Orthognathic surgery involves surgical procedures to correct dentofacial deformities involving the maxilla, mandible, or both. It is carried out along with orthodontic treatment. Indications include severe class II or III malocclusions, deep overbites, open bites, vertical excess or deficiency, asymmetry, and compromised periodontal health. The goals are optimal facial and dental aesthetics, functional occlusion, future oral health, rapid treatment, stability, and minimal morbidity. Treatment requires joint planning by an orthodontist and oral surgeon, including presurgical orthodontics, surgical splint fabrication, and sagittal, transverse, or vertical surgical procedures like le fort osteotomies or sagittal split

1. Orthognathic Surgery
PROF (Dr.) SAIBEL FARISHTA

2. Orthognathic Surgery
• Orthognathic surgeries are surgical
procedures carried out along with
orthodontic treatment to correct dento
facial deformities of severe orofacial
disproportions, involving maxilla,the
mandible or both in combination

3. Etiology
• Prenatal
• Hereditary
• environmental

4. Envelope of Discrepancy

5. Indications
• Severe class II or class III discrepancy
• Deep over bite in non growing patients
• Severe anterior open bite
• Extreme vertical excess or deficiency in max or
mandible
• Severe dentoalveolar problem
• Extreme compromised periodontal situation
• Skeletal asymmetry

6. Contraindications
• Minor skeletal problem
• Patients with only dentoalveolar problems
• Uncontrolled systemic disease
• Unstable patients with poor personality or
pathologic personality

7. Aims of Orthognathic Surgery
• Optimum facial aesthetics
• Optimum dental aesthetics
• Functional occlusion
• Future health of orofacial structures
• Rapid treatment
• A stable result
• Minimum morbidity

8. Principles of Treatment
• Patient motivation
• Diagnosis
• Joint planning

9. Patients Motivation
• Understand patient’s chief complain
• Patient-parent conference
– Description of problem list
– Review of risk benefit & treatment alternatives
– Consideration of patients expectations & values
. Explain the probable outcome
. Use of computers for prediction of probable
outcome

10. Diagnosis
• Clinical examination and evaluation of
history
• Lateral ceph & OPG
• Study models
• photographs

11. Joint Planning
• Treatment plan must be undertaken by an
orthodontist and oral surgeon from the
onset. Choice of surgical procedure, type
of presurgical orthodontics, need and type
of extraction all should be planned before
bonding the patients

12. Adjunct used for Planning
• Mock model surgery / prediction
• Cephalometric prediction tracing
• Computerized prediction

13. Presurgical Orthodontics
The objective of pre-surgical orthodontic
treatment is to prepare the patient for
surgery and not to make occlusal
relationships as ideal as possible

14. Summary of Pre-surgical Orthodontics
• Leveling, aligning,& co-ordination of the
dental arches
• Correct incisor angulation
• Closure of extraction space, unless it
involves an osteotomy site
• Establishment of compatible archforms
• Intrusion – it may be postponed post
surgically
• Major crossbite correction

15. Surgical Splint
An occlusion wafer splint is used in the
operating room to help in positioning the
teeth and add to stabilization. The splint is
made on the dental casts that show the
result from the model surgery

16. Orthognathic Surgical procedures
• Sagittal procedures
• Transverse procedures
• Vertical procedures

17. Saggital procedures
Maxillary prognathism
• Subapical osteotomy
• Le fort I osteotomy
Maxillary retrognathism
Le fort I osteotomy
Le fort II & III osteotomy
Mandibular prognathism
Sigattal split osteotomy
Extra oral vertical osteotomy
Reduction genioplasty
Mandibular retrognathism
Sagittal split osteotomy
Intra oral vertical osteotomy
Agumentation genioplasty

18. III Transverse procedures
Mid palatal osteotomy
III Vertical procedures
Sagittal split osteotomy
Le fort I with Sub apical osteotomy

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33. THANK YOU