Orthognathic surgery /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Orthognathic surgery /certified fixed orthodontic courses by Indian dental academy

  1. 1. WHY ORTHOGNATHIC SURGERY? www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. WHY ORTHOGNATHIC ? SURGERY www.indiandentalacademy.com
  3. 3. www.indiandentalacademy.com
  4. 4. ORTHOGNATHIC SURGERY  Orthognathic surgery is a process in which dentofacial deformities and malocclusions are corrected with orthodontic treatment and surgical operation of facial skeleton ,sometimes combined with various soft tissue procedures. www.indiandentalacademy.com
  6. 6.  Orthognathic surgery mainly used for correction of dentofacial deformities and various malocclusions. www.indiandentalacademy.com
  7. 7.  Dentofacial deformities:Dentofacial deformities refers to deviation from normal facial proportion and dental relationship that are severe enough to be handicapping. www.indiandentalacademy.com
  8. 8.  The affected individual are handicapped in two ways: 1)compromised jaw function. 2)discrimination in social interaction because of dental and facial appearance. www.indiandentalacademy.com
  9. 9.  Various dentofacial deformities are: a)facial syndrome and congenital anomalies:a)fetal alcohol syndrome b)hemifacial microsomnia c)facial clefting syndrome d)achodroplasia e)maxillary and mandibular trauma www.indiandentalacademy.com
  10. 10.  Various malocclusions are: Anteroposterior direction: Anteroposterior discrepancy- A))classl B) classll- a)div1 b)div2 C) classlll www.indiandentalacademy.com
  11. 11. 2)vertical discrepancy: a)open bite b)deep bite 3)Transverse discrepancy: a)narrowing of jaws b)widening of jaws www.indiandentalacademy.com
  12. 12.  Various dentofacial deformities and malocclusions are associated with underlying skeletal discrepancy. www.indiandentalacademy.com
  13. 13.  Question arises: who is a candidate for surgery in addition to orthodontics? www.indiandentalacademy.com
  14. 14.  Is that surgery will be needed if there is severe skeletal or very severe dentoalveolar problem ,too severe to correct with orthodontics alone?. www.indiandentalacademy.com
  15. 15.  The answer to second question is:what makes a problem too severe for orthodontics alone?? www.indiandentalacademy.com
  16. 16.  If the jaw relationship is correct ,crowded and malaligned teeth nearly always can be corrected by orthodontic tooth movement.however there are limits to how far a tooth can be moved www.indiandentalacademy.com
  17. 17.  For this reason ,surgery to reposition the jaw often is required for successful treatment,and soft tissue surgical procedure may also be needed. Orthodontic treatment even if successful in bringing the teeth into proper relationship,may not correct the underlying skeletal problem well enough to overcome psychological handicap. www.indiandentalacademy.com
  18. 18.  If a discrepancy In the size and position of the jaw contribute to the malocclusion and it is reflected in improper facial proportion there are only 3 possible treatment: www.indiandentalacademy.com
  19. 19. 2)Orthodontic camouflage. 3)surgical repositioning of the jaws. 1)modification of growth www.indiandentalacademy.com
  20. 20.  GROWTH MODIFICATION DENTOFACIAL ORTHOPEDICS www.indiandentalacademy.com
  21. 21.  Nancy and Weaver:  Age have influence on treatment.  No absolute consensus about age limit on orthopedic therapy and orthognathic surgery.  Latest recommended age for orthopedic therapy-97% completion of skeletal growth. www.indiandentalacademy.com
  22. 22.  Female-13.5,males-15 years.  Earliest recommended age for orthognathic surgery -99% skeletal growth is complete  Female-14.9 years,male-16.5 years  In severe deformities surgery would be recommended before the age of 8 years. www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24.  Dental compensation prevents correction of skeletal discrepancy introduce an element of camouflage www.indiandentalacademy.com
  25. 25.  Mature patient correction of malocclusion orthodontic camouflage www.indiandentalacademy.com
  26. 26.  Dental camouflage mild discrepancy exist and no potential for future growth.  Repositioning of the teeth to compensate for skeletal discrepancy. www.indiandentalacademy.com
  27. 27.  Example:classll malocclusion with underdeveloped lower jaw and proclined upper incisor.  Camouflage should be abandoned when it has the potential to correct malocclusion at the expense of facial esthetics. www.indiandentalacademy.com
  28. 28.  Essence of camouflage Improve facial improve relationship dental relationship www.indiandentalacademy.com
  29. 29.  After the growth has ceased surgery is the only alternative www.indiandentalacademy.com
  30. 30.  Reverse orthodontics:Making the malocclusion worse for the orthognathic surgery. www.indiandentalacademy.com
  31. 31.  When is a problem too severe for orthodontic treatment only? www.indiandentalacademy.com
  32. 32.  Tremendous advance in the area of orthognathic surgery since 1970.  Major role of orthgnathic surgery in treating patient successfully who has aesthetically unacceptable and unstable results after orthodontic camouflage. www.indiandentalacademy.com
  33. 33.  Need for orthognathic surgery- 1)impaired mastication. 2)tempromandibular pain and dysfunction. 3)susceptibility to caries and periodontal disease. 4)psychological effect resulting from the unaesthetic appearance from the dentofacial deformities .www.indiandentalacademy.com
  34. 34.  Involvement of patient and parents is necessary in treatment plan.  Ackerman and Proffit –clinician influenced by objective findings  Patients influenced by subjective findings www.indiandentalacademy.com
  35. 35.  Soft tissue limitation –1)Pressure exerted by soft tissue lips,cheeks and tongue which are the primary determinant of stability.  2)The periodontal attachment apparatus  3)Tempromandibular and soft tissue components. www.indiandentalacademy.com
  36. 36.  4)soft tissue integument of the entire face which determines esthetics. www.indiandentalacademy.com
  37. 37.  Aesthetic guidelines given by Ackerman and proffit:  1)protraction of incisors would be more favorable in a patient with large nose or chin providing there would not be excessive deepening of mentolabial fold. www.indiandentalacademy.com
  38. 38.  2)orthodontics alone can rarely correct severe midface deficiency or mandibular prognathism because these 2 conditions are always accompanied by unaesthetic lip position and neck form. www.indiandentalacademy.com
  39. 39.  3)moderate amount of mandibular deficiency are often acceptable to patients although the orthodontist might more prominence of the lower face.  4)maxillary incisor should never retracted to the point that the inclination of the upper lip becomes negative to a true vertical line. www.indiandentalacademy.com
  40. 40.  5)short lower facial height or protrusion of the teeth may create an ill defined labiomental sulcus as a result of the necessity to strain the lips in an efforts to gain a lip seal. www.indiandentalacademy.com
  41. 41.  6)overretraction of the maxillary incisor often tilts the occlusal plane down anteriorly creating an excessive display of gingiva which is considered unesthetic .patient do not mind if only moderate amount of gingiva shows on smile. www.indiandentalacademy.com
  42. 42.  7)when the lower lip is trapped under the maxillary incisor or when the mandibular incisor have been excessively proclined the resulting lip position is unacceptable.  www.indiandentalacademy.com
  43. 43.  8)lack of a vermilion border is not desirable tooth movement that proclines the incisors would create an aesthetically fuller lip.  9)extreme bilabial protrusion is generally percieved as unacceptable regardless of the racial or ethnic group. www.indiandentalacademy.com
  44. 44.  Proffit and colleagues(1992) – guidelines For predicting successful outcome when the choise between surgery and orthodontic correction Sample size-40 patients www.indiandentalacademy.com
  45. 45.  Conclusion-surgery is likely to be needed for adolescents beyond the growth spurts with a classll malocclusion when  1)overjet greater then 10 mm  2)pogonion to nasion perpendicular is greater then 18mm www.indiandentalacademy.com
  46. 46.  3)mandibular body length less then 70 mm  4)face height is greater than 125mm. www.indiandentalacademy.com
  47. 47. www.indiandentalacademy.com
  48. 48.  Envelop of discrepancy:introduced by Proffit and Ackerman www.indiandentalacademy.com
  49. 49.  Orthognathic surgery is required for Psychological Better esthetic improved satisfaction and function jaw discrepancywww.indiandentalacademy.com
  50. 50.  Evaluation before orthognathic surgery: 1)psychological 2) soft tissue 3) jaw evaluation evaluation discrepancy evaluation www.indiandentalacademy.com
  51. 51.  Psychological evaluation: Dentofacial deformities and malocclusion Handicapping malocclusion Social discrimination Functional abnormalities www.indiandentalacademy.com
  52. 52.  Not so long ago the patient thoughts and patient perception were considered soft data ,less important than what could be physically measured during a clinical examination or analysis of diagnostic images. www.indiandentalacademy.com
  53. 53.  From 1990 changed occur and treatment plan inclined more towards patients facial esthetics.  Evaluation of patients feeling and perception has become necessary. www.indiandentalacademy.com
  54. 54.  psychological impact of dentofacial deformities reaction to effect of Facial appearance dentofacial deformities www.indiandentalacademy.com
  55. 55.  Reaction to facial appearance- baby face large eyes individual www.indiandentalacademy.com
  56. 56.  Orthognathic surgery-challenge the patients capacity to adapt.  Studies also reported 2 main reasons for which patients are seeking for treatment:1)esthetic improvement 2)functional improvement www.indiandentalacademy.com
  57. 57.  Edgerton and Knorr(1971): 1)external motivation 2)internal motivation Helm(1985)-Adult with deep bite,severe crowding,extreme overjet causes unfavorable self perception. www.indiandentalacademy.com
  58. 58.  Gerzenic (2002)-studied the psychological profile of 100 classll and classlll patients preoperatively and postoperatively.  Results-preoperatively classlll patient felt less attractive then classll patient. www.indiandentalacademy.com
  59. 59.  Attractiveness and self-confidence has increased more in classlll patients after surgery.  Esthetic improvement was the driven force behind classlll patients to seek treatment. www.indiandentalacademy.com
  60. 60.  Ceib Phillip-people with dentofacial disharmony may encounter psychological distress directly from teasing or indirectly from sociocultural percepts. -Individual with dentofacial disharmonies who are seeking treatment are experiencing a level of psychological distress that warrants intervention. www.indiandentalacademy.com
  61. 61.  Growth modification  Orthodontic camouflage  Surgical repositioning of the jaws www.indiandentalacademy.com
  62. 62.  Envelop of discrepency www.indiandentalacademy.com
  63. 63.  Psychological aspect of Dentofacial deformities www.indiandentalacademy.com
  64. 64. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com