Postoperative Orthodontic Treatment Research Articles

Comparison of Different Decompensation Approaches on Facial Profile in Orthodontic-Orthognathic Treatment for Skeletal Class III Patients.

The objective of the present study was to assess the hard and soft tissue differences of skeletal Class III malocclusion patients treated with orthodontic-orthognathic surgery treatment between two decompensation approaches including extraction of maxillary premolars in preoperative orthodontics and clockwise rotation of the maxilla in orthognathic surgery. 22 skeletal Class III patients with the crowding of maxillary dental arch less than 3mm were included in this study. These patients were divided into two groups: extraction group and non-extraction group. Lateral cephalograms taken before preoperative orthodontic treatment and after postoperative orthodontic treatment were used to analyze the differences of hard and soft tissues between two groups. Independent t test was used to evaluate the differences of variables between extraction group and non-extraction group. After treatment, there was significant difference of Wits between extraction group and non-extraction group (- 4.34 mm vs - 2.82 mm, respectively, P <0.05). Co-Gn was significantly greater in non-extraction group than in extraction group (77.18 mm vs 71.58 mm, P <0.05). U1-SN and L1-MP in extraction group were significantly closer to the normal values than non-extraction group (P <0.05). Regarding the change of variables before and after orthodontic-orthognathic treatment, NLA (7.25° vs 1.46°, P <0.01) and G-Sn-Pog' (8.06° vs 4.62°, P <0.05) were significantly greater in extraction group than in non-extraction group. For patients with skeletal Class III malocclusion, extraction of maxillary premolars in preoperative orthodontic treatment can more effectively eliminate the dental compensation and achieve a more harmonious facial profile compared to clockwise rotation of the maxilla in orthognathic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three-dimensional cephalometric outcome predictability of virtual orthodontic-surgical planning in surgery-first approach

ObjectivesThe aim of this study is to introduce a novel 3D cephalometric analysis (3DCA) and to validate its use in evaluating the reproducibility of virtual orthodontic-surgical planning (VOSP) in surgery-first approach (SF) comparing VOSP and post-operative outcome (PostOp).MethodsThe cohort of nineteen patients underwent bimaxillary orthognathic surgery following the VOSP designed in SimPlant O&O software by processing cone-beam computed tomography (CBCT) scans and intraoral digital scanning of the dental arches. Said records were re-acquired once the post-operative orthodontic treatment was completed. The 3DCA was performed by three expert operators on VOSP and PostOp 3D models. Descriptive statistics of 3DCA measures were evaluated, and outcomes were compared via Wilcoxon test.ResultsIn the comparison between cephalometric outcomes against planned ones, the following values showed significant differences: Wits Index, which suggests a tendency towards skeletal class III in PostOp (p = 0.033); decreased PFH/AFH ratio (p = 0.010); decreased upper incisors inclination (p < 0.001); and increased OVJ (p = 0.001). However not significant (p = 0.053), a tendency towards maxillary retroposition was found in PostOp (A/McNamara VOSP: 5.05 ± 2.64 mm; PostOp: 4.1 ± 2.6 mm). On average, however, when McNamara’s plane was considered as reference, a tendency to biprotrusion was found. Upper incisal protrusion was greater in PostOp as an orthodontic compensation for residual maxillary retrusion (VOSP: 5.68 ± 2.56 mm; PostOp: 6.53 ± 2.63 mm; p = 0.084). Finally, the frontal symmetry in relation to the median sagittal plane decreased in craniocaudal direction.LimitationsA potential limit of studies making use of closest point distance analysis is represented by the complexity that surgeons and orthodontists face in applying this three-dimensional evaluation of SF accuracy/predictability to everyday clinical practice and diagnosis. Also, heterogeneity and limited sample size may impact the results of the study comparison.ConclusionsThe presented 3DCA offers a valid aid in performing VOSP and analysing orthognathic surgery outcomes, especially in SF. Thanks to the cephalometric analysis, we found that surgery-first approach outcome unpredictability is mainly tied to the sagittal positioning of the maxilla and that the transverse symmetry is progressively less predictable in a craniocaudal direction.

Hybrid mandibular Bologna midline distractor in combination with surgically assisted rapid maxillary expansion for transverse facial expansion: clinical and cephalometric results

Transverse maxillomandibular hypoplasia can be treated with surgically assisted rapid maxillary expansion (SARME) in association with mandibular symphyseal distraction (MSD). This paper introduces a hybrid mandibular Bologna midline distractor (BMD); the effectiveness of the distractor in combination with SARME for the treatment of transverse skeletal deficiency was evaluated. This two-centre study included 10 patients with a transverse arch width deficit>7 mm and dental crowding, in both the maxilla and mandible, treated with SARME and MSD. The study design was partly retrospective (seven patients) and partly prospective (three patients). Frontal and lateral cephalometric analyses, as well as measurements on dental models, were performed at three different times: before treatment, after the distraction, and 6 months after postoperative orthodontic treatment. The cephalometric analyses and measurements on dental impressions confirmed a balanced and stable skeletal and dental mandibular expansion. An average symphyseal expansion of 7.8 mm was obtained, resolving dental crowding without dental extractions. In conclusion, mandibular expansion performed with the BMD in combination with SARME appears to be a viable surgical approach to transverse maxillomandibular hypoplasia. This technique allows the surgeon to obtain a balanced skeletal and dental expansion, with a low level of relapse.

Patient motivation and satisfaction from orthognathic surgery—a case series

This study attempted to understand the specific motivations of patients who undergo orthognathic surgery and determine their satisfaction with the surgery. The study also assessed the prevalence of complications and how they may impact patient satisfaction. Patients who underwent orthognathic surgery at the University of California between 2016 and 2019 and had completed postoperative orthodontic treatment for ≥9 months were interviewed. They responded to an open-ended telephone interview regarding their motivations, satisfaction, and complications. The patients showed a high level of satisfaction with the surgery, but there were persistent complications that affected satisfaction. The predominant complication was paresthesia over the distribution of the inferior alveolar nerve. The majority of patients who reported prior headaches and temporomandibular joint problems described improvement in those areas. Comparing the patients' motivations before and after surgery showed that before surgery, patients reported functional concerns, whereas postoperatively they were much more likely to recall aesthetic reasons for the surgery. This study showed that although patients are generally satisfied after orthognathic surgery, patients need to be realistically informed of their expectations and adequately informed of possible complications.

Redefining our protocol of the orthognathic surgery-first approach after 10 years of experience

The objective of this study was to update and redefine some concepts of the surgery-first (SF) approach, regarding its indications and contraindications, virtual planning work-up, surgical tips, and postoperative orthodontic benefits, after 10 years of experience. A retrospective analysis was made of orthognathic surgical procedures following the SF protocol between January 2010 and December 2019 to review inclusion and exclusion criteria, diagnostic workflow, surgical tips, and postoperative outcomes. A total of 148 SF procedures were performed during this period, which corresponded to only 9.2% of the total orthognathic surgeries performed, which means that we have broadened the exclusion criteria instead of reducing them. Surgical tips include interdental corticotomies solely in cases of anterior crowding and leaving the intermaxillary fixation miniscrews in place postoperatively for orthodontic skeletal anchorage. The mean duration of postoperative orthodontic treatment was reduced in comparison to conventional surgery (36.8 vs 87.5 weeks). The overall degree of satisfaction was high not only for the patients, but also for the orthodontists and surgeon. SF is especially indicated for patients who desire an immediate aesthetic result, with short-term orthodontics, or for treatment of sleep-related breathing disorders, if they meet the established criteria.

Surgical-Orthodontic Treatment of Skeletal Class II Malocclusion with Obstructive Sleep Apnea and Multiple Missing Teeth

In the treatment of skeletal Class II retrognathic mandible, the airway should be considered for the progress and outcome of the treatment. The case report demonstrates combined orthodontic and orthognathic surgery in a 39-year-old woman with chief complaint of maxillary protrusion. The clinical examination and X-ray revealed skeletal Class II with a retrognathic mandible, high mandibular plane, vertical maxillary excess (VME), bilateral deformed condyles, and narrow posterior airway space. Moreover, the patient had several missing teeth with a posterior lingual crossbite. Polysomnography revealed obstructive sleep apnea (OSA), with a high apnea–hypopnea index (AHI) of 12.1/h. Her body mass index was low at 17.2. The preoperative orthodontic treatment included leveling, alignment, and molar uprighting. Maxillary segmental LeFort I was designed to expand her maxillary intermolar width and impact the anterior part of her maxilla. Also, bilateral sagittal split osteotomies were performed to advance her mandible position with a counterclockwise rotation of the maxillomandibular complex. The postoperative orthodontic treatment included settling the bite, monitoring the relapse, and managing the dental space for future prosthodontic rehabilitation. After a total treatment time of 1 year and 10 months, her profile was improved, her airway volume was enlarged, and her OSA was resolved, with the AHI changed to 4.3/h at 11 months after surgery then further decreased to 0/h when debonded.

Ortognatik Cerrahi Hastalarında Postoperatif Doğruluğun ve Nüks Miktarının Değerlendirilmesi: Olgu Kontrol Araştırması

Objective: The success of orthognatic surgery depends on careful physical examination, correct diagnosis and good treatment planning. The aim of this study was to determine the accuracy of presurgical orthognatic planning and postoperative outcomes in single jaw or double jaw orthognathic surgery cases operated on in the Tokat Gaziosmanpaşa University Dentistry Faculty Department of Oral and Maxillofacial Surgery. Material and Methods: A total of 34 Class III patients were grouped in the form of bimaxillary osteotomy (Group 1), single jaw mandibular osteotomy with mandibular set-back (Group 2) and single jaw maxillary osteotomy with maxillary advancement (Group 3). Orthodontic analysis and measurements were performed on preoperative (T0), immediate postoperative (T1), 6 months (T2) and 12 months (T3) lateral cephalometric radiographs. Results: Based on multivariate analyses, there was no statistically significant difference in any of the groups between our T1-T0 values (p>0.05), with the exception of the distance of the ANS point from the vertical reference point (p=0.004). To evaluate the recurrence rates, the values between the T2- T1 and the T3-T1 periods were examined, and were not found to be statistically significant. However in Group 1, T3-T1 differences with regard to VR-ANS (p=0.003) and VR-L1 (p=0.033) showed a statistically significant recurrence. Conclusion: This study showed that the orthognathic surgical plan resulting from the methods we used were transferred to the surgery correctly. In addition, besides the postoperative orthodontic treatment, our techniques for fixation and osteotomy were effective in reducing the potential for relapse.

Postoperative Stability of Patients Undergoing Orthognathic Surgery with Orthodontic Treatment Using Clear Aligners: A Preliminary Study

Backgrond: Until now, there have been many studies on the postoperative stability of orthognathic patients treated with traditional fixed orthodontic appliances. Recently, the use of clear aligners as orthodontic appliances has increased in orthodontic treatment for aesthetic and patient convenience. The aim of this preliminary study was to investigate the stability and characteristics of patients undergoing orthognathic surgery using clear aligners. Patients and Methods: This study was performed on patients who underwent orthognathic surgery by one surgeon at Pusan National University Dental Hospital from April 2017 to August 2021. A comparative study was conducted on five patients treated with clear aligners during orthodontic treatment and ten patients treated with traditional fixed appliances as a control group. Postoperative skeletal changes and recurrence were evaluated by cone beam computed tomography and lateral cephalometric radiographs taken two days postoperatively and six months postoperatively. Several measurement variables were used to confirm the presence or absence of recurrence, preoperative and postoperative orthodontic treatment period, and the number of extracted teeth. Results: Postoperative stability for six months after surgery was not significantly different between the clear aligner group and the traditional fixed appliance group. The preoperative orthodontic treatment period was also shorter in the clear aligner group, and the number of extracted premolar teeth and impacted teeth were also fewer in the clear aligner group, but there was no significant difference. Conclusions: Orthodontic treatment using clear aligners continues to develop, and it is believed that there is no limit to what can be accomplished during orthodontic surgery accompanied by clear aligners.

A comparison of postoperative, three-dimensional soft tissue changes in patients with skeletal class III malocclusions treated via orthodontics-first and surgery-first approaches

The aim of this retrospective study was to compare three-dimensional (3D) soft tissue and hard tissue changes between orthodontics-first approach (OFA) and surgery-first approach (SFA) after mandibular setback surgery. All patients underwent bilateral sagittal split osteotomy, and were examined by lateral cephalograms and 3D optical scanner before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Three standard angles (FMA, U1 to FH, IMPA) were measured as hard tissue change and the 2 sets of 3D data were superimposed, and volumetric differences were calculated as soft tissue change. Statistical analyses were performed by using unpaired t-tests. Differences with P < 0.05 were considered significant. A total of 39 patients with mandibular prognathism were included in this study. The OFA group consisted of 24 patients and the SFA group of 15 patients. The SFA group exhibited more labial inclination from T1 to T2 (p = 0.008) and T2 to T3 (p = 0.003) than did the OFA group. There were no significant changes at maxilla and mandible at each term of T0, T1, T2 and T3 (p > 0.05), but compared to before surgery, mandibular volume in SFA group significant increased at 1year (p = 0.049) after surgery. We found that the soft tissue changes after the SFA differed significantly from those after the OFA; thus, soft tissue predictions require more care. An analysis of our data compared with OFA and SFA for the patient with mandibular prognathism confirm that the mandibular soft tissue changes by postoperative orthodontic treatment and occlusal relationship in SFA.

LE FORT I OSTEOTOMİSİNDE İKİ PLAK İLE MAKSİLLER FİKSASYON YÖNTEMİ :TEKNİK RAPOR VE VAKA SUNUMU

Restoring facial esthetics and occlusion while maintaining long term stability are the goals of orthognathic surgery. Le Fort I osteotomy is frequently used for the correction of dentofacial deformities and is accepted as a relatively stable procedure. Many factors affecting the stability of the mobilized maxilla have been reported. Among these, the use of a stable internal fixation method is of primary importance to postoperative stability. Most oral and maxillofacial surgeons prefer bilaterally applying titanium miniplates in both the anterior apertura piriformis region and the posterior zygomaticomaxillary buttress region to achieve the rigid fixation of the maxillary segment following Le Fort I osteotomy. In the literature, there is currently a lack of agreement on the number of plates required to adequately secure the mobilized maxilla to prevent postoperative relapse. Reducing the number of miniplates allows surgeons to reduce any potential complications, operation time, and costs. In this case report, a patient with maxillary retrognathia and mandibular prognathia, manifesting dental Class III characteristics who underwent one piece Le Fort I osteotomy at Baskent University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery was presented. Under general anesthesia one piece Le Fort I osteotomy was performed. Following down fracture, mobilization of the maxillary segment was completed and 10 mm horizontal advancement movement was achieved. Surgical rigid fixation was performed under intermaxillary fixation with surgical splints. Maxillary fixation was completed with two pre-bent titanium Le Fort I plate placed bilaterally at the piriform apertura with no zygomaticomaxillary buttress fixation. Prior to extubation, intermaxillary fixation and surgical splints were released. Intermaxillary elastics were used six to eight weeks following surgery in addition to a soft, no-chew diet. The patient received both preoperative and postoperative orthodontic treatment. Digital lateral cephalometric radiographs, which were taken one week before orthognatic surgery (T1), one week postoperatively (T2), and nine months postoperatively (T3), were used to analyze skeletal movement and stability of the maxilla. Lateral cephalometric measurements were performed digitally using a computer-assisted software program. Linear and angular measurements of sagittal and vertical maxillary positions was calculated. A horizontal reference plane (HR) +7° to the SN plane at the S point and a vertical reference plane (VR) 90° to the horizontal plane at the Sella point were used in the analyses. After completion of growth and development, the SN plane remains in the same position, giving us the opportunity to measure skeletal movement with these horizontal and vertical reference planes. The difference in the A point-HR distances between the pre and postoperative radiographs indicates the horizontal movement of the maxilla, whereas the difference in the A point-VR distances indicates the vertical movement of the maxilla. The major criteria for maxillary skeletal relapse was the change in the distance from the A point to the horizontal and vertical reference planes. Significant immediate postsurgical changes were found in early postoperative lateral cephalometric radiography (T2). In 9 month follow-up lateral cephalometric measurements (T3) all landmarks in the horizontal and vertical plane showed skeletal stability. The relapse amount in maxillary movement was less than 1 mm in both horizontal and vertical planes. According to the postoperative lateral cephalometric measurements, the two plate anterior fixation method in the one piece Le Fort I ostetomy showed satisfactory results in terms of skeletal stability.

Changes in the temporomandibular joint clicking and pain disorders after orthognathic surgery: Comparison of orthodontics-first approach and surgery-first approach.

The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.

A Retrospective Cohort Study of 45 Cases Treated With Surgery First Approach in Orthognathic Surgery and a Short Review.

Retrospective cohort study. The purpose of this study was to evaluate and share our experience with the surgery first approach (SFA) for correction of skeletal malocclusion. After consultation with the department of orthodontics, 45 patients with skeletal malocclusions suitable to undergo SFA were enrolled in this study (14 bimaxillary protrusion and 31 skeletal class III malocclusion). Le Fort I maxillary osteotomy, bilateral sagittal split ramus osteotomy, subapical osteotomy, and genioplasty were performed as required. After a healing period of 2 weeks, postoperative orthodontic treatment was started to achieve the final occlusion. The mean duration of postoperative orthodontic treatment was 15.2 months, which is much shorter than the conventional orthodontic first approach (OFA) where presurgical orthodontic duration alone takes 12-24 months according to an individual. In the bimaxillary protrusion group, it was 18 months, which was significantly longer than for the other group (P < .05). SFA offers an efficient alternative to conventional OFA with shorter total treatment duration, immediate marked improvement in facial profile, reduced biological costs, and similar operative stability. However, it comes at the cost of heightened challenges regarding case selection, accurate prediction, and surgical precision. With a joint venture between skilled and experienced surgeons and orthodontists, the outcome can be very promising.

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Value-Based Analysis of Virtual Versus Traditional Surgical Planning for Orthognathic Surgery.

In orthognathic surgery, virtual surgical planning (VSP) is gaining popularity over traditional surgical planning (TSP); however, concerns about cost of VSP have slowed adoption of this technology. This study investigates the clinical value of VSP versus TSP over the entire clinical care continuum. Retrospective cohort study was conducted for patients undergoing maxillomandibular surgery between 2005 and 2016 at a tertiary pediatric hospital. Clinical value, defined as patient outcomes per unit cost, was analyzed between the 2 groups with appropriate statistics. The VSP (n = 19) and TSP (n = 10) cohorts had statistically similar hospital lengths of stay, rates of complications, readmissions, and duration of postoperative orthodontic treatment (P = 0.518, P > 0.999, P > 0.999, P = 0.812, respectively). VSP maxillomandibular procedures trended towards shorter operative times (P = 0.052). Total hospital charges were statistically similar between the TSP and VSP cohorts (P = 0.160). Medication, laboratory and testing, and room charges were also statistically similar between the TSP and VSP cohorts (P = 0.169, P = 0.953, and P = 0.196 respectively). Indexed patient outcomes and costs incurred for maxillomandibular procedures were statistically similar between those utilizing TSP or VSP leading us to conclude that these 2 methods are associated with similar clinical value. This retrospective analysis should be followed with prospective data to give patients and insurers the best estimate of clinical value utilizing TSP and VSP.

Presurgical orthopedic treatment of children with unilateral cleft lip and palate with a sequential splints method: indications and long-term results

To justify the use of the Sequential Splints Method of presurgical orthopedic treatment for children with unilateral cleft lip and palate depending on extent of initial deformation and to estimate long-term results. The method was applied in 17 unilateral cleft lip and palate infants who received treatment at the age from 4 days to 3 months. There was a control group of 28 cleft lip and palate patients operated with no early orthodontics. Average age in both groups at the time of research was 3.8±0.9 years. Comparative assessment was conducted before the beginning of the post-operative orthodontic treatment for the following parameters: residual width of the alveolar process cleft, presence of lateral incisor's bud, the extent of the nose deformation on the cleft side. It was found that residual width of the alveolar process cleft was, on average, 5.95 mm in the main group and 12.6 mm in the control group. The percentage of the lateral incisor adentia was 28% in the main group and 66% in the control group. The mean score of alar nose deformation was 3.9 and 3.1 points, correspondingly. According to obtained results patients who did not receive the presurgical orthopedic treatment were more likely to have residual deformations and larger residual width of the alveolar process cleft. There was higher risk of teeth germs loss in the control group. The Sequential Splints Method of presurgical orthopedic treatment is recommended as a necessary part of the treatment for the unilateral cleft lip and palate.

Virtual Orthodontic Surgical Planning to Improve the Accuracy of the Surgery-First Approach: A Prospective Evaluation

We developed an innovative computer-assisted method to increase the accuracy of the surgery-first (SF) approach by linking the virtual orthodontic planning (VOP) with the virtual surgical planning(VSP). Fifteen consecutive patients were enrolled from 2013 to 2015. All 15 patients had initially undergone cone-beam computed tomography (CBCT; 15×15 field-of-view) and intraoral digital scanning of the dental arches. The DICOM (Digital Imaging and Communications in Medicine) data set and STL files were processed using the SimPlant O&O platform (Dentsply-Sirona, York, PA), which facilitates skeletal, dental, and soft tissue modeling and subsequent realization of the VOP/VSP. The VSP was reproduced using computer-aided design and computer-aided manufacturing surgical splints, and the VOP was realized via postoperative orthodontic treatment. At the end of treatment, all the patients underwent repeat CBCT and digital scanning of the dental arches, and the new data sets were compared with the original data sets to determine the deviations. To evaluate skeletal accuracy, we assessed all points within an arbitrary range of -2 to+2mm. To evaluate dental accuracy, the arbitrary range was -0.8 to+0.8mm. The average duration of orthodontic treatment was 17.9months. The accuracy of maxillary treatment averaged 0.0702±2.0724mm and that of mandibular treatment, 0.2811±1.9993mm. The average upper and lower dental arch accuracy was -0.0029±1.125 and -0.0147±1.263mm, respectively. The maxillary surgery accuracy was 75.3% and that of mandibular surgery 74.0%, both within the -2 to+2-mm range. The upper and lower arch accuracy was 58.86 and 51.53%, respectively, both within the -0.8 to+0.8-mm range. The use of the VOP/VSP improved the diagnostic and therapeutic SF preoperative planning. VOP contributed significantly in this context. The accuracy of skeletal repositioning was acceptable; however, the VSP should be rendered more reproducibly in the future to minimize the need for orthodontic compensation and to maximize the advantages of SF.

Maintenance of Segmental Maxillary Expansion: The Use of Custom, Virtually Designed, and Manufactured Palatal Appliances Without the Use of an Occlusal Splint

Expansion of the maxilla using a segmental Le Fort I osteotomy is a routine and commonly used procedure in the treatment of dentofacial deformities. Although orthognathic surgery has seen tremendous advancement in technology, including virtual surgical planning and customized hardware, some room for advancement exists in the maintenance of surgical maxillary expansion. Traditionally, this has been accomplished with retention of a maxillary occlusal splint 4 to 8weeks postoperatively. This article introduces some novel techniques to help maintain this expansion, including the intraoperative transpalatal archwire and custom palatal strap appliance in conjunction with autogenous bone harvest and grafting in lieu of using occlusal-based splints. The aim of these techniques is to improve postoperative patient comfort and surgical outcomes and shorten postoperative orthodontic treatment time.

Evaluation of Postoperative Mandibular Positional Changes After Mandibular Setback Surgery in a Surgery-First Approach: Isolated Mandibular Surgery Versus Bimaxillary Surgery

The aim of this study was to compare postoperative positional changes in the mandible after isolated mandibular surgery (IMS) or bimaxillary surgery (BMS) in a surgery-first approach (SFA). The authors designed and implemented a retrospective cohort study composed of patients who underwent mandibular setback surgery using the SFA. Surgical and postoperative changes were evaluated using lateral cephalograms taken 1month before surgery (T0), 1week after surgery (T1), and immediately after debonding of orthodontic appliances (T2; 16.6±8.7months after surgery). To predict postoperative mandibular positional changes from the increase in vertical dimension (VD) in surgical occlusion, the mandible was rotated counterclockwise to the preoperative VD on the lateral cephalogram at T1, and resultant mandibular positional changes were measured. To evaluate actual postoperative mandibular positional changes between each time point and compare them between the 2groups, independent t test, paired t test, and repeated-measures analysis of variance were performed. Thirty patients were evaluated (16 in IMS group and 14 in BMS group). The 2 groups showed significant time-course mandibular positional changes from T0 to T1 and from T1 to T2 within each group (point B, P<.001), although no statistically significant differences were observed between groups. There was no statistically relevant difference between groups in the predicted and actual postoperative rotational movements. In addition to the mandibular forward movement that resulted from postoperative mandibular counterclockwise rotation, additional horizontal relapse occurred. The present findings suggest that the mandible exhibits notable postoperative forward movement during postoperative orthodontic treatment, regardless of the extent of the orthognathic surgery in the SFA, and it is necessary to consider mandibular forward movement from the VD increase in surgical occlusion and additional relapse during the treatment planning stage.

Anterior Maxillary Segmental Distraction Osteogenesis for Treatment of Maxillary Hypoplasia in Patients With Repaired Cleft Palate.

This study is to present experiences of using anterior maxillary segmental distraction osteogenesis (AMSDO) with internal distractors for treatment of maxillary hypoplasia in patients with repaired cleft palate. A total of 42 patients of maxillary hypoplasia with repaired cleft palate were included in this study, and underwent AMSDO. Cephalometric analysis and speech quality assessments were performed to evaluate the changes after AMSDO and its long-term effect on stability. All cases had successfully accomplished AMSDO. The average SNA (°), NA-FH (°), ANS-PNS (millimeter), and Overjet (millimeter) have change to 80.41°, 89.51°, 55.64 mm, and 2.52 mm, respectively (P < 0.01). Maxillary advancement has reached 13.80 mm on average (ranging from 10.0 mm to 20.0 mm). Speech quality assessment demonstrated that nasal resonance, speech articulation, nasal emission, intelligibility, and velopharyngeal function did not get worse after AMSDO. AMSDO has unique advantages as follows: can effectively correct maxillary hypoplasia in patients with repaired cleft palate; can create a space for postoperative orthodontic treatment to solve the crowding teeth situation; the postoperative velopharyngeal function and speech quality show no significant change. The results shown AMSDO is an effective and appropriate treanment for curing maxillary hypoplasia in patients with repaired cleft palate.

Systematic Analysis of Clinical Outcomes of Bilateral Sagittal Split Ramus Osteotomy With Preoperative Modeling and Postoperative Orthodontic in the Treatment of Mandibular Protrusion.

The purpose of this study was to determine the changes in hard tissues, soft tissues, and teeth after bilateral sagittal split ramus osteotomy and orthodontic treatment for the treatment of mandibular protrusion. Cephalometric analysis was used to evaluate the aesthetic effects and occlusal relationships obtained. The subjects included 11 women and 9 men (aged 18-27 years; average, 20 years) with mandibular protrusion who underwent bilateral sagittal split ramus osteotomy. Based on a preoperative computer-aided manufacturing/design-assisted, model surgical design and an occlusal guide plate, new occlusal relationships were established for the patients. In addition, the preoperative and the end of postoperative orthodontic treatment cephalometric radiographs were systematically analyzed. In all patients, the surgical incisions underwent primary healing, with no infection or osteonecrosis. Significant differences were observed in the preoperative and the end of postoperative orthodontic treatment values of all hard tissue and teeth parameters, except for SNA°, ANB°, GoGn-SN°, SE (mm), NP-FH°, SGn-FH°, OP-FH°, 1-MP°, Li-E (mm). The most obvious significant differences were seen in SNB°, SND°, 1_-NA°, 1_-NA (mm), 1-NB (mm), 1-NB°, Po-NB (mm), NA-PA°, AB-NP°, 1-OP°, Ui-E (mm), and S-N'-B'° (P < 0.001). Postoperative follow-up lasted for 10 to 12 months. All patients eventually achieved normal downjaw relationship, tooth arch forms, and spee curves. There were no evident irregularities of teeth arrangement or abnormal occlusal relationships were observed. All patients were satisfied with their facial appearance and occlusal relationships at the end of postoperative orthodontic treatment. The authors found a precise preoperative model surgical design combined with postoperative orthodontic treatment is a simple and time-saving technique. It can be used to correct mandibular protrusion with satisfactory occlusal relationship, facial appearance, and minimal postoperative complications.