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Prediction of maxillary repositioning in lefort 1 surgery /certified fixed orthodontic courses by Indian dental academy
 

Prediction of maxillary repositioning in lefort 1 surgery /certified fixed orthodontic courses by Indian dental academy

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    Prediction of maxillary repositioning in lefort 1 surgery /certified fixed orthodontic courses by Indian dental academy Prediction of maxillary repositioning in lefort 1 surgery /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • “PREDICTABILITY OF MAXILLARY REPOSITIONING AND THE UPPER LIP RESPONSE IN MAXILLARY LEFORT I OSTEOTOMIES.” -A CEPHALOMETRIC STUDY. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • INTRODUCTION www.indiandentalacademy.com
    • • For more than three decades, orthognathic surgery has proved to be a significant tool in correcting severe dentofacial skeletal discrepancies. • The success of surgical orthodontic therapy, is determined by factors such as function, stability and esthetics. www.indiandentalacademy.com
    • • Defining ideal esthetic results is very subjective and may be viewed differently by the clinician and the patient. • Patients who have viewed prediction outcomes prior to treatment are more likely to be satisfied with the outcome than those who did not, also patients feel grateful for being empowered and involved in planning their treatment www.indiandentalacademy.com
    • • It is important to achieve an optimal profile change which requires a correct balance of midfacial dentoskeletal structures and soft tissue contour. • It would be necessary to be able to predict, reliably and accurately, the changes in the skeletal and soft tissues, which would occur by a maxillary surgery. www.indiandentalacademy.com
    • • The final soft tissue profile of the lips is of particular importance because when asked to evaluate esthetics of life-sized lateral photographs, laymen place more emphasis on postoperative changes in the lips than on the nose or the chin. www.indiandentalacademy.com
    • • Therefore an attempt is made here to study the reliability of the predictions of hard tissues in Maxillary LeFort I Osteotomies, and assessing the changes in the upper lip related to these surgeries. www.indiandentalacademy.com
    • Aims and Objectives www.indiandentalacademy.com
    • 1. To compare the pre-surgical predictions and the actual changes in the midface dentoskeletal structure, after a Maxillary Le-Fort I osteotomy. 2. To predict the upper lip response to a Maxillary LeFort I osteotomy. www.indiandentalacademy.com
    • Materials and Method www.indiandentalacademy.com
    • • Pre-surgical and post-surgical (two months following surgery) lateral cephalograms of 11 adult patients • The age group of these patients ranged from 14 to 23 years. • Treated by a Pre-adjusted Edgewise appliance for pre-surgical decompensation. • Maxillary Le-Fort I osteotomy was carried out under the supervision of a single surgeon. www.indiandentalacademy.com
    • • 0.003 inch acetate tracing paper. • 0.3 mm lead pencil. • Geometry box (scale, protractor, set squares, eraser). • Scotch tapes. • Tracing board. • Scissors and calculator. www.indiandentalacademy.com
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    • Primary Criterions For Selection Of Patients 1.Patients who were treated by Maxillary Le-fort I advancement/impaction osteotomy with rigid fixation. 2.Patients had completed their growth phase of maximum growth. 3.No concomitant or previous nasal surgery. www.indiandentalacademy.com
    • 4. No history of oral clefting. 5. No previous trauma to the midface. 6. Presurgical and cephalograms were standardized technique. www.indiandentalacademy.com postsurgical taken by
    • HARD TISSUE VERTICAL CHANGES (Fig. 2) Na S S-Na + 7 PNS A ANS UM Is www.indiandentalacademy.com S-Na + 7 To PNS Upper Molar Point A Point Is Point ANS
    • HARD TISSUE HORIZONTAL CHANGES (Fig. 3) Na S S-Na + 7 PNS A ANS UM Is Perpendicular of S-Na + 7 To PNS Upper Molar Point A Point Is www.indiandentalacademy.com Point ANS
    • HARD TISSUE ANGULAR CHANGES (Fig. 4) Na S PNS ANS A Sella Nasion to Nasion Point A Sella Nasion to Palatal Plane www.indiandentalacademy.com
    • UPPER LIP RESPONSE (Fig. 5) ANS 10 UL UL 0 A 75 Sn SLS Pro UL Ia 50 UL 25 STO ANS-SN A-SLS Pr-LS Ia-LS Sn-STO LIPLT www.indiandentalacademy.com LS 0 UL
    • CEPHALOMETRIC PREDICTION TRACING FOR SUPERIOR REPOSITIONING OF MAXILLA AS PER FISH AND EPKER STEP – 1 STEP – 2 STEP – 3 STEP – 5 STEP www.indiandentalacademy.com – 6 STEP – 4
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    • PRE TREATMENT www.indiandentalacademy.com
    • PRE SURGICAL www.indiandentalacademy.com
    • MAXILLARY LE-FORT I PROCEDURE Le-Fort I Osteotomy Cuts Plated Maxillary Segment Incision Sutured With Splint in Place www.indiandentalacademy.com
    • POST TREATMENT www.indiandentalacademy.com
    • RESULTS www.indiandentalacademy.com
    • RELIABILITY OF PREDICTION • This part of the study comprised of two angular, five vertical and five horizontal measurements. • For these measurements “Wilcoxons signed rank test” was done and the P value was determined to find if the prediction was significantly accurate. www.indiandentalacademy.com
    • Graph 2 Sn +7 TO PALATAL PLANE ANGLE (Degrees) 3.5 3.5 Graph 1 82 ANGLE SNA (Degrees) 81.3 81.2 81 2.5 Pre Surgical Predicted 80 2 79 78 2.7 3 1.6 Post Treatment 1.5 Post Treatment 77.6 1 77 0.5 76 0 Pre Surgical Predicted Post Treatment 75 Pre Surgical Predicted Post Treatment Graph 2 Sn +7 TO PALATAL PLANE ANGLE (Degrees) 3.5 3.5 Parameters 2.7 3 2.5 2 1.6 SNA 1.5 1 0.5 Sn+7 to Palatal Plane 0 Pre Surgical Predicted P Significance 0.82 NS 0.11 NS Pre Surgical Predicted Post Treatment Post Treatment www.indiandentalacademy.com Pre Surgical Predicted
    • Graph 4 Graph 3 70 POINT A HORIZONTAL (mm) 69.9 69.4 72.5 72 Pre Surgical Predicted 71.5 69 Pre Surgical Predicted 68 71 70.5 67 66 POINT ANS HORIZONTAL (mm) 72.2 72.1 70 65.7 Post Treatment Post Treatment 69.5 69.5 69 65 68.5 64 68 Pre Surgical Predicted Post Treatment 63 Pre Surgical Predicted Post Treatment Graph 4 72.5 POINT ANS HORIZONTAL (mm) 72.2 72.1 72 71.5 Parameters 71 70.5 70 69.5 69.5 Point A ANS 69 Pre Surgical Predicted P Significance Post Treatment 0.21 NS 0.86 NS 68.5 68 Pre Surgical Predicted Post Treatment www.indiandentalacademy.com
    • Graph 6 Graph 5 20 POINT PNS HORIZONTAL (mm) 19.9 19.7 19.5 UPPER INCISOR HORIZONTAL (mm) 73.2 72.9 73 Pre Surgical Predicted 19 18.5 74 Pre Surgical Predicted 72 71 Post Treatment 69.7 70 Post Treatment 69 18 18 68 17.5 67 Pre Surgical Predicted Post Treatment 17 Pre Surgical Predicted Post Treatment Graph 6 74 UPPER INCISOR HORIZONTAL (mm) 73.2 72.9 73 72 70 69 68 Significance NS 0.41 NS Post Treatment 69.7 PNS UPPER INCISOR 67 Pre Surgical P 0.77 Parameters 71 Pre Surgical Predicted Predicted Post Treatment www.indiandentalacademy.com
    • Graph 7 UPPER FIRST MOLAR HORIZONTAL (mm) 48 47.4 46.4 47 Pre Surgical Predicted 46 45 43.1 44 Post Treatment 43 42 41 40 Pre Surgical Predicted Post Treatment Parameters P Significance UPPER 1ST MOLAR 0.25 NS www.indiandentalacademy.com
    • Graph 9 Graph 8 50 POINT A VERTICAL (mm) 49.5 45.5 POINT ANS VERTICAL (mm) 45.2 45 Pre Surgical Predicted 44.5 49 Pre Surgical Predicted 48 46.3 47 45.8 Post Treatment 46 44 43.5 42.9 43 Post Treatment 42.1 42.5 42 41.5 45 41 44 40.5 Pre Surgical Predicted Post Treatment 43 Pre Surgical Predicted Post Treatment Graph 9 45.5 POINT ANS VERTICAL (mm) 45.2 45 44.5 44 42.5 42.9 Point A 42.1 42 41.5 ANS P Significance 0.09 NS 0.04 Parameters 43.5 43 Pre Surgical Predicted S Post Treatment 41 40.5 Pre Surgical Predicted Post Treatment www.indiandentalacademy.com
    • Graph 11 Graph 10 42.5 POINT PNS VERTICAL (mm) 42.2 76 UPPER INCISOR VERTICAL (mm) 75.3 75 Pre Surgical Predicted 42 Pre Surgical Predicted 41.5 41 40.1 40.5 73 72 Post Treatment 39.5 40 74 71.3 71.2 71 39.5 70 39 69 38.5 Pre Surgical Predicted Post Treatment 38 Pre Surgical Predicted Post Treatment Graph 11 76 75 UPPER INCISOR VERTICAL (mm) 75.3 Parameters Pre Surgical Predicted 74 73 PNS 72 71 71.2 71.3 UPPER INCISOR Post Treatment P Significance 0.1 NS 1 NS 70 69 Pre Surgical Predicted Post Treatmentwww.indiandentalacademy.com Post Treatment
    • Graph 12 69 UPPER FIRST MOLAR VERTICAL (mm) 68.5 68 67 66.2 Pre Surgical Predicted 66 64.7 65 Post Treatment 64 63 62 Pre Surgical Predicted Post Treatment P Parameters UPPER 1ST MOLAR Significance 0.003 S www.indiandentalacademy.com
    • UPPER LIP RESPONSE • The change in the upper lip morphology was correlated using the soft tissue measurements of pre and post surgical tracings. • Pearson’s correlation coefficient was calculated to assess the nature and degree of the relation. Linear regression analysis was then carried out to predict the changes in the soft tissue measurements for the changes carried out in the hard tissue measurements. www.indiandentalacademy.com
    • • There were a total of twelve correlations of the thickness of the lip to the various hard tissue measurements and six correlations of the length of the lip to the various hard tissue measurements. www.indiandentalacademy.com
    • Y Pt. A Predicted Y LIP THICKNESS CHANGE Graph 14 Graph 13 PREDICTION OF A-SLS FROM POINT A PREDICTION OF ANS-Sn FROM POINT A 8.0 12 10 6.0 8 6 4.0 A-SLS 2 0 0 1 2 3 4 5 6 7 8 9 2.0 0.0 -2 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 -2.0 -4 -6 -4.0 -8 -10 -6.0 Y Pt. A Y Pt. A Predicted Y Predicted Y Graph 14 PREDICTION OF A-SLS FROM POINT A Ratio Parameters 8.0 Change Pearson correlation Coefficient (r-value) Regression Coefficient -0.55 -0.92 6.0 Point A 4.0 A-SLS ANS-Sn 4 2.0 2.3:1 ANS-Sn 0.0 0.0 -2.0 -4.0 1.0 2.0 Point3.0 A A-SLS 4.0 5.0 6.0 7.0 8.0 9.0 www.indiandentalacademy.com 02:01 -0.48 -0.06
    • Graph 15 PREDICTION OF Ia-Ls FROM POINT A 4.0 3.0 2.0 1.0 La- Ls 0.0 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 -1.0 -2.0 -3.0 -4.0 -5.0 Y -6.0 Parameters Point A Pro-LS Predicted Y Pt.A Ratio Change Pearson correlation Coefficient (r-value) Regression Coefficient 3.6:1 -0.04 NS www.indiandentalacademy.com
    • Graph 16 Graph 17 PREDICTION OF ANS-Sn FROM POINT ANS PREDICTION OF A-SLS FROM POINT ANS 12.0 8.0 10.0 8.0 6.0 6.0 4.0 2.0 0.0 -4.0 -2.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 -2.0 -4.0 -4.0 2.0 A-SLS ANS-Sn 4.0 0.0 -2.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 -2.0 -6.0 -4.0 -8.0 -10.0 ANS Y -6.0 Y Predicted Y ANS Predicted Y Linear (Predicted Y) Graph 17 Ratio PREDICTION OF A-SLS FROM POINT ANS Parameters Change Pearson correlation Coefficient (r-value) Regression Coefficient -0.64 -0.53 -0.59 -0.36 8.0 ANS 6.0 4.0 ANS-Sn 2.0 A-SLS -4.0 1.6:1 ANS 0.0 -2.0 0.0 -2.0 2.0 4.0 6.0 A-SLS 1.4:1 8.0 10.0 12.0 14.0 -4.0 Y www.indiandentalacademy.com -6.0 ANS Predicted Y Linear (Predicted Y)
    • Graph 18 Graph 19 PREDICTION OF Pro-SLS FROM POINT ANS PREDICTION OF Ia-LS FROM POINT ANS 8.0 7.0 4.0 6.0 3.0 5.0 2.0 3.0 Pro-SLS 4.0 1.0 2.0 0.0 La-LS 1.0 0.0 -4.0 -2.0 -1.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 -4.0 -2.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 -1.0 14.0 -2.0 -2.0 -3.0 -3.0 -4.0 ANS -5.0 Y Y -6.0 Predicted Y Predicted Y ANS Graph 19 PREDICTION OF Ia-LS FROMRatio ANS POINT Parameters Change Regression Coefficient 0.01 NS 0.36 4.0 Pearson correlation Coefficient (r-value) 0.19 3.0 ANS 2.0 1.0 Pro-LS La-LS 0.0 -4.0 -2.0 0.0 -1.0 2.6:1 2.0 4.0 6.0 ANS 10.0 12.0 14.0 4.3:1(-) -2.0 -3.0 8.0 Ia-Ls -4.0 www.indiandentalacademy.com -5.0 Y -6.0 ANS Predicted Y
    • Graph 21 PREDICTION OF A-SLS FROM POINT UI Graph 20 PREDICTION OF ANS-Sn FROM POINT UI 8.00 12.0 6.00 10.0 8.0 4.00 6.0 A-SLS ANS-Sn 4.0 2.0 0.0 -2.0 0.0 2.0 4.0 6.0 8.0 10.0 -2.0 -2.00 2.00 0.00 0.00 2.00 4.00 6.00 8.00 10.00 -2.00 -4.0 -6.0 -4.00 -8.0 Y Y -10.0 Predicted Y UI -6.00 UI Predicted Y Graph 21 PREDICTION OF A-SLS FROM POINT UI Ratio Parameters Change Regression Coefficient 0.03 NS 0.17 8.00 Pearson correlation Coefficient (r-value) 0.23 6.00 A-SLS 4.00 -2.00 2.00 0.00 0.00 -2.00 -4.00 -6.00 UPPER INCISOR 2.2:1 ANS-Sn UPPER INCISOR 2.00 4.00 6.00 8.00 10.00 1.9:1 www.indiandentalacademy.com A-SLS Y UI Predicted Y
    • Graph 23 Graph 22 PREDICTION OF Ia-LS FROM POINT UI PREDICTION OF Pro-LS FROM POINT UI 8.00 4.00 7.00 3.00 6.00 2.00 5.00 1.00 La-LS Pro-LS 4.00 3.00 2.00 -2.00 0.00 0.00 -1.00 2.00 4.00 6.00 8.00 -2.00 1.00 -3.00 -2.00 0.00 0.00 -1.00 2.00 4.00 6.00 8.00 -4.00 10.00 -5.00 -2.00 -6.00 -3.00 UI Y UI Y Predic Predicted Y Graph 23 PREDICTION OF Ia-LS FROM POINT UI Ratio Parameters Change Pearson correlation Coefficient (r-value) Regression Coefficient 0.16 0.18 0.15 0.18 4.00 3.00 2.00 La-LS 1.00 -2.00 0.00 0.00 -1.00 UPPER INCISOR Pro-LS 2.00 3.5:1 4.00 6.00 8.00 10.00 -2.00 -3.00 -4.00 UPPER INCISOR 5.7:1 (-) -5.00 -6.00 Ia-Ls www.indiandentalacademy.com Y UI Predicted Y
    • PT.A Y Predicted Y LIP LENGTH CHANGE Graph 24 Graph 25 PREDICTION OF Sn-STO FROM POINT A PREDICTION OF LIPLT FROM POINT A 3.5 4.0 3.0 3.0 2.5 2.0 2.0 1.0 LIPLT SN-STO 1.5 1.0 0.5 0.0 -10.0 -8.0 -6.0 -4.0 -2.0 0.0 -10.0 -8.0 -6.0 -4.0 -2.0 0.0 2.0 -1.0 0.0 2.0 4.0 4.0 -0.5 -2.0 -1.0 -3.0 -1.5 PT.A PT.A Y Predicted Y Y Predicted Y Graph 25 PREDICTION OF LIPLT FROM POINT A Ratio Parameters Change Pearson correlation Coefficient (r-value) Regression Coefficient 0.21 -0.1 4.0 Point A 3.0 (-)2.9:1 2.0 LIPLT Sn-STO -10.0 -8.0 -6.0 -4.0 Point A LIPLT 1.0 0.0 -2.0 0.0 2.0 4.0 -1.0 (-)4.6:1 0.24 www.indiandentalacademy.com -2.0 -3.0 0.11
    • Graph 27 Graph 26 PREDICTION OF LIPLT FROM POINT ANS PREDICTION OF Sn-STO FROM POINT ANS 3.5 3.0 4.0 2.5 3.0 2.0 2.0 Sn-STO 1.5 1.0 1.0 LIPLT 0.5 0.0 0.0 -10.0 -8.0 -6.0 -4.0 -2.0 -0.5 0.0 2.0 4.0 6.0 -8.0 8.0 -6.0 -4.0 -2.0 0.0 2.0 4.0 6.0 8.0 -1.0 -1.0 -2.0 -1.5 ANS -3.0 ANS Y Y Predicted Y Predicted Y Graph 27 PREDICTION OF LIPLT FROM Ratio ANS POINT Parameters Change Pearson correlation Coefficient (r-value) Regression Coefficient -0.14 -0.05 0.19 0.07 4.0 ANS 3.0 (-)2.1:1 2.0 Sn-STO LIPLT 1.0 -8.0 -6.0 -4.0 ANS 0.0 -2.0 0.0 -1.0 LILPT 2.0 (-)3.3:1 4.0 6.0 8.0 -2.0 -3.0 ANS Y www.indiandentalacademy.com Predicted Y
    • Graph 28 Graph 29 PREDICTION OF Sn-STO FROM POINT UI PREDICTION OF LIPLT FROM POINT UI 4.00 3.00 3.5 3.0 2.00 2.5 2.0 1.00 LIPLT Sn-STO 1.5 1.0 -14.00 0.5 -12.00 -10.00 -8.00 -6.00 -4.00 -12.0 -10.0 -8.0 -6.0 -4.0 -2.0 -0.5 0.00 0.00 2.00 0.0 2.0 4.0 -2.00 -1.5 Y Predicted Y UI -3.00 UI Graph 29 PREDICTION OF LIPLT FROM POINT UI Ratio Parameters Change Pearson correlation Coefficient (r-value) Regression Coefficient 0.11 4.00 NS 0.01 NS 3.00 LIPLT -14.00 -12.00 Sn-STO -10.00 -8.00 -6.00 2.00 (-)3.5:1 1.00 -4.00 -2.00 0.00 0.00 -2.00 (-)5.6:1 -3.00 LILPT 2.00 4.00 6.00 -1.00 UPPER INCISOR UI 6.00 6.0 -1.0 UPPER INCISOR 4.00 -1.00 0.0 -14.0 -2.00 Y www.indiandentalacademy.com Predicted Y Y Predicted Y
    • DISCUSSION www.indiandentalacademy.com
    • • Cephalometric radiographs, photographic analysis, and mounted casts are routinely used for diagnosis and treatment planning of maxillary surgeries. In these, prediction tracings are mainly based on the functional and esthetic requirements of the patient www.indiandentalacademy.com
    • • The predictability of maxillary surgery is influenced by the ability of the surgeon to accurately place the maxilla, the stability of the maxilla in its new location, and the variability of the soft tissue response. www.indiandentalacademy.com
    • • It was found that most of the hard tissue points showed a good correlation with the final outcome, in both the horizontal and vertical position. • Jacobson and Sarver, Bryan and Hunt as well as Mankad et al. also showed a good correlation with various predicted and post treatment results. www.indiandentalacademy.com
    • • In this study it was found out that the lip thickness decreased at the base of the nose and at the soft tissue point A, however at the vermillion border of the upper lip the thickness actually increased. www.indiandentalacademy.com
    • • Lines and Steinhauser reasoned that the soft tissue in the maxilla was prevented from following the hard tissue in a one-to-one manner, as in the mandible, because of the fact that it was firmly connected to the base of the nose. www.indiandentalacademy.com
    • • In this study the length of the upper lip was divided into two parts one being Sn-STO which was seen to be increasing with the superior repositioning of the maxilla. The other being LIPLT which tells us of the curvature which was seen to be decreasing showing that the upper lip became straighter. www.indiandentalacademy.com
    • Summary and Conclusion www.indiandentalacademy.com
    • 1. The hard tissue prediction done using the method devised by Fish and Epker was found to be reliable. 2. The upper lip thickness (ANS-Sn) decreased at the base of the nose after a Lefort I osteotomy. 3. The vermillion border of upper lip (Pro-Ls, Ia-Ls) becomes thicker after a lefort I osteotomy. www.indiandentalacademy.com
    • 4. On doing a lefort I osteotomy the upper lip length (Sn-STO) increases. 5. Lefort I osteotomy decreases the mid lip length (LIPLT) because of straightening of the lip. www.indiandentalacademy.com
    • THANK YOU www.indiandentalacademy.com