?

Abstract: Patients requiring combined orthodontic and orthognathic surgical treatment make up 7% of a UK-based Orthodontic Consultant's caseload. This has significant time and cost implications within the NHS. In a climate of spending cuts across our health service, a need has arisen to justify service provision. Accordingly, a new index has been devised to aid in the prioritization and provision of care for orthognathic patients. CPD/Clinical Relevance: To carry out a retrospective audit of 44 patients who had orthognathic surgery in the NHS between May 2012 and October 2014, assign each an Index of Orthognathic Functional and Orthodontic Treatment Need, IOFTN and IOTN, score, respectively and identify any differences.

Experiences Of Individuals Concerning Combined Orthodontic and Orthognathic Surgical Treatment: A Qualitative Twitter Analysis

Objective: The aim of this qualitative study was to analyze the content of posts on Twitter in order to gain an in-depth understanding of patients’ thoughts and experiences surrounding orthognathic surgical treatment. Materials and Methods: Using the Twitter search function, with the keywords “jaw surgery,” the 1,000 most recent posts on Twitter with relevance to a combined orthodontic and orthognathic surgical treatment were extracted. After applying relevant inclusion and exclusion criteria, the selected posts were analyzed using thematic analysis by 2 independent investigators. Distinct themes and subthemes were developed. Results: A total of 689 posts were analyzed; the 3 main themes identified in relation to orthognathic surgery were preoperative engagement, postoperative difficulties, and posttreatment satisfaction. Twelve subthemes were also identified, expressing issues such as anticipation or apprehension of the surgical procedure, postoperative pain and edema, dietary restrictions and weight loss, paresthesia, depression, and satisfaction with improvements in appearance and self-confidence. The 6 terms most frequently used in tweets were “recovery,” “braces,” “swollen,” “eat,” “liquid diet,” and “pain.” Conclusions: The findings from the present study can increase the awareness of clinicians involved in the combined orthodontic and orthognathic surgical treatment of patients with dentofacial deformities, allowing them to better educate and counsel their patients throughout the entire treatment process.

Orthognathic Surgery and Facial Changes - A Review

Overlying facial soft tissue is influenced by both surgical movement of bony segment and orthodontic movement of the teeth. That is why supportive evidence about calculation of surgical movement and changes in soft tissue positions should be considered before making any treatment plan to predict soft tissue changes that can occur with dental and skeletal tissue alteration after surgery. Thus, soft tissue consideration is an important factor for any orthognathic surgical treatment planning for excellent, acceptable and satisfactory results. This review article is focused on soft tissue changes associated with various orthognathic surgeries.

Orthognathic Surgical Treatment of Patient with High Angle Growth Pattern and Skeletal Open Bite Malocclusion: A Case Report

Orthognathic Surgical Treatment of Patient with High Angle Growth Pattern and Skeletal Open Bite Malocclusion: A Case Report

Evaluation for vertical stability after various orthognathic surgical treatment plans for skeletal class Ⅲ malocclusion with anterior open-bite

To evaluate vertical stability after various orthognathic surgical treatment plans for skeletal class Ⅲ malocclusion with anterior openbite. A retrospective multicenter cohort study was conducted to investigate vertical stability after various orthognathic surgical treatment plans for skeletal class Ⅲ malocclusion with anterior openbite. From 2010-2016, 122 patients from two domestic stomatological hospitals were included in our study. Patients were divided into four groups according to their treatment plans, namely, bilateral sagittal split ramus osteotomy (BSSRO), intraoral vertical ramus osteotomy (IVRO), BSSRO+Le Fort Ⅰ, and IVRO+Le Fort Ⅰ. All patients followed a standardized examination procedure at 6 and 24 months post-treatment. The observation indexes include overbite, mandibular plane angle, and intermaxillary angle. 1) The significantly reduced ratio of the overbite in the BSSRO+Le Fort Ⅰ and IVRO+Le Fort Ⅰ groups were less than the BSSRO and IVRO groups at 6 and 24 months post-treatment. 2) The significantly increased ratio of the mandibular plane in BSSRO+Le Fort Ⅰ and IVRO+Le Fort Ⅰ groups were less than BSSRO and IVRO groups at 6 and 24 months post-treatment. 3) The significantly increased ratio of the intermaxillary angles in BSSRO+Le Fort Ⅰ and IVRO+Le Fort Ⅰ groups were less than the BSSRO and IVRO groups at 6 months post-treatment, while there was no statistical difference at 24 months post-treatment. Bimaxillary surgery (BSSRO+Le Fort Ⅰ and IVRO+Le Fort Ⅰ) is more effective than mandibular surgery to control vertical relapse.

Clinical predictive factors for temporomandibular disorders following combined orthodontic and orthognathic surgical treatment in patients with Class III malocclusion

Objective: The aim of this study was to identify clinical factors predisposing to the development or worsening of temporomandibular disorders (TMDs) following orthodontic surgical treatment for Class III malocclusion.Methods: A retrospective cohort study was performed on 88 patients with Class III malocclusion having undergone a combined orthodontic and orthognathic surgical treatment. Temporomandibular joint and masticatory muscle examinations were available prior to treatment and one year post-operatively. Multivariate logistic regression was used to predict the development of post-operative TMDs, and linear regression was used to predict the worsening of TMDs using Helkimo indices.Results: Patients with Class III malocclusion presenting with pre-treatment anamnestic TMJ clicking (OR = 5.8; p = 0.03) and undergoing bimaxillary osteotomy procedures (OR = 18.6; p = 0.04) were more at risk for the development of TMDs.Discussion: TMDs must be evaluated, monitored, and managed with caution in patients with Class III malocclusion presenting with pre-treatment joint clicking and who are planned for bimaxillary osteotomies.

Facial Mobility after Maxilla-Mandibular Advancement in Patients with Severe Obstructive Sleep Apnea Syndrome: A Three-Dimensional Study

Introduction. The functional results of surgery in terms of facial mobility are key elements in the treatment of patients. Little is actually known about changes in facial mobility following surgical treatment with maxillomandibular advancement (MMA). Objectives. The three-dimensional (3D) methods study of basic facial movements in typical OSAS patients treated with MMA was the topic of the present research. Materials and Methods. Ten patients affected by severe obstructive sleep apnea syndrome (OSAS) were engaged for the study. Their facial surface data was acquired using a 3D laser scanner one week before (T1) and 12 months after (T2) orthognathic surgery. The facial movements were frowning, grimace, smiling, and lip purse. They were described in terms of surface and landmark displacements (mm). The mean landmark displacement was calculated for right and left sides of the face, at T1 and at T2. Results. One year after surgery, facial movements were similar to presurgical registrations. No modifications of symmetry were present. Conclusions. Despite the skeletal maxilla-mandible expansion, orthognathic surgical treatment (MMA) of OSAS patients does not seem to modify facial mobility. Only an enhancement of amplitude in smiling and knitting brows was observed. These results could have reliable medical and surgical applications.

Skeletal and dental stability after intraoral vertical ramus osteotomy: a long-term follow-up

The purpose of this study was to elucidate the long-term skeletal and dental stability after combined orthodontic and orthognathic surgical treatment of mandibular prognathism with the intraoral vertical ramus osteotomy (IVRO) as the surgical technique followed by 6 weeks of intermaxillary fixation (IMF). Thirty-six patients were included in the study. Mean age at surgery was 21.6 years. Lateral cephalograms and study casts obtained before the start of treatment (T0), and 8 weeks (T1), 1 year (T2), and 12.5 years (T3) after the operation were evaluated. Mean mandibular setback measured at point B was 8.3mm. Between T1 and T2, a mean anterior relapse of 12% of the setback was observed. Between T2 and T3, the anterior relapse persisted, but decreased to 7% of the setback measured at point B. Despite dental adjustments in both jaws, a statistically significant reduction in overjet was observed during both observation periods. However, the change of the mandible in an anterior direction was small and of minor clinical importance for most of the patients. In conclusion these results indicate that combined orthodontic and orthognathic surgical treatment of mandibular prognathism with the IVRO as the surgical procedure followed by 6 weeks of IMF provides predictable and good long-term clinical results.

Modern trends in Class III orthognathic treatment: A time series analysis.

To examine the current trends in surgical-orthodontic treatment for patients with Class III malocclusion using time-series analysis. The records of 2994 consecutive patients who underwent orthognathic surgery from January 1, 2004, through December 31, 2015, at Seoul National University Dental Hospital, Seoul, Korea, were reviewed. Clinical data from each surgical and orthodontic treatment record included patient's sex, age at the time of surgery, malocclusion classification, type of orthognathic surgical procedure, place where the orthodontic treatment was performed, orthodontic treatment modality, and time elapsed for pre- and postoperative orthodontic treatment. Out of the orthognathic surgery patients, 86% had Class III malocclusion. Among them, two-jaw surgeries have become by far the most common orthognathic surgical treatment these days. The age at the time of surgery and the number of new patients had seasonal variations, which demonstrated opposing patterns. There was neither positive nor negative correlation between pre- and postoperative orthodontic treatment time. Elapsed orthodontic treatment time for both before and after Class III orthognathic surgeries has been decreasing over the years. Results of the time series analysis might provide clinicians with some insights into current surgical and orthodontic management.