This document discusses anterior segmental maxillary osteotomy techniques. It provides a brief history, noting the first osteotomy was performed in 1921 using a wedge resection. Current indications include correcting protruding maxillary anterior teeth and anterior open bites. Techniques described include the Wassmund, Wunderer, and Cupar's approaches. The Wassmund technique involves vertical incisions between the canine and premolar with palatal osteotomies. Fixation methods after repositioning the anterior segment include occlusal splints, wiring, or plates. Potential complications are also outlined.

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ANTERIOR
SEGMENTAL
MAXILLARY
OSTEOTOMY
PRESENTED BY
DINESH VENKATESAN
FINAL YEAR BDS
MAXILLARY OSTEOTOMY

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HISTORICAL EVIDENCE
 1921 – Cohn Stock performed first maxillary ostetomy
 Wedge shaped maxillary Osteotomy through transverse palatal
incisions
 Succeeded by green stick fracture of Anterior maxillary segment
that was retracted
 Relapsed in 4 weeks

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INDICATIONS
 In Correction of Protrusion of Maxillary Anterior Teeth with
normal axial inclination with alveolar bone.
 In Correction of Anterior Open Bite provided absence of
maxillary excess.
 Vertical Plane Premaxilla correction – Openbite / Deep Bite.
 Failure in Orthodontic Therapy due to Ankylois or Pathological
Resortion of Maxillary Anterior Teeth.
 To improve Facial Appearance in prognathic maxilla with
competent lips and adequate lip length.

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Techniques in AMO
 Wassmund Technique
 Wunderer Technique
 Cupar’s Technique

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WASSMUND TECHNIQUE
 Vertical Incision between Canine and Premolar extending to
nasal floor.
 Mucoperiosteum is reflected posteriorly.
 In apical region of canine, reflection is made till nasal pyriform
aperture.
 First Premolars are extracted (if planned) at this stage

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 Midline Sagittal Incision is made anteroposteriorly on palate to
perform palatal osteotomy.
 Palatal Mucosa is reflected and care is taken not to injure anterior
palatine vessels.

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 Bony Cut is made on buccal aspect of alveolus.
 Cut is taken vertically upwards and turned medially to pyriform
aperture so that 3-5 mm of bone remains intact in canine apex.
 Transpalatal osteotomy of palatal bone from alveolus of one side
to other side.
 As advancing to midline osteotomy becomes hard dure to
thickness of bone and access difficulty which is overcome by
Midpalatine insidion made early.

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 Maxillary segment is now separated from nasal septum by finger
pressure sometimes.
 Usually Vertical incision is placed over anterior nasal spine;
mucoperiosteum is reflected from nasal spine & cartilaginous
nasal septum.
 Nasal Osteotome is used to separate anterior maxillary segment
and nasal septum.
 Folds of soft tissue are checked for proper blood supply and
closed using catgut 3-0

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WUNDERER TECHNIQUE
 Used especially when second premolar is extracted
 Labial Approach is similar to Wassmund Technique.
 Palatal Surgery is started after Buccal part of Surgery.

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 Here Transverse Palatal Cut anterior to planned osteotomy site.
 In midline bone is little harder but access is good and cut can
done as posterior as second premolar.
 Anterior Segment can be mobilized and separated from nasal
septum.
 It is then postioned & fixed using prefabricated occlusal splints.

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Cupar’s Technique
 Buccal Vestibular Incision is created.
 Nasal Mucosa is elevated from superior surface of maxilla.
 Vertical Osteotomy is done.
 Through this vertical cut, transpalatal osteotomy is completed
using osteotome or reciprocating saw.
 A finger is placed on palatal mucosa to palpate the osteotome to
prevent palatal tissue damage.

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AMO FIXATION
 OCCLUSAL STENT STABILIZATION
 OSSEOUS WIRING
 SKELETAL FIXATION
 REIGID INTERNAL FIXATION

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ADVANTAGES
 Direct access to nasal structures
 Preservation of blood supply through excellent palatal pedicle.
 Ability to remove palatal none directly after down fracture of
anterior maxilla.
 Excellent access to superior maxilla.
 Easy placement of rigid fixation.

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COMPLICATIONS
 Loss of Vitality
 Damage to Tooth Roots
 Persistent Periodontal Problmes
 Osseous Necrosis of Dento-osseous segments
 Communication of nasal cavity and maxillary sinus
 Hemorrhage
 Oronasal or Oroantral Fistulas
 Atrophic Rhinitis
 Nasal Septal Deviation
 Unfavorable nasal esthetics

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