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June 6, 2002 - Orthognathic Surgical Treatment

June 6, 2002 - Orthognathic Surgical Treatment






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    June 6, 2002 - Orthognathic Surgical Treatment June 6, 2002 - Orthognathic Surgical Treatment Presentation Transcript

    • Orthognathic Surgical Treatment Adriana Da Silveira, DDS, MS, PhD ORTD 323 Summer 2002
    • Indications for Orthognathic Surgery
      • Severity of skeletal and dental malocclusion
      • When growth modification can not be achieved
      • Esthetic and psychosocial considerations
    • Timing of Surgery
      • Usually done when all growth is complete
      • Assessed by superimposition of serial lat cephs
      • Can be performed when growth is not yet complete in cases of psychosocial problems or great severity when function is compromised (i.e. breathing, chewing)
    • Orthognathic Surgery
      • Correction of A-P relationships:
      • maxillary advancement
      • retraction of anterior maxillary segment
      • mandibular advancement
      • mandibular setback
      • double jaw surgery
    • Orthognathic Surgery
      • Correction of Vertical Relationships:
      • maxillary impaction/intrusion
      • maxillary extrusion
      • mandibular ramus surgery
    • Orthognathic Surgery
      • Correction of Transverse Relationships:
      • surgically assisted maxillary expansion
      • surgically assisted mandibular expansion
    • Orthognathic Surgery
      • Correction of Asymmetries:
      • maxilla
      • mandible
      • maxilla and mandible
    • Surgical Techniques
      • Le Fort I
      • Le Fort II
      • Le Fort III
      Le Fort I Le Fort II Le Fort III
    • Surgical Techniques
      • BSSO
      • Genioplasty
    • Pre Surgical Orthodontic Objectives
      • To level and align the arches and make them compatible
      • to resolve crowding and/or spacing
      • to establish anteroposterior and vertical position of incisors (decompensate)
      • to place teeth relative to their own supporting bone
    • Check List for Treatment Planning
      • A-P relationships maxillary deficiency/protrusion
      • mand prognathism/deficiency
      • amount of deficiency
      • Vertical relationships open bite
      • deep bite
      • Transverse relationships crossbites
      • before surgery expansion
      • surgically assisted expansion
      • during surgery
    • Check List for Treatment Planning
      • Asymmetries cant of occlusal plane
      • mandible/chin deviation
      • Occlusal relationships
      • Missing teeth/ malformed teeth
      • Genioplasty
      • Nose/lip relationship - rhinoplasty
    • Diagnostic Records
      • Analysis of pictures
      • cephalometric analysis
      • Surgical prediction - STO
      • model/occlusion analysis
    • STO-Mandible Only
    • STO-Maxilla Only
    • STO-Double Jaw
    • STO-Double Jaw
    • Preparation for Surgery
      • Removal of third molars 6 months before mandibular osteotomy
      • Check for any TMJ problems
      • Manipulate models mounted in an articulator to check for interferences and occlusion
      • Splint fabrication (1 or 2 splints)
      • Prognathic, increased lower facial height, Cl III, open bite, crowding on the upper arch.
      • Previous orthodontic treatment with extraction of lower first premolars.
      Mandibular Setback with Maxillary Advancement and Impaction for Correction of Prognathism and Open Bite
    • Mandibular Advancement for Correction of Retrognathism
      • Retrognathic, decreased lower facial height, Cl II, deep bite, protruded upper incisors, spacing.
      • Previous orthodontic treatment w/ extraction of upper first premolars.
    • Mandibular Setback for with Correction of Prognathism and Asymmetry
    • Maxillary Advancement with Le Fort III for Correction of Maxillary Deficiency
    • Maxillary Advancement with Le Fort III for Correction of Maxillary Deficiency
      • Additional Le Fort I surgical procedure will be performed after initial orthodontic treatment has been completed for correction of maxillary deficiency and open bite.
    • Post Surgical Orthodontic Treatment
      • 1 week: check occlusion, splint and appliances
      • 4-6 weeks: reinitiate orthodontic tx (after range of motion and stability are achieved)
      • remove splint
      • change to light wires and light vertical elastics
      • treatment usually completed in 4 to 12 months (average 6 months)
    • Relapse and Stability
      • Rigid fixation has improved stability
      • Stability is mostly influenced by the pattern of rotation of the mandible as it is advanced
      • Advancement of maxilla and/or mandible will stretch soft tissues promoting relapse
      • The more advancement needed, the greater the probability for relapse
    • Relapse and Stability
    • Distraction Osteogenesis
      • First described by Ilizarov for limbs
      • Distraction osteogenesis = callostasis = stretching of a bone callus
      • Gradual distraction of bones is accompanied by the soft tissues = less probability of relapse
      • Can be performed for the mandible, maxilla, calvarium, orbit, midpalatal suture and maxillary or mandibular alveolus
      • Distraction devices can be internal or external
      • Internal devices can also be resorbable
    • Distraction Osteogenesis for the Mandible
    • Distraction Osteogenesis for the Maxilla