June 6, 2002 - Orthognathic Surgical Treatment


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June 6, 2002 - Orthognathic Surgical Treatment

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