This case report describes the expedited correction of significant dentofacial asymmetry in a 20-year-old female using a "surgery first" approach. The patient presented with mandibular asymmetry and a Class III malocclusion. Treatment involved asymmetrical mandibular setbacks of 7mm on the left and 3mm on the right combined with a sliding genioplasty. Miniplates were placed for anchorage. Postsurgical orthodontics used the miniplates to distalize the maxillary arch and align the teeth. Treatment time was reduced to 7 months by eliminating presurgical orthodontics and taking advantage of accelerated bone turnover after surgery. The results showed good esthetic and occlusal correction of
This document provides an overview of the surgery-first orthognathic (SFOA) approach. Some key points:
- SFOA involves performing jaw surgery prior to orthodontic treatment to correct malocclusions. This is a paradigm shift from the traditional "orthodontics-first" approach.
- Diagnosis and treatment planning for SFOA relies heavily on 3D imaging and modeling to visualize the planned post-surgery occlusion. Mock surgeries may also be performed.
- Biological principles like regional acceleratory phenomenon can accelerate orthodontic tooth movement and bone healing after surgery.
- Indications for SFOA include minimal crowding, favorable tooth alignment, and normal
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
1) Oral skeletal discrepancies are common in Vietnam and the surgery-first approach has become favored over traditional orthodontics-first treatment.
2) Malocclusions are typically caused by incisor or jaw protrusion and the treatment approach depends on the specific discrepancy - orthodontics for incisors or orthognathic surgery for jaws.
3) Over 1000 orthognathic surgery cases have been performed at JW Korea Hospital using techniques like anterior segmental osteotomies, Le fort I, and BSSO to correct skeletal issues prior to orthodontic treatment.
This document discusses the Sendai surgery-first (SF) protocol for treating orthognathic cases. It begins by outlining the 15 steps of the Sendai SF protocol, focusing on the first 4 major steps: 1) Diagnosis and establishing treatment goals, 2) Model surgery to simulate surgical movements, 3) Surgery to reposition the jaws, and 4) Immediate postsurgical orthodontics using temporary anchorage devices. It then provides a detailed example of a 37-year-old female patient treated with the Sendai SF protocol, including her initial presentation, cephalometric analysis, treatment goals of mandibular setback and decompensation, model surgery simulation, and surgical splint fabrication.
This document discusses various treatment approaches for idiopathic condylar resorption (ICR), including:
1) Orthodontic treatment is contraindicated during active ICR due to risk of accelerating resorption or litigation.
2) Surgical options like orthognathic surgery place demands on compromised TMJs that may lead to relapse.
3) Combining pre- and post-operative medical management with anti-inflammatory drugs and supplements with orthognathic surgery may help control resorption.
4) Total alloplastic TMJ replacement avoids relying on compromised TMJ tissues, providing an option when other treatments aren't viable.
This document discusses orthognathic surgery decision making, treatment planning, and timing of surgery. It covers collecting patient data, diagnosing issues, cephalometric analysis, developing a treatment plan, and predicting soft tissue changes. Treatment options include orthodontics, dentofacial orthopedics, and orthognathic surgery to correct jaw and facial skeletal issues.
This document provides an overview of major surgical procedures, including orthognathic surgeries. It defines orthognathic surgery as combining orthodontics and oral surgery to correct dentofacial deformities. The key steps are described as diagnosis, presurgical orthodontics, surgical treatment planning, mock surgery, the surgery and stabilization, and postsurgical orthodontics. Various surgical methods are outlined for maxillary osteotomies including LeFort I, II, and III, and for mandibular procedures including sagittal split osteotomy and genioplasty. Distraction osteogenesis is also summarized as a technique for gradual bone expansion.
This document provides an overview of the surgery-first orthognathic (SFOA) approach. Some key points:
- SFOA involves performing jaw surgery prior to orthodontic treatment to correct malocclusions. This is a paradigm shift from the traditional "orthodontics-first" approach.
- Diagnosis and treatment planning for SFOA relies heavily on 3D imaging and modeling to visualize the planned post-surgery occlusion. Mock surgeries may also be performed.
- Biological principles like regional acceleratory phenomenon can accelerate orthodontic tooth movement and bone healing after surgery.
- Indications for SFOA include minimal crowding, favorable tooth alignment, and normal
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
1) Oral skeletal discrepancies are common in Vietnam and the surgery-first approach has become favored over traditional orthodontics-first treatment.
2) Malocclusions are typically caused by incisor or jaw protrusion and the treatment approach depends on the specific discrepancy - orthodontics for incisors or orthognathic surgery for jaws.
3) Over 1000 orthognathic surgery cases have been performed at JW Korea Hospital using techniques like anterior segmental osteotomies, Le fort I, and BSSO to correct skeletal issues prior to orthodontic treatment.
This document discusses the Sendai surgery-first (SF) protocol for treating orthognathic cases. It begins by outlining the 15 steps of the Sendai SF protocol, focusing on the first 4 major steps: 1) Diagnosis and establishing treatment goals, 2) Model surgery to simulate surgical movements, 3) Surgery to reposition the jaws, and 4) Immediate postsurgical orthodontics using temporary anchorage devices. It then provides a detailed example of a 37-year-old female patient treated with the Sendai SF protocol, including her initial presentation, cephalometric analysis, treatment goals of mandibular setback and decompensation, model surgery simulation, and surgical splint fabrication.
This document discusses various treatment approaches for idiopathic condylar resorption (ICR), including:
1) Orthodontic treatment is contraindicated during active ICR due to risk of accelerating resorption or litigation.
2) Surgical options like orthognathic surgery place demands on compromised TMJs that may lead to relapse.
3) Combining pre- and post-operative medical management with anti-inflammatory drugs and supplements with orthognathic surgery may help control resorption.
4) Total alloplastic TMJ replacement avoids relying on compromised TMJ tissues, providing an option when other treatments aren't viable.
This document discusses orthognathic surgery decision making, treatment planning, and timing of surgery. It covers collecting patient data, diagnosing issues, cephalometric analysis, developing a treatment plan, and predicting soft tissue changes. Treatment options include orthodontics, dentofacial orthopedics, and orthognathic surgery to correct jaw and facial skeletal issues.
This document provides an overview of major surgical procedures, including orthognathic surgeries. It defines orthognathic surgery as combining orthodontics and oral surgery to correct dentofacial deformities. The key steps are described as diagnosis, presurgical orthodontics, surgical treatment planning, mock surgery, the surgery and stabilization, and postsurgical orthodontics. Various surgical methods are outlined for maxillary osteotomies including LeFort I, II, and III, and for mandibular procedures including sagittal split osteotomy and genioplasty. Distraction osteogenesis is also summarized as a technique for gradual bone expansion.
This document provides an overview of maxillary and midface osteotomies. It begins with an introduction discussing the history and goals of orthognathic surgery. It then covers various osteotomy techniques including single tooth, anterior maxillary, posterior maxillary, Lefort I, II, and III osteotomies. For each technique, it discusses the relevant history, indications, surgical approach, complications, and advances. It emphasizes the Lefort I osteotomy as the mainstay procedure, covering its evolution, blood supply considerations, rigid fixation approaches, and indications. In summary, the document comprehensively reviews different maxillary osteotomy techniques for orthognathic surgery.
Description :
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.for more details please visit
www.indiandentalacademy.com
This document discusses orthodontics and orthognathic surgery. It describes the typical treatment steps which involve orthodontic decompensation by an orthodontist, analytic model planning, the surgical operation by a maxillofacial surgeon, and case finishing by an orthodontist. Malocclusions associated with significant skeletal discrepancies often require a combination of orthodontics and jaw surgery for correction. Common facial deformities involve anteroposterior disproportion, vertical disproportion, transverse anomalies, and asymmetries. Orthodontic surgery can involve maxillary and mandibular movements to reposition the jaws. Assessment of patients for combined treatment involves comprehensive records and treatment planning.
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
This study aimed to assess changes in the maxillary sinuses (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). 48 patients underwent either maxillary advancement with mandibular setback (Group 1) or maxillomandibular advancement (Group 2). CBCT scans were taken pre-operatively and 6-8 months post-operatively. The results showed a statistically significant reduction in most MS measurements post-operatively. Meanwhile, there was a significant increase in minimum axial area and total volume of the PAS. The study concludes that bimaxillary orthognathic surgery can significantly change dimensions of the MS and PAS
Surgical orthodontics, also known as orthognathic surgery, aims to correct dentofacial deformities through a combination of orthodontic treatment and corrective jaw surgery. It seeks to improve both facial and dental aesthetics as well as create a functional bite. Key developments over time have improved surgical outcomes and patient comfort. Common indications for orthognathic surgery include severe class II or III malocclusions, facial asymmetries, and craniofacial anomalies. Careful examination, investigations, planning and multidisciplinary treatment are required to achieve optimal results.
This document discusses major surgical procedures for correcting orofacial abnormalities, including orthognathic surgeries to correct jaw discrepancies. The key steps in orthognathic surgery are outlined, beginning with clinical diagnosis and evaluation to determine the nature and severity of skeletal problems. This is followed by presurgical orthodontics to position teeth in preparation for surgery. A surgical treatment objective is then developed using prediction tracings to plan the procedure and simulate it on models. The actual surgery is then performed followed by postoperative orthodontics and retention.
In order to solve the serious problems of traditional surgical
orthodontic treatment, a new approach was adopted:
the first step is OGS, and this is followed by orthodontic alignment. This approach is named as Surgery First Orthognathic Approach (SFOA)
Orthognathic surgery new microsoft power point presentationmemoalawad
Orthognathic surgery involves correcting dentofacial deformities through surgical procedures on the jaws and chin. It requires a combined surgical and orthodontic approach to achieve optimal results. Surgery is indicated for severe malocclusions that cannot be treated through orthodontics or growth modification alone. The decision to pursue surgery or camouflage treatment must be made before starting treatment, as the orthodontics differ significantly between the two approaches. Computer simulation can help patients understand treatment options and decide between camouflage and surgery.
Role of ortho in surgery /certified fixed orthodontic courses by Indian denta...Indian dental academy
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
0091-9248678078
Distraction osteogenesis versus bsso for advancement of the retrognathic mand...Indian dental academy
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.
Orthognathic surgery involves correcting musculoskeletal, dento-osseous, and soft tissue deformities of the jaws and associated structures through a combination of orthodontics and oral and maxillofacial surgery. It is best performed after growth is complete to avoid potential need for resurgery. There are several classifications of orthognathic surgeries including maxillary, mandibular, and combined surgeries. Maxillary surgeries involve osteotomies of different segments of the maxilla like the anterior segment or total maxilla. Mandibular surgeries involve osteotomies like ramus, body, or genioplasty osteotomies.
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
Growth modification of different types of malocclusionbilal falahi
This document discusses different types of growth modification appliances used to treat malocclusions. It begins by explaining that growth modification uses remaining growth potential to alter jaw size and positioning. Key appliances discussed include the Andresen activator, twin block, and various types of headgear. Factors like timing of treatment, force magnitude, and duration of force application are reviewed. Both passive and active functional appliances are indicated, with considerations for skeletal, dental, and vertical discrepancies.
This document outlines the process for assessing and treating patients undergoing orthognathic or jaw surgery. It discusses the initial patient assessment, examination and diagnostic procedures. Treatment planning involves an interdisciplinary team approach, with options including orthodontics only, surgery only or combined orthodontic and surgical treatment. Key steps in the treatment and surgical process are described, along with potential complications and factors that can contribute to poor outcomes.
Surgical orthodontics ii /certified fixed orthodontic courses by Indian den...Indian dental academy
This document discusses surgical procedures for correcting various maxillary deficiencies. It describes LeFort I, II, and III osteotomies for advancing or repositioning the maxilla. Specific deficiencies discussed in detail include maxillary anteroposterior deficiency, excess, vertical deficiency, and combinations thereof. For each, the document outlines characteristic facial and dental features, differential diagnosis, presurgical orthodontics, surgical technique including grafting and fixation considerations, and postsurgical orthodontic treatment. Risk factors for relapse after LeFort I advancement are also examined based on a retrospective study. The document provides an in-depth overview of surgical orthodontic treatment approaches for correcting various maxillary skeletal discrepancies.
PROSTHODONTIC MANAGEMENT OF MAXILLECTOMY/ OBTURATORS PART 2NAMITHA ANAND
This document discusses the rehabilitation of maxillectomy defects through implant-retained prostheses. It describes how implants can be placed in residual bone such as the anterior maxilla, tuberosity, zygomatic arches and pterygoid plates to aid in retaining prostheses. Placement in the anterior maxilla often leads to bone loss due to excessive forces while placement in the tuberosity has higher failure rates. Tissue bar attachments are recommended to distribute forces along the implant axes. The document outlines the surgical and prosthodontic procedures for fabricating implant-retained obturator prostheses.
Orthognathic surgery involves correcting jaw deformities through combining orthodontics and maxillofacial surgery. It is primarily used in adults once growth has ceased to treat conditions too severe for orthodontics alone, such as malocclusions, airway issues, pain, or poor aesthetics. Planning involves clinical exams, models, virtual surgical planning, and splint fabrication to simulate and guide the surgery, which may include Le Fort osteotomies of the maxilla, sagittal split or vertical ramus osteotomies of the mandible, and genioplasty. Risks include nerve damage, bleeding, infection, and relapse, so patients must be informed and compliant.
Cephalometric& model mock surgery for orthodontic surgical planingIndian dental academy
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.for more details please visit
www.indiandentalacademy.com
ORTHODONTIC CORRECTION OF OCCLUSAL PLANE CANTING MaherFouda1
This document summarizes the orthodontic treatment of a 22-year-old patient with a canted occlusal plane, facial asymmetry, and mandibular prognathism. Miniscrews were implanted to intrude extruded teeth and correct the cant. After decompensation with elastics, the patient underwent bilateral sagittal split ramus osteotomy and genioplasty. Post-treatment, the patient's occlusion, facial asymmetry, and cant were significantly improved, though a two-jaw approach may have achieved better results. Miniscrews were effective for intrusion but require careful placement between roots to avoid complications.
This document describes a case study of using titanium screw anchorage to successfully treat a 31-year-old female patient with a severe anterior open bite of 7 mm. Mini screws were implanted in the maxilla and mandible to provide anchorage for intruding the upper and lower first molars by 3 mm each over 19 months of active treatment. This led to a counterclockwise rotation of the mandible which corrected the open bite and improved her retrognathic facial profile. The results suggest titanium screws are useful for intruding molars and treating anterior open bites in adult patients.
This document provides an overview of maxillary and midface osteotomies. It begins with an introduction discussing the history and goals of orthognathic surgery. It then covers various osteotomy techniques including single tooth, anterior maxillary, posterior maxillary, Lefort I, II, and III osteotomies. For each technique, it discusses the relevant history, indications, surgical approach, complications, and advances. It emphasizes the Lefort I osteotomy as the mainstay procedure, covering its evolution, blood supply considerations, rigid fixation approaches, and indications. In summary, the document comprehensively reviews different maxillary osteotomy techniques for orthognathic surgery.
Description :
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.for more details please visit
www.indiandentalacademy.com
This document discusses orthodontics and orthognathic surgery. It describes the typical treatment steps which involve orthodontic decompensation by an orthodontist, analytic model planning, the surgical operation by a maxillofacial surgeon, and case finishing by an orthodontist. Malocclusions associated with significant skeletal discrepancies often require a combination of orthodontics and jaw surgery for correction. Common facial deformities involve anteroposterior disproportion, vertical disproportion, transverse anomalies, and asymmetries. Orthodontic surgery can involve maxillary and mandibular movements to reposition the jaws. Assessment of patients for combined treatment involves comprehensive records and treatment planning.
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
This study aimed to assess changes in the maxillary sinuses (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). 48 patients underwent either maxillary advancement with mandibular setback (Group 1) or maxillomandibular advancement (Group 2). CBCT scans were taken pre-operatively and 6-8 months post-operatively. The results showed a statistically significant reduction in most MS measurements post-operatively. Meanwhile, there was a significant increase in minimum axial area and total volume of the PAS. The study concludes that bimaxillary orthognathic surgery can significantly change dimensions of the MS and PAS
Surgical orthodontics, also known as orthognathic surgery, aims to correct dentofacial deformities through a combination of orthodontic treatment and corrective jaw surgery. It seeks to improve both facial and dental aesthetics as well as create a functional bite. Key developments over time have improved surgical outcomes and patient comfort. Common indications for orthognathic surgery include severe class II or III malocclusions, facial asymmetries, and craniofacial anomalies. Careful examination, investigations, planning and multidisciplinary treatment are required to achieve optimal results.
This document discusses major surgical procedures for correcting orofacial abnormalities, including orthognathic surgeries to correct jaw discrepancies. The key steps in orthognathic surgery are outlined, beginning with clinical diagnosis and evaluation to determine the nature and severity of skeletal problems. This is followed by presurgical orthodontics to position teeth in preparation for surgery. A surgical treatment objective is then developed using prediction tracings to plan the procedure and simulate it on models. The actual surgery is then performed followed by postoperative orthodontics and retention.
In order to solve the serious problems of traditional surgical
orthodontic treatment, a new approach was adopted:
the first step is OGS, and this is followed by orthodontic alignment. This approach is named as Surgery First Orthognathic Approach (SFOA)
Orthognathic surgery new microsoft power point presentationmemoalawad
Orthognathic surgery involves correcting dentofacial deformities through surgical procedures on the jaws and chin. It requires a combined surgical and orthodontic approach to achieve optimal results. Surgery is indicated for severe malocclusions that cannot be treated through orthodontics or growth modification alone. The decision to pursue surgery or camouflage treatment must be made before starting treatment, as the orthodontics differ significantly between the two approaches. Computer simulation can help patients understand treatment options and decide between camouflage and surgery.
Role of ortho in surgery /certified fixed orthodontic courses by Indian denta...Indian dental academy
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
0091-9248678078
Distraction osteogenesis versus bsso for advancement of the retrognathic mand...Indian dental academy
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.
Orthognathic surgery involves correcting musculoskeletal, dento-osseous, and soft tissue deformities of the jaws and associated structures through a combination of orthodontics and oral and maxillofacial surgery. It is best performed after growth is complete to avoid potential need for resurgery. There are several classifications of orthognathic surgeries including maxillary, mandibular, and combined surgeries. Maxillary surgeries involve osteotomies of different segments of the maxilla like the anterior segment or total maxilla. Mandibular surgeries involve osteotomies like ramus, body, or genioplasty osteotomies.
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
Growth modification of different types of malocclusionbilal falahi
This document discusses different types of growth modification appliances used to treat malocclusions. It begins by explaining that growth modification uses remaining growth potential to alter jaw size and positioning. Key appliances discussed include the Andresen activator, twin block, and various types of headgear. Factors like timing of treatment, force magnitude, and duration of force application are reviewed. Both passive and active functional appliances are indicated, with considerations for skeletal, dental, and vertical discrepancies.
This document outlines the process for assessing and treating patients undergoing orthognathic or jaw surgery. It discusses the initial patient assessment, examination and diagnostic procedures. Treatment planning involves an interdisciplinary team approach, with options including orthodontics only, surgery only or combined orthodontic and surgical treatment. Key steps in the treatment and surgical process are described, along with potential complications and factors that can contribute to poor outcomes.
Surgical orthodontics ii /certified fixed orthodontic courses by Indian den...Indian dental academy
This document discusses surgical procedures for correcting various maxillary deficiencies. It describes LeFort I, II, and III osteotomies for advancing or repositioning the maxilla. Specific deficiencies discussed in detail include maxillary anteroposterior deficiency, excess, vertical deficiency, and combinations thereof. For each, the document outlines characteristic facial and dental features, differential diagnosis, presurgical orthodontics, surgical technique including grafting and fixation considerations, and postsurgical orthodontic treatment. Risk factors for relapse after LeFort I advancement are also examined based on a retrospective study. The document provides an in-depth overview of surgical orthodontic treatment approaches for correcting various maxillary skeletal discrepancies.
PROSTHODONTIC MANAGEMENT OF MAXILLECTOMY/ OBTURATORS PART 2NAMITHA ANAND
This document discusses the rehabilitation of maxillectomy defects through implant-retained prostheses. It describes how implants can be placed in residual bone such as the anterior maxilla, tuberosity, zygomatic arches and pterygoid plates to aid in retaining prostheses. Placement in the anterior maxilla often leads to bone loss due to excessive forces while placement in the tuberosity has higher failure rates. Tissue bar attachments are recommended to distribute forces along the implant axes. The document outlines the surgical and prosthodontic procedures for fabricating implant-retained obturator prostheses.
Orthognathic surgery involves correcting jaw deformities through combining orthodontics and maxillofacial surgery. It is primarily used in adults once growth has ceased to treat conditions too severe for orthodontics alone, such as malocclusions, airway issues, pain, or poor aesthetics. Planning involves clinical exams, models, virtual surgical planning, and splint fabrication to simulate and guide the surgery, which may include Le Fort osteotomies of the maxilla, sagittal split or vertical ramus osteotomies of the mandible, and genioplasty. Risks include nerve damage, bleeding, infection, and relapse, so patients must be informed and compliant.
Cephalometric& model mock surgery for orthodontic surgical planingIndian dental academy
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.for more details please visit
www.indiandentalacademy.com
ORTHODONTIC CORRECTION OF OCCLUSAL PLANE CANTING MaherFouda1
This document summarizes the orthodontic treatment of a 22-year-old patient with a canted occlusal plane, facial asymmetry, and mandibular prognathism. Miniscrews were implanted to intrude extruded teeth and correct the cant. After decompensation with elastics, the patient underwent bilateral sagittal split ramus osteotomy and genioplasty. Post-treatment, the patient's occlusion, facial asymmetry, and cant were significantly improved, though a two-jaw approach may have achieved better results. Miniscrews were effective for intrusion but require careful placement between roots to avoid complications.
This document describes a case study of using titanium screw anchorage to successfully treat a 31-year-old female patient with a severe anterior open bite of 7 mm. Mini screws were implanted in the maxilla and mandible to provide anchorage for intruding the upper and lower first molars by 3 mm each over 19 months of active treatment. This led to a counterclockwise rotation of the mandible which corrected the open bite and improved her retrognathic facial profile. The results suggest titanium screws are useful for intruding molars and treating anterior open bites in adult patients.
Zygomatic anchorage ( mini plates ) in orthodontic bilal falahi
1. The document discusses using zygomatic miniplates as anchorage for orthodontic tooth movement, such as intrusion and retraction.
2. Miniplates are surgically placed on the zygomatic bones and used to apply orthodontic forces from elastic threads or coils.
3. Several case reports describe using this technique to correct anterior open bites, close spaces, and intrude supererupted molars.
치아교정을 통해서도 부정교합을 치료하는 동안 각진 턱이 갸름해지면서 사각턱이 개선될 수 있다는 사실의 논문입니다.
치아교정 중에 부가적인 효과로 자연스럽게 사각턱도 개선될 수 있다는 사실을 발견한 청아치과의 홍윤기박사팀이 2014년 미국임상교정학저널(Journal of Clinical Orthodontics)에 발표한 내용입니다.
Treatment of bimaxillary protrusion with lever-arm mechanics and micro-implant anchorage
Diagnosis and conservative treatment of skeletaldentalid
A man, aged 28 years 9 months, came for an orthodontic consultation for a skeletal Class III malocclusion
(ANB angle, 3) with a modest asymmetric Class II and Class III molar relationship, complicated by an anterior
crossbite, a deepbite, and 12 mm of asymmetric maxillary crowding. Despite the severity of the malocclusion
(Discrepancy Index, 37), the patient desired noninvasive camouflage treatment. The 3-Ring diagnosis showed
that treatment without extractions or orthognathic surgery was a viable approach. Arch length analysis indicated
that differential interproximal enamel reduction could resolve the crowding and midline discrepancy, but a
miniscrew in the infrazygomatic crest was needed to retract the right buccal segment. The patient accepted
the complex, staged treatment plan with the understanding that it would require about 3.5 years. Fixed appliance
treatment with passive self-ligating brackets, early light short elastics, bite turbos, interproximal enamel
reduction, and infrazygomatic crest retraction opened the vertical dimension of the occlusion, improved the
ANB angle by 2, and achieved excellent alignment, as evidenced by a Cast Radiograph Evaluation score of
28 and a Pink and White dental esthetic score of 3. (
orthodontic management of Idiopathic condylar resorption part 2MaherFouda2
This document summarizes the management of idiopathic condylar resorption through several case studies and articles. It finds that orthodontic treatment is contraindicated during active idiopathic condylar resorption but can be used once the condition is in remission. For severe cases, orthognathic surgery may be needed but there is a risk of relapse, especially in women. Miniscrew-assisted camouflage treatment helped one patient by retracting teeth and inducing counterclockwise mandibular rotation to improve her lip incompetence and profile.
hollow obturator in case of total maxillectomyDHANANJAYSHETH1
With the incorporation of neodymium magnets, the patient was able to insert and remove the 2-piece maxillary obturator prosthesis, engaging both the anterior and posterior undercuts without difficulty. This resulted in increased retention, stability, and improved speech and deglutition. At follow-up appointments, the patient expressed satisfaction with the prosthesis and gratitude that his chief complaints had been addressed.
The document describes the vertical incision subperiosteal tunnel (VISTA) technique for managing severely impacted maxillary canines. It involves using vertical incisions to expose the impacted tooth and create tunnels to retract the canine into position with elastic traction. The technique minimizes invasive surgery, optimizes esthetic outcomes, and limits risk of root resorption compared to other approaches. Clinical cases demonstrate successful use of VISTA to align impacted canines over a course of 17-30 months with stable results.
Modern Treatment for Congenitally Missing Teeth : A Multidisciplinary Appro...Abu-Hussein Muhamad
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisors using dental implants. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics
orthodontic biomechanics andtreatment of skeletal deformitiesMaherFouda1
1) Maxillary advancement can be done with a device attached directly to the maxilla and cranial bones, or with a rigid frame fixed to the cranium from which a screw device advances the maxilla forward and downward.
2) Errors in maxillary or mandibular positioning can occur during surgery and be difficult to correct, such as the maxilla being placed too high or low in the vertical dimension.
3) "Condylar sag" describes problems where the condyle is not properly seated in the glenoid fossa after surgery, which can result in occlusal discrepancies if not addressed. Precise placement of the condyles during surgery is important for postoperative stability.
orthodontic biomechanics of skeleta deformities part 3MaherFouda1
1) Maxillary advancement can be done with a device attached directly to the maxilla and cranial bones, or with a rigid frame fixed to the cranium from which a screw device advances the maxilla forward and downward.
2) Errors in maxillary or mandibular positioning can occur during surgery and be difficult to correct, such as the maxilla being placed too high or low in the vertical dimension.
3) "Condylar sag" describes problems where the condyle is not properly seated in the glenoid fossa after surgery, which can result in occlusal discrepancies if not addressed. Precise placement of the condyles during surgery is important for postoperative stability.
Inadequate presurgical orthodontics fo different surgical casesMaherFouda1
1. Inadequate pre-orthodontic planning in surgical orthodontic cases can lead to unfavorable outcomes or complications.
2. It is critical for the orthodontist and surgeon to agree on the diagnosis, treatment goals, and plan before beginning treatment to ensure success.
3. Common errors include complications related to treatment planning, inadequate dental decompensation, appliances, and postsurgical care that can result in increased treatment time or need to change the surgical plan. Careful coordination between the orthodontist and surgeon is important.
1. The document discusses the management of implant placement in sites with cysts, comparing cyst treatment with marsupialization versus enucleation.
2. A case study describes using decompression for 6 months followed by enucleation of a large dentigerous cyst, with adequate bone regeneration 18 months later to allow placement of two dental implants.
3. The document provides several case studies of implant placement after cyst treatment, finding it can be a predictable treatment to replace teeth when grafting is not needed due to adequate bone regeneration.
orthodontic correction of canted occlusal plane part 4Maher Fouda
This document discusses the orthodontic correction of occlusal plane canting through several case studies. It begins by defining occlusal plane canting and how it can influence smile esthetics. It then describes two types of maxillary occlusal canting - Type 1 with a wavy occlusal plane but good tooth angulations, and Type 2 with total maxillary skeletal canting. The document presents several cases where occlusal canting was corrected through methods like segmental surgery, temporary anchorage devices, and orthognathic surgery. It concludes that occlusal plane canting can be successfully treated to improve smile esthetics.
Biomechanics and treatment of skeletal deformities part 2MaherFouda1
This document discusses using bone plates for decompensation in orthodontic treatment of dentofacial deformities. Bone plates can be placed near the mandibular or maxillary molars to serve as anchors for decompensating teeth. This allows for retraction or protraction of the entire dental arch to correct malocclusions. The technique reduces treatment time compared to other methods and can achieve ideal tooth positions before orthognathic surgery. Precise force application near the dental center of resistance is important to control tooth movement. Good oral hygiene around the plates is also essential for successful treatment.
Zygoma implants provide an alternative treatment for severely resorbed maxillae, avoiding the need for bone grafts. Three clinical cases are described where zygoma implants were used to support fixed prostheses for edentulous maxillae or maxillary defects. For patients with advanced resorption or anatomical constraints, zygoma implants can be placed high in the cheekbone to provide support without additional grafting, though complications like fracture can occasionally occur.
IZC Bone Screw Anchorage for Conservative Treatment of Bimaxillary Crowding i...ALFREDO NOVOA VASQUEZ
UN EXCELENTE ARTICULO DEL DR. CRIS CHANG.
USO DE LOS MINIIMPLANTES INFRAZIGOMÁTICOS PARA EL TRATAMIENTO DE UNA CLASE II -1 / SUBDIVISION 1 ASIMETRICA CON APIÑAMIENTO BIMAXILAR.
IZC Bone Screw Anchorage for Conservative Treatment of Bimaxillary Crowding in an Asymmetric Class II/I Subdivision 1 Malocclusion
Drs. Chang MJ, Lin JJ, Roberts WE.
An Interdisciplinary Approach for Improved Esthetic Results in the Anterior M...Abu-Hussein Muhamad
This document describes a case study of an interdisciplinary approach used to treat a maxillary midline diastema. A 42-year-old woman presented with uneven spaces between her front maxillary teeth, asymmetrical tooth positioning, and malocclusion. An evaluation determined tooth size discrepancies and improper clinical crown lengths were contributing factors. The treatment plan involved initial orthodontic treatment using brackets and springs to align the teeth. This was followed by porcelain laminate veneers to further improve esthetics. The veneers required only minimal tooth preparation and provided conservative, esthetic results. Through this coordinated orthodontic and restorative approach, the interdental spaces were closed and a pleasing smile was achieved to satisfy
Similar to 2010 expedited correction of significant dentofacial (20)
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
2. Correction of Dentofacial Asymmetry Using a “Surgery First” Approach
Fig. 1 20-year-old female with sig
nificant mandibular asymmetry and
skeletal Class III malocclusion be
fore treatment.
98 JCO/FEBRUARY 2010
3. but there was no vertical compo-
nent to the asymmetry. She had a
consonant smile with 80% incisor
display, but an asymmetrical
lower lip line with less animation
on the right.
The maxillary dental mid-
line was coincident with the
cupid’s bow, while the mandibu-
lar dental midline was deviated
5mm to the right. In the sagittal
view, the patient had a slight con-
cavity of the hard tissues due to a
prognathic mandible. The soft-
tissue profile was straight, how-
ever, because of deficient chin
thickness. The lower lip was
slightly protrusive, and there was
no mentolabial fold.
The patient had a Class I
molar occlusion on the right, a
full-cusp Class III occlusion on
the left, and a negative overjet of
4mm, with moderate anterior
crowding in both arches. The
maxillary incisor inclination was
ideal, while the mandibular inci-
sors were slightly upright. A uni-
lateral crossbite was noted on the
right side, and there was a mild
anterior open bite.
Because the patient was
extremely self-conscious about
her facial asymmetry, she was
amenable to surgical options.
She accepted a “surgery first”
ap
proach that would achieve an
esthetic smile and normal occlu-
sion while minimizing the time
required in fixed appliances and
addressing her main esthetic
concern.
Surgical Plan
Although the patient had a
slight paranasal deficiency, the
maxillary anteroposterior posi-
tion was adequate. Based on the
etiology of the malocclusion, we
decided on an asymmetrical sin-
gle-jaw surgery, with the mandi-
ble set back 7mm on the left and
3mm on the right, to address both
the prognathism and the asym-
metry. In addition, an anteriorly
sliding genioplasty would main-
tain soft-tissue convexity, reduce
the lower lip protrusion, and
accentuate the mentolabial fold
(Fig. 2).
The postsurgical occlusion
was planned to exhibit excessive
overjet and an end-to-end Class II
Fig. 2 A. Model surgery showing asymmetrical mandibular setbacks of 7mm on left and 3mm on right, with
menton and lower dental midline moved 3mm left to match facial and maxillary dental midlines. B. Expected
postsurgical Class II occlusion, intended to maintain maxillary incisor inclination.
VOLUME XLIV NUMBER 2 99
Villegas, Uribe, Sugawara, and Nanda
A
B
4. relationship. The buccal segments
would then be distalized into a
Class I occlusion, using maxillary
miniplates as anchorage, to create
the space needed to align the
maxillary anterior teeth without
affecting the ideal incisor inclina-
tion. The excessive overjet would
be resolved by labial movement
of the lower incisors.
Treatment Progress
One week before ortho
gnathic surgery, .022" preadjusted
brackets were bonded, and bands
were placed on the first and sec-
ond molars. A bilateral sagittal
split osteotomy was performed to
achieve the required asymmetri-
cal setback, accompanied by a
sliding genioplasty with a 4mm
advancement. All four third
molars were extracted to avoid the
need for later surgery.4,5 In addi-
tion, four miniplates were placed
on the infrazygomatic crest of the
maxilla and in the external
oblique ridge of the mandible
(Fig. 3).
After soft-tissue closure,
.016" × .016" and .014" nickel
titanium wires were inserted in
the maxillary and mandibular
arches, respectively, with the
maxillary archwire bypassing the
crowded central incisors and left
lateral incisor (Fig. 4). Intermax
illary elastics were worn from the
maxillary first premolars to the
mandibular canines and from the
maxillary miniplate to the man-
dibular canines.
Two weeks after surgery,
the patient exhibited moderate
swelling, but an .016" × .016"
stainless steel maxillary archwire
could still be tied in, again bypass-
ing the central incisors and the
left lateral incisor. An elastomer-
ic chain was extended from the
miniplate to the canine on the
right side and from the miniplate
to the first premolar on the left
side (Fig. 5). Two weeks later, the
elastomeric chains were replaced
by nickel titanium coil springs.
Two months after surgery,
the molars and canines were in
Class I occlusion. Conveniently, a
slight space had opened between
the maxillary right central and
lateral incisors, and this was used
to match the midlines.
Treatment Results
Seven months after surgery,
the fixed appliances were re
moved. The final records showed
good esthetic and occlusal results,
and the superimpositions con-
firmed the achievement of all
treatment objectives.
The miniplates were left in
place for six months of retention.
During this time, we evaluated
the stability of the orthodontic
treatment, and the miniplates
could have been used if any post-
operative orthodontic or surgical
relapse had occurred. With no
relapse evident, the miniplates
were removed after six months
(Fig. 6).
Discussion
Because orthodontic tooth
movement generally has little ef
100 JCO/FEBRUARY 2010
Correction of Dentofacial Asymmetry Using a “Surgery First” Approach
Fig. 3 Placement of four miniplates in infrazygomatic crest of maxilla and external oblique ridge of mandible
during surgery.
5. fect on extraoral soft-tissue esthet-
ics, camouflage treatment alone
cannot be relied on to rectify
severe dentofacial asymmetries.
Surgical correction becomes
complicated, however, when the
soft- and hard-tissue discrepan-
cies do not match. In this patient,
although the hard-tissue profile
was concave, the soft tissues were
straight. Cor
rection of the maloc-
clusion therefore required an
asymmetrical setback with an
advancing genioplasty.
The “surgery first” approach
described by Nagasaka and col-
leagues has two significant advan-
tages: immediate correction of
soft-tissue deformities and reduced
treatment time.6-8 In addition, the
placement of four miniplates pro-
vides three-dimensional control
for postsurgical correction of any
relapse tendencies or slight dis-
crepancies be
tween the planned
and actual surgical outcomes. If
plates are inserted in all quad-
rants regardless of the surgical
procedure (one- or two-jaw), these
vertical and anteroposterior ad
justments in tooth position need
not rely solely on elastics. Placing
miniplates does increase the time
required for surgery by an average
10-15 minutes per plate, but we
have not encountered any intra- or
postoperative complications with
this surgical approach.
In contrast to the technique
described by Nagasaka and col-
leagues, who placed passive stiff
wires conforming to the maloc-
VOLUME XLIV NUMBER 2 101
Villegas, Uribe, Sugawara, and Nanda
Fig. 4 .016" .016" nickel titanium wire placed in maxillary arch,
bypassing incisors to prevent flaring; .014" nickel titanium wire placed
in mandibular arch for alignment.
Fig. 5 Distalization of maxillary buccal segments into Class I relation
ship, using anchorage from maxillary miniplates.
6. Fig. 6 A. Patient after seven months of treatment. B. Radiographs taken six months later, after removal of
miniplates at end of retention period. C. Superimposition of cephalometric tracings before treatment (black),
immediately after surgery (blue), and after six months of retention (red).
B
A
102 JCO/FEBRUARY 2010
Correction of Dentofacial Asymmetry Using a “Surgery First” Approach
C
7. VOLUME XLIV NUMBER 2 103
Villegas, Uribe, Sugawara, and Nanda
clusion,6 we inserted nickel tita-
nium archwires after the soft
tissues were sutured in the operat-
ing room. This method could
expedite tooth movement by tak-
ing advantage of the increased
cell turnover that occurs after
mechanical alteration of bone.9
Such biological response has been
noted with corticotomy-assisted
tooth movement; bone turnover
can also be accelerated in areas
distant to the surgical site.10
In another departure from
Nagasaka’s approach, we did not
use a splint to stabilize the occlu-
sion after surgery. Model surgery
indicated that the occlusion would
be stable in a cusp-to-cusp rela-
tionship, and the maxillary teeth
could then be distalized to relieve
the anterior crowding while
maintaining the incisor positions
and inclination. The patient was
delighted with the dramatic
esthetic change achieved in such
a short per
iod of wearing fixed
appliances.
Conclusion
The “surgery first” approach
can be used to address complex
dentofacial asymmetry, as shown
in this case. Treatment time can
be substantially reduced by elim-
inating the presurgical phase and
taking advantage of increased
bone turnover, which in turn can
accelerate tooth movement.
ACKNOWLEDGMENTS: The authors thank
Drs. Brett Holliday and Amirparviz Davoody
for their collaboration on the manuscript.
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