Surgical Orthodontic Treatment Research Articles

Orthodontic Treatment and Mini Wing Osteotomy: A Case Report of Changes in Facial Aesthetic

For correction of dentofacial deformities, orthosurgical treatment is recommended and often involves bi-maxillary orthognathic surgery. The chin area is an important key for a harmonious facial profile and plays an important role. The present case (of a 38- year-old female) describes one successful surgical-orthodontic treatment. The treatment consisted of the use of an Edgewise fixed appliance (0.022”×0.028”), mini Wing osteotomy (mWo), correction of the deviated nasal septum, and rhinoplasty. The treatment resulted in a better facial harmony and aesthetic with greater definition and lengthening of the submental region, adipose tissue elimination, and an upturned nose due to the correction of the deviated nasal septum associated with rhinoplasty. The Class I canine and molar relationship, the upper and lower midlines coincident with the facial midline, and the compensatory projection of the lower incisors were maintained. A satisfactory overbite and overjet, and leveled curve of Spee were obtained. In conclusion, the orthodontic treatment associated with mWo, correction of the deviated nasal septum, and rhinoplasty surgery provided satisfactory functional and aesthetic results.

Facial asymmetry correction with surgical-orthodontic treatment: Challenges of the surgical and postsurgical phases

Asymmetry is commonly diagnosed in orthodontic clinical practice and is more or less perceived depending on its severity. In more severe cases, orthodontic-surgical treatment is the only treatment option. Although presurgical orthodontics is fundamental, occasionally, the occlusion obtained after surgery is far from that planned, and the orthodontist must decide between surgical re-intervention or orthodontic finishing. This clinical report describes the case of an 18-year-old man, presenting a severe facial asymmetry with class III malocclusion, who underwent a surgical-orthodontic treatment. One week after orthognathic surgery, the patient was reoperated because the intercuspation was different from the one obtained at the end of surgery. However, after the second surgery, the intercuspation was still far from what was planned. Despite that, at the end of treatment, a functional and stable occlusion was obtained, associated with a significant improvement in facial harmony and function.

Three-dimensional assessment of periodontal support of lower incisors for skeletal Class II malocclusion undergoing presurgical orthodontic treatment with different vertical skeletal patterns

BackgroundThe aim of the present study was to compare periodontal support changes during retraction of mandibular anterior teeth for skeletal Class II malocclusion with different facial divergence and to analyze relevant factors influencing bone remodeling by applying three-dimensional (3D) cone-beam computed tomography (CBCT) reconstruction technology.MethodsForty-eight patients with Class II malocclusion requiring surgical orthodontic treatment enrolled in the study were divided into the hyperdivergent group (n = 16), normodivergent group (n = 16) and hypodivergent group (n = 16) according to their vertical skeletal patterns. Cone-beam computed tomography (CBCT) scans were obtained before treatment (T1) and after presurgical orthodontic treatment (T2). The two-dimensional (2D) alveolar bone morphology, movement of mandibular central incisors and volume of the alveolar bone around incisors were measured on the labial and lingual sides by 3D CBCT reconstruction technology. Statistical analyses were performed with one-way ANOVA, paired t tests and multiple linear regression.ResultsDuring presurgical orthodontic treatment, the alveolar bone height on the labial side of the hyperdivergent group decreased significantly (P ≤ 0.05), but was maintained in the normodivergent and hypodivergent groups (P > 0.05). However, the alveolar bone volume, alveolar bone thickness at each level and alveolar bone height on the lingual side decreased significantly for all the groups. Apart from the initial morphometric measurements at T1, the morphology of lingual alveolar bone at T2 was significantly influenced by the direction and amount of tooth movement. Horizontal retraction and vertical protrusion of the root apex were negatively related to the alveolar bone on the lingual side after presurgical orthodontic treatment.ConclusionFor Class II malocclusion patients undergoing presurgical orthodontic treatment, the changes in the periodontal support of the lower central incisors varied in different vertical skeletal patterns. There exists a great periodontal risk of alveolar bone resorption on the lingual side for various vertical types. To avoid alveolar bone deterioration, it is essential to investigate the bone remodeling of patients with different alveolar bone conditions and cautiously plan tooth movement prior to orthodontic treatment. Moreover, 3D measurements based on CBCT construction can provide complementary information to traditional 2D measurements.

COMBINED ORTHODONTIC AND SURGICAL TREATMEN IN PATIENT WITH MANDIBULAR PROGNATHISM

The aim of this case was to present a combined orthodontic-surgical treatment for a 30-year-old patient. The initial clinical examination revealed a Class III malocclusion, concave profile, 4.5mm overjet, and 2mm overbite. The treatment plan included orthodontic preparation with fixed appliances, surgical correction of skeletal discrepancies, and post-surgical orthodontic treatment. Lateral cephalograms were taken before the orthodontic therapy, just before the surgical intervention, and after the treatment, following the removal of fixed appliances. On the initial lateral cephalogram SNB angle was 88°, ANB -5°, SpP/MP 28°, total Bjork’s polygon angle 405°, I/SpP 71°, i/MP 111° and mandibular corpus length was increased by +11mm. On the final post-surgical lateral cephalogram, after the intervention and appliance removal the SNB angle was 81°, ANB 3°, SpP/MP 25°, total Bjork’s polygon angle 398°, I/SpP 64°, i/MP 96° and man- dibular corpus length was increased by +3mm. The pre-surgical orthodontic treatment lasted 12 months, followed by bimaxillary surgery. The post-surgical orthodontic treatment lasted 12 months. After appliance removal, a retentive phase with night-time wear of retainers was implemented. The result was stable Class I occlusion, satisfactory profile appearance, 2.5mm overbite, and 2mm overjet.

Is cutaneous profile perception an indicator of skeletal class III malformation treatment plan? A cross sectional Study

Background: The treatment choice in adults with skeletal class III malocclusion represents a challenging task for orthodontists, especially in borderline cases. With the growth spurt being surpassed, the clinician is left between two treatment options: orthodontic camouflage or orthognathic surgery. Around the years, many studies tried to uncover a guide model which enables practitioners to distinguish between skeletal class III that can be appropriately treated by orthodontics alone and those needing surgical intervention. Aim: The aim of this study is to demonstrate the importance of cutaneous profile perception as a subjective decisive parameter in the treatment of borderline skeletal class III adult patients and, as a secondary objective, to compare it with the most decisive cephalometric parameters found in previous studies. Material and methods: Among 28 skeletal class III patients found in the Saint Joseph university orthodontics department’s data base, 10 different adult patients: 4 males and 6 females have met the inclusion criteria. Three types of data have been gathered from each patient: lateral cephalograms, profile photographs and the treatment that the patient underwent. To understand the significance of profile perception in the treatment plan for these patients, all of the 10 patients profile photographs were put in a survey that was sent to 3 groups of people: orthodontists, dentists, and laypersons. Each participant should evaluate based only on his/her perception of the photo if the patient should be treated by orthodontic-surgical treatment or if an orthodontic camouflage alone is enough. In addition, the efficiency of profile perception will be compared with the efficiency of the most decisive cephalometric parameters found in literature: ANB angle=-4°, Witts appraisal =-5.8mm. Results: A total of 158 participants were included in this study. When we compare what participants chose based on profile perception with real treatment, 75% of orthodontists have correctly classified the patients. Lower rates were noted for dentists and laypeople, respectively 65% and 64.5%. If we also consider the cephalometric values found in literature (ANB=-4°, Witts appraisal=-5.8mm) as the correct treatment that should have been done, 70% of the patients were correctly treated in our faculty. Conclusion: There are no cephalometric or clinical golden standards to decide between surgical intervention or orthodontic camouflage in adult patients presenting skeletal class III malformation. Cephalometric values are very useful but insufficient tools even when many parameters are combined. Both objective and subjective criteria should be taken into consideration to individualize each treatment plan according to each patient.

Costs and duration of orthodontic-surgical treatment with mandibular advancement surgery.

The aim was to analyse the costs and duration of orthodontic-surgical treatment with mandibular advancement in the public health care sector in Finland. The study was conducted as a retrospective registry study in a public district hospital on all nonsyndromic patients that were ethnic Finns and treated with full fixed appliances and mandibular advancement surgery in 2016-2020. The mean treatment duration of the included 45 patients was 28.1 months, including 18.9 months pre and 9.2 months postoperative orthodontics. The median number of visits was 27, including 17 visits before and 9 visits after surgery. The mean total treatment time was 14.5 h. The mean total direct costs per course of treatment were 7574 € to the municipality and 947 € to the patient. The costs positively correlated with the duration of the treatment (rho = 0.71, P = .000), but were not associated to gender or age of patient. The mean surgery time was 78 minutes, and significantly less with an experienced surgeon (P = .002). It was calculated that the mean minimum treatment costs would be 45% of the present total, achievable with a patient with optimum dental arches at the start of treatment. The major limitation of the study is the relatively small number of study subjects. A 55% share of the costs is influenced by case- and operator-dependent factors. This indicates that the complexity and performance of the orthodontic phases of treatment are important determinants in the cost structure.

The impact of orthodontic-surgical treatment on facial expressions—a four-dimensional clinical trial

ObjectiveThe objective of this clinical trial was to compare facial expressions (magnitude, shape change, time, and symmetry) before (T0) and after (T1) orthognathic surgery by implementing a novel method of four-dimensional (4D) motion capture analysis, known as videostereophotogrammetry, in orthodontics.MethodsThis prospective, single-centre, single-arm trial included a total of 26 adult patients (mean age 28.4 years; skeletal class II: n = 13, skeletal class III: n = 13) with indication for orthodontic-surgical treatment. Two reproducible facial expressions (maximum smile, lip purse) were captured at T0 and T1 by videostereophotogrammetry as 4D face scan. The magnitude, shape change, symmetry, and time of the facial movements were analysed. The motion changes were analysed in dependence of skeletal class and surgical movements.Results4D motion capture analysis was feasible in all cases. The magnitude of the expression maximum smile increased from 15.24 to 17.27 mm (p = 0.002), while that of the expression lip purse decreased from 9.34 to 8.31 mm (p = 0.01). Shape change, symmetry, and time of the facial movements did not differ significantly pre- and postsurgical. The changes in facial movements following orthodontic-surgical treatment were observed independently of skeletal class and surgical movements.ConclusionsOrthodontic-surgical treatment not only affects static soft tissue but also soft tissue dynamics while smiling or lip pursing.Clinical relevanceTo achieve comprehensive orthodontic treatment plans, the integration of facial dynamics via videostereophotogrammetry provides a promising approach in diagnostics.Trial registration numberDRKS00017206.

Association of scoliosis with skeletal jaw asymmetry

ObjectiveThe objective of this study was to evaluate the relationship between scoliosis and skeletal jaw asymmetry. MethodsThe subjects were one hundred and thirty-eight (43 male, 95 female) patients with jaw deformity, who underwent surgical orthodontic treatment at Cyubu Rosai Hospital from April 2017 to March 2022, without congenital disease or scoliosis treatment history. Posteroanterior cephalograms and posteroanterior chest radiographs obtained before surgery were used to evaluate horizontal displacement of the jawbone, Cobb angle of scoliosis, respectively. Actual values of spines curved to the right and left of the body and of displacement of the mandible in these directions were both deemed positive and negative, respectively. Correlations between absolute values of spine and jaw displacement, namely values without regard to their direction, and correlations between actual values of spine and jaw displacement were analyzed using Spearman, non-parametric, and Pearson, parametric, tests respectively. ResultsTwenty-two patients (15.9 %) had Cobb angle > 10°. Although there was no significant correlation between Cobb angle and Me angle in the actual values (p = 0.606), there was a significant correlation in the absolute values (p = 0.023). ConclusionsThis study suggests a relationship between horizontal deviation of the mandible and scoliosis in patients with jaw deformity, albeit not necessarily in the same direction.

Assessing the Impact of Maxillomandibular Difference on the Success of Orthodontic Decompensation Preparation in Orthognathic Surgical Skeletal Class-III Patients

Background: Combined orthodontic-surgical treatment includes a thorough diagnosis and analysis of dental and facial deformities. Cephalometric analysis is a common tool for this, in which measurements of specific anatomical landmarks are performed. In order to achieve a successful surgery, orthodontic teeth preparation is mandatory, including dental decompensation before surgery. This should be planned and adequately executed to allow the surgeon to move the jaws to the correct ideal position. Aim: The current study aimed to check if the orthodontic decompensation amount is influenced and compromised by the maxillomandibular difference and if there is a correlation between the deformity’s severity and the orthodontist’s difficulty in achieving an accurate result in the orthodontic decompensation preparation. Methods: The study consisted of 50 pre-operational cephalometric radiographs of patients with Class-III (prognathic) deformity. The measurements included the angles of the upper incisor (U1) longitudinal axis to the Frankfort plane (FH) and palatal plane (PP), lower incisor (L1) longitudinal axis to the lower mandibular plane (MP), overjet (OJ), effective maxillary length, effective mandibular length, and the maxilla–mandibular difference (Diff); Pearson correlation coefficient was applied. Results: There was a significant correlation between the maxilla–mandibular difference and U1 to FH angle (r = 0.254, p = 0.037), U1 to PP angle (r = 0.447, p < 0.001), OJ (r = (−0.426), p < 0.001). There was no statistical significance for Diff and L1 to MP angle (p = 0.342). Conclusions: In Class-III patients, achieving adequate decompensation is more challenging with the maxillary incisors rather than with the mandibular incisors, especially in more severe cases.

Skeletal Class III Surgical-Orthodontic Treatment and Remote Digital Monitoring during COVID-19 Pandemic: A Case Report

Skeletal Class III Surgical-Orthodontic Treatment and Remote Digital Monitoring during COVID-19 Pandemic: A Case Report

Long-term stability of surgical orthodontic treatment for patients with asymmetric mandibular prognathism: a retrospective comparison study on surgical methods

ABSTRACT Purpose To consider long-term postoperative stability, and its contributing factors in surgical orthodontic treatment for asymmetric mandibular prognathism by comparing a sagittal split ramus osteotomy (SSRO) and a combination of Le Fort I osteotomy and SSRO. Materials and Methods Patients with asymmetric mandibular prognathism had undergone SSRO (14 patients; one-jaw surgery group) or a combination of Le Fort I osteotomy and SSRO (15 patients; two-jaw surgery group) were enrolled. Cephalometric analyses were performed at five time points: initial visit (T0), pre-surgery (T1), several months after surgery (T2), start of retention (T3) and more than 5 years after surgery (T4). Factors were evaluated by measuring two groups at each time point, comparing changes in measurements during each time period, correlating mandibular changes between each period, and correlating changes in lower first molar and ramus inclination with T2-T4 measurements. Results The two-jaw surgery group had significantly smaller transverse changes of menton (Me) at T3–T4 and T2–T4 compared to the one-jaw surgery group. In the one-jaw surgery group, transverse changes in Me at T2–T4 were positively correlated with changes in transverse inclination of mandibular ramus at the deviated side observed at T1–T2. Vertical change of pogonion at T2–T4 was positively correlated with change in bucco-lingual inclination of lower first molar at T0–T1. Conclusions Two-jaw surgery is suggested to be more effective than one-jaw surgery in achieving long-term stability of mandibular position in the transverse and anteroposterior dimensions after surgical orthodontic treatment for asymmetric mandibular prognathism. Long-term follow-up is necessary to monitor potential mandibular relapse.

Subregional pharyngeal changes after orthognathic surgery in skeletal Class III patients analyzed by convolutional neural networks-based segmentation

ObjectivesTo evaluate the accuracy of fully automatic segmentation of pharyngeal volume of interests (VOIs) before and after orthognathic surgery in skeletal Class III patients using a convolutional neural network (CNN) model and to investigate the clinical applicability of artificial intelligence for quantitative evaluation of treatment changes in pharyngeal VOIs. Methods310 cone-beam computed tomography (CBCT) images were divided into a training set (n = 150), validation set (n = 40), and test set (n = 120). The test datasets comprised matched pairs of pre- and post-treatment images of 60 skeletal Class III patients (mean age 23.1 ± 5.0 years; ANB<-2⁰) who underwent bimaxillary orthognathic surgery with orthodontic treatment. A 3D U-Net CNNs model was applied for fully automatic segmentation and measurement of subregional pharyngeal volumes of pre-treatment (T0) and post-treatment (T1) scans. The model's accuracy was compared to semi-automatic segmentation outcomes by humans using the dice similarity coefficient (DSC) and volume similarity (VS). The correlation between surgical skeletal changes and model accuracy was obtained. ResultsThe proposed model achieved high performance of subregional pharyngeal segmentation on both T0 and T1 images, representing a significant T1–T0 difference of DSC only in the nasopharynx. Region-specific differences amongst pharyngeal VOIs, which were observed at T0, disappeared on the T1 images. The decreased DSC of nasopharyngeal segmentation after treatment was weakly correlated with the amount of maxillary advancement. There was no correlation between the mandibular setback amount and model accuracy. ConclusionsThe proposed model offers fast and accurate subregional pharyngeal segmentation on both pre-treatment and post-treatment CBCT images in skeletal Class III patients. Clinical significanceWe elucidated the clinical applicability of the CNNs model to quantitatively evaluate subregional pharyngeal changes after surgical-orthodontic treatment, which offers a basis for developing a fully integrated multiclass CNNs model to predict pharyngeal responses after dentoskeletal treatments.

Orthodontisch-chirurgische aspecten bij dentale en beenderige correcties van schisis

Orthodontic-surgical considerations of dental and bone corrections in cleft Cleft lip and palate is a collective term for a heterogeneous group of congenital abnormalities at the level of the lips and mouth. It is the most frequent congenital craniofacial disorder and is subdivided into cleft palate and cleft lip with or without cleft palate. The condition has a major impact on the patient’s speech, hearing, appearance, nutritional intake and mental stress. Therefore, the goal of the treatment is to restore function and form with ultimately a satisfied patient. After primary surgery, closing lip and palate clefts, dento-maxillofacial growth should be monitored, adjusted and corrected. Orthodontic-surgical treatment should provide restoration of the jaw wall, tooth arch, occlusion and facial relationships. This aspect of multidisciplinary treatment is subject to specific clinical challenges for the orthodontist, oral and maxillofacial surgeon and restorative dentistry team. The orthodontic-surgical interventions in dental and bony corrections run from birth to adult age and include a postnatal presurgical orthopedic intervention (0 to 4 months), an early orthopedic-orthodontic treatment (2,5 to 6/7 years), a conventional orthopedic-orthodontic treatment (from the age of 7), the placement of a bone graft or bone-in-gnatho (BIG) intervention, a definitive orthodontic treatment (12 to 14 years) and finally, if necessary, orthognathic surgery (from the age of 17).

Relapse after Orthodontic-Surgical Treatment: A Retrospective Longitudinal Study

Long-term stability is a crucial point in order to keep the patient’s aesthetic and functional balance. The aim of this study was to evaluate dental and skeletal relapse in patients who underwent orthodontic-surgical treatment. This retrospective study included 25 patients who corrected their dentofacial deformity through orthodontics and orthognathic surgery. The dental casts and lateral cephalograms were evaluated prior to orthodontic treatment (T0), final of orthodontic-surgical treatment (T1) and long-term retention phase (T2). The Wilcoxon test with p-value corrected by the Benjamini–Hochberg method was used to assess differences between the groups. The influence of retention duration was assessed using the Kruskal–Wallis method. The association of nominal variables and differences between quantitative variables were assessed using the Fisher and Mann–Whitney tests, respectively. No dental or skeletal variable presented statistically significant differences between the final orthodontic-surgical treatment and the long-term retention phase. Eight patients presented dental relapse (32–95% CI [12.4%; 51.7%]), but no skeletal relapse was observed in any of the 25 individuals. The type of malocclusion did not influence the relapse rate of orthodontic-surgical treatment (Fisher, p = 0.202). No differences were found between the different retention times, sex and age at the end of treatment. Orthodontic-surgical treatment showed long-term stability in the present study group.

Meta-analysis of outcomes related to the quality of life after orthodontic-surgical treatment.

Orthognathic surgery causes functional and aesthetic changes, which could affect patients' quality of life (QOL). The current analysis assessed the impact of orthodontic-surgical treatment on the parameters affecting the QOL using different scoring systems. The criteria for inclusion were studies written in various languages that compared the effects of the intervention on patients' QOL before surgery and at various periods after surgery (3 weeks to several months), which resulted in including 19 studies into this meta-analysis. The outcomes of these studies underwent random-effect modeling to calculate the mean difference (MD) and 95% confidence intervals (95% CIs) of the impact of different surgical techniques on clinical parameters, and publication bias was analyzed with Begg's test. According to the total score of the Orthognathic Quality of Life Questionnaire (OQLQ), surgery significantly affected patients' QOL after 2 months or less (p = 0.049), up to 6 months (p < 0.001), and when comparing 2 months or less with up to 6 months (2-6 months) (p < 0.001). In addition, the total Oral Health Impact Profile-14 (OHIP-14) score showed a significant difference in the QOL after 6 months (p = 0.003) and up to 12 months (p = 0.002) after surgery. Therefore, orthodontic-surgical treatment significantly improves patients' QOL after surgery compared to before surgery.

Klippel-Trenaunay syndrome: A case report of orthodontic-surgical treatment

Introduction: Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by a clinical triad of capillary malformation; varicose veins; and soft tissue and/or bony hypertrophy. This rare syndrome has an estimated incidence of about 2–5/100,000 live births. KTS usually affects the extremities but occasionally can manifest in the craniofacial region, including the oral cavity. Case Presentation: Our patient, a 17-year-old girl, presented with large areas of port wine stain, unilateral hypertrophy of the facial region, and varicose veins. She was diagnosed with KTS. Orthodontic treatment followed by orthognathic surgery was performed to address her complaint of facial asymmetry and poor chewing efficacy. Treatment resulted in significant improvement in her appearance and dental occlusion and our patient was very satisfied with the results. Conclusion: This report illustrates an orthodontic and surgical treatment approach of a case with KTS. Effective management of orthodontic and facial manifestations of KTS considerably enhances the patient’s function, appearance, and overall quality of life.

Surgical-Orthodontic Treatment of Class III Malocclusion with Anterior Open Bite

A 21-year-old female came with chief complaints of inability to incise food and poor esthetics. The patient presented with a concave facial profile, long face with a steep mandibular angle, incompetent lip closure, and acute nasolabial angle. Intraorally, she had negative 6 mm overjet, 3 mm open bite and dental crowding. She was diagnosed as severe skeletal Class III malocclusion and anterior open bite. The treatment plan included orthodontic treatment with orthognathic surgery and extraction of maxillary second molars, which were supra-erupted and tipped buccally. The pre-operative orthodontic alignment took 11 months. The surgical correction included maxillary Le Fort I osteotomy with 4 mm advancement, mandibular intraoral vertical ramus osteotomy with 6.5 mm setback and genioplasty. The total surgical-orthodontic treatment time was 16 months. The final result presented a straight profile with stable occlusion. The patient’s facial and dental esthetics, masticatory function, and quality of life were all significantly improved after surgical-orthodontic treatment.

Assessment of masticatory performance in patients undergoing orthognathic surgery: A systematic review and meta-analysis.

One of the main goals of orthognathic surgery is to improve the masticatory performance in patients with maxillofacial deformities. The aim of this study was to evaluate the literature on assessing masticatory performance before, after orthognathic surgery and normal occlusion. An electronic search was performed via Pubmed, Scopus, LILACs and Web of Science without any restrictions until June 2022. The articles assessing masticatory performance using a comminution assay, bite force or occlusal contact area in patients undergoing orthognathic surgery with or without comparing controls were included. The risk of bias of the selected articles was assessed using the appropriate tools according to the study design. Of the 2507 records identified, 21 studies were included in the qualitative evaluation and 17 studies in the meta-analysis. Nine articles were cohort studies, and the other eight were before-after studies. Moderate to high risks of bias were found among the articles. Comparing the values before and after surgery, the meta-analysis revealed a significant improvement in the bite force and occlusal contact area at 1- and 2-year post-surgery. However, regardless of the assessed parameters, the masticatory performance in patients with normal occlusion was significantly greater than those in patients undergoing orthognathic surgery at all evaluated time points. Although combined surgical orthodontic treatment can improve impaired masticatory function, assessed by the comminution method, bite force and occlusal contact area, the improvement may not reach that of normal occlusion.

Assessment of condylar positional changes in severe skeletal class II malocclusion after surgical-orthodontic treatment.

This study aimed to determine the positional changes in the condyle in the temporomandibular joint (TMJ) of severe skeletal class II malocclusion patients treated with surgical-orthodontics. The measurements of TMJ space in 97 severe skeletal class II malocclusion patients (20 males, 77 females, mean age, 24.8 years, mean ANB = 7.41°) were assessed using limited cone-beam computed tomography (LCBCT) images acquired before orthodontics (T0) and 12 months after surgery (T1). 3D remodeling of the TMJ and measurements of the anterior space (AS), superior space (SS), and posterior space (PS) were performed to determine the position of the condyle for each joint. All data were analyzed by t test, correlation analysis, and Pearson correlation coefficient. The mean AS, SS, and PS values after the therapy changed from 1.684 to 1.680 mm (0.24%), 3.086 to 2.748 mm (10.968%), and 2.873 to 2.155 mm (24.985%), respectively. The decreases in SS and PS were statistically significant. Positive correlations were found in the mean AS, SS, and PS values between the right and left sides. The combination of orthodontic and surgical treatment makes the condyle move counterclockwise in the TMJ in severe skeletal class II patients. Studies of temporomandibular joint (TMJ) intervals changes in patients with severe skeletal class II after sagittal split ramus osteotomy (SSRO) are limited. The postoperative joint remodeling, resorption, and related complications remain unstudied.

Surgery-First Orthognathic Approach for Correction of Dentofacial Deformity in Unilateral Cleft Lip and Palate.

Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of class III deformity, there is no report of the success of this approach for patients with cleft lip and palate. Therefore, the purpose of this study was to evaluate the stability and outcome of bimaxillary surgery for cleft-related dentofacial deformity using a surgery-first approach. Forty-one patients with unilateral cleft lip and palate who consecutively underwent Le Fort I and bilateral sagittal split osteotomies for skeletal class III deformity were included. Cone-beam computed tomographic scans before surgery, 1 week after surgery, and after orthodontic treatment were used to measure the surgical and postsurgical changes in jaw position by landmarks, and outcomes of jaw protrusion and relation, incisor angle and occlusion, and menton deviation after treatment. Self-report questionnaires regarding satisfaction with overall appearance of the face and seven facial regions were administered after treatment. A clinically insignificant relapse was found in the maxilla (<1 mm) and mandible (<2 mm). There was a significant improvement in the jaw protrusion and relation, incisor angle and occlusion, and menton deviation. Responses from the self-report questionnaires completed after treatment indicated that patient satisfaction was high. These findings demonstrate surgical-orthodontic treatment with a surgery-first approach can successfully improve cleft-related dentofacial deformity in patients with unilateral cleft lip and palate. Therapeutic, IV.