Combined surgical-orthodontic treatment: how did it evolve and what are the best practices now?

Digital Innovations in Orthognathic Surgery: A Systematic Review of Virtual Surgical Planning, Digital Transfer, and Conventional Model Surgery

OBJECTIVES

Orthognathic surgery has evolved due to the use of virtual surgical planning (VSP) and digital model surgery, which are technological advancements replacing conventional approaches with accurate personalised digital models made from computed tomography (CT) or magnetic resonance imaging (MRI) scans. Their integration has enhanced surgical efficiency, patient satisfaction and communication among surgeons and patients, while some challenges such as cybersecurity issues and the requirement for information technology backup have also been noted in hospitals.

MATERIALS AND METHODS

From January 2013 to October 2024, this systematic review aimed at orthognathic surgery virtual planning; it was carried out on the basis of a digital library with 437 works from PubMed, Embase, Cochrane, Web of Science and Scopus searched through an initial selection of specific keywords. The final step is filtering out irrelevant studies through scrutiny, resulting in 25 original interventional studies that met inclusion criteria for quality control purposes via bias analysis.

RESULTS

In relation to the future of orthognathic surgery, it can be advanced by improving VSP, digital transfer techniques and conventional model surgery with technical innovations that need to meet the challenges. The integration of Artificial Intelligence (AI) into VSP can be an opportunity for its development in the sphere of accuracy and visualisation during surgery with augmented reality (AR) utilisation. Among them are the real-time data integration offered by digital transfer techniques, but they are hindered in cost and standardisation. On the other hand, conventional model surgery may revolutionise with three-dimensional (3D) printing; however, there is a long way to go for conventional model surgery to address time constraints as well as ecological concerns. Compatibility issues, training needs and ethical considerations represent three major obstacles that must be tackled successfully so that surgery will have a bright future.

CONCLUSION

Case complexity and patient preferences are important factors that should be considered before making a decision about orthognathic surgery. VSP offers precision for complicated cases. Real-time guidance can be achieved using digital transfer techniques, whereas traditional model surgery provides a tactile, hands-on experience. Analysing digital innovations jointly will enhance orthognathic patient care and education while improving patient safety.

Management of facial asymmetry assisted with digitally designed surgical guide for 3-dimensional maxillary repositioning: A case report

Orthodontists play a pivotal role in diagnosing, planning, and preparing patients for orthognathic surgeries. Digital technologies like cephalometry, intraoral scans, CBCT scans, CAD-CAM-assisted 3-D planning, and printed surgical splints, have largely replaced conventional techniques. The automated software produces surgical splints with a design similar to conventional which may not address complex scenarios, involving symmetric and asymmetric maxillary impaction. To address this, a surgical splint designed using 3D dolphin software was modified with 3-matic software for precise guidance. This article gives insight into the digitally designed surgical splint for the correction of facial asymmetry on skeletal Class III bases and occlusal canting in an 18-year-old woman. The precise relocation of the maxilla was achieved as planned pre-surgically leading to significant improvement in the facial aesthetics. In conclusion, modified splint design fabrication offers more predictable outcomes, reduces laborious laboratory procedures, and acts as a reliable guide for precise surgical results.

Evaluation of Satisfaction Levels Following Orthognathic Treatment in Adult Patients: A Systematic Review

Dentofacial deformities can significantly impact an individual's quality of life, affecting facial aesthetics, self-esteem, and overall well-being. The combined orthognathic surgery-orthodontic treatment is the preferred approach for correcting moderate-to-severe deformities. However, patient satisfaction following orthognathic surgery remains a crucial outcome measure, influenced by various factors, including the type of malocclusion, surgical procedure, and demographic characteristics. This systematic review aimed to synthesize the available evidence regarding patient satisfaction following orthognathic surgery, exploring the effects of the type of malocclusion, surgical procedure, age, and gender on satisfaction rates, addressing a gap left by previous outdated reviews. A comprehensive literature search was conducted across multiple databases, including PubMed®, Scopus®, Web of Science™, and Embase®. Eligibility criteria were defined using the PICOS (population, intervention, comparison, outcomes, and study design) framework. Cochrane's ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions) tool was employed for non-randomized intervention studies within clinical controlled trials to assess the risk of bias. In parallel, a revised version of the Newcastle-Ottawa scale determined the methodological quality of cohort and cross-sectional studies. Sixteen studies were analyzed, revealing satisfaction levels ranging from 83% to 100%. Findings indicate that class III malocclusion patients report higher satisfaction than class II patients and satisfaction varies based on surgical type, with bimaxillary procedures generally yielding better outcomes. While most studies found no significant correlation between satisfaction and demographic factors such as age and gender, some suggested younger patients may express higher satisfaction and that female patients might report lower satisfaction levels. The review highlights the importance of effective patient communication and expectation management in achieving optimal satisfaction outcomes in orthognathic surgery. Limitations such as memory bias and methodological diversity across studies restrict the ability to perform meta-analyses, underscoring the need for further research in this area.

The Stability of Anterior Open Bite Closure After Bimaxillary Osteotomy

Introduction

The aim of this study was to evaluate the long-term success rate of combined surgical-orthodontic therapy of skeletal anterior open bite.

Materials and Methods

A total of 11 patients with an anterior open bite treated with a combined surgical-orthodontic therapy were retrospectively analysed via lateral cephalometric radiographs and models before treatment, 7-10 days after surgery (T1), one year post-operatively (T2) and two years post-operatively (T3).

Results

Ten patients continued to experience a positive overbite at T2. This decreased to 8 at T3. Three patients experienced relapse and had a negative overbite at T3. The average pre-treatment overbite was greater in the positive overbite group compared to the relapse group. Spearman's correlation analysis revealed a correlation between preoperative maxilla-mandibular plane angle (MMPA) with the overall change in overbite. Friedman's test followed by Bonferroni post-hoc analysis was carried out to identify any statistical significance.

Conclusion

In conclusion, combined surgical-orthodontic treatment achieves good results for anterior open bite. Patients with a high pre-operative MMPA have a higher risk of relapse. Lower anterior facial height ratio to total anterior facial height (LAFH/TAFH) and the amount of impaction do not significantly contribute to the risk of relapse. Long-term stability of overbite for anterior open bite patients should be around 75%.

Assessment of condylar positional changes in severe skeletal class II malocclusion after surgical-orthodontic treatment

OBJECTIVES

This study aimed to determine the positional changes in the condyle in the temporomandibular joint (TMJ) of severe skeletal class II malocclusion patients treated with surgical-orthodontics.

MATERIALS AND METHODS

The measurements of TMJ space in 97 severe skeletal class II malocclusion patients (20 males, 77 females, mean age, 24.8 years, mean ANB = 7.41°) were assessed using limited cone-beam computed tomography (LCBCT) images acquired before orthodontics (T0) and 12 months after surgery (T1). 3D remodeling of the TMJ and measurements of the anterior space (AS), superior space (SS), and posterior space (PS) were performed to determine the position of the condyle for each joint. All data were analyzed by t test, correlation analysis, and Pearson correlation coefficient.

RESULTS

The mean AS, SS, and PS values after the therapy changed from 1.684 to 1.680 mm (0.24%), 3.086 to 2.748 mm (10.968%), and 2.873 to 2.155 mm (24.985%), respectively. The decreases in SS and PS were statistically significant. Positive correlations were found in the mean AS, SS, and PS values between the right and left sides.

CONCLUSIONS

The combination of orthodontic and surgical treatment makes the condyle move counterclockwise in the TMJ in severe skeletal class II patients.

CLINICAL RELEVANCE

Studies of temporomandibular joint (TMJ) intervals changes in patients with severe skeletal class II after sagittal split ramus osteotomy (SSRO) are limited. The postoperative joint remodeling, resorption, and related complications remain unstudied.

"Surgery First" vs "Traditional Sequence" Surgery: A Qualitative Study of Health Experiences in 46 Bimaxillary Orthognathic Patients

Introduction

Orthognathic patients are advocating an active role in selecting their appropriate ortho-surgical treatment, between the surgery first (SF) and the traditional sequence (TS) approaches. The aim of this study was to evaluate, through qualitative analysis, the subjective perceptions of the outcomes of each protocol.

Methods

In-depth interviews were conducted with 46 (10 male and 36 female) orthognathic patients (23 SF and 23 TS) treated with bimaxillary orthognathic surgery by the same surgeon, between 2013 and 2015. Average treatment duration was 6.5 months for SF and 12 months for TS. Inclusion criteria were: the presence of Class III or Class II asymmetries and open bite. Patients were excluded if they refused interviews or stopped attending post-treatment follow-up. Investigated health experiences included overall satisfaction with appearance, self-confidence after surgery, perceived treatment time, functional recovery, and diet restrictions.

Results

All SF and TS patients showed overall satisfaction with their appearance (though TS showed more enthusiastic tones) and approved their degree of functional recovery after surgery. Class III SF patients had earlier improvements in self-confidence after surgery. Orthodontics was considered enduring by both SF and TS patients.

Conclusions

SF patients expressed a higher degree of satisfaction with the reduction in overall treatment time and with the early psychological benefit deriving therefrom. Both SF and TS patients completely approved of the aesthetic outcomes and the functional recovery from which they benefitted due to the entire procedure.

Current Trends in Skeletal Borderline Patients: Surgical versus Orthodontic Treatment Decisions—What Is the Evidence?

Background: The aim is to assess the current evidence-based knowledge about treatment decisions for skeletal malocclusion in adult borderline patients. Methods: A literature search was conducted through three databases. Inclusion criteria were restricted to systematic reviews, prospective, retrospective, and control studies. Only articles comparing orthodontic camouflage and orthognathic surgical treatment for Class II and Class III malocclusions in adult patients were selected to be reviewed. Results: Seven articles concerning Class II and nine concerning Class III met the inclusion criteria. Scientific evidence was poor due to low methodological quality. Conclusions: Surgical treatment was found to better improve skeletal and soft-tissue cephalometric values, whereas camouflage treatment mainly involved dentoalveolar movements. Aesthetic changes, as perceived by the patient, were not significantly different in the two groups. Recently improved surgical techniques, differing from those described in the analyzed articles, may provide similar or more stable outcomes compared with orthodontic-only treatment. Although some cephalometric variables can be helpful, the most important parameters for treatment selection are the patient’s presenting complaint and their self-image perception. Further studies with larger sample sizes and similar pretreatment conditions, and considering patient self-evaluation of esthetics and function, should be undertaken.

Nonsurgical treatment of a hyperdivergent skeletal Class III patient with mini-screw-assisted mandibular dentition distalization and flattening of the occlusal plane

Treatment of hyperdivergent skeletal Class III malocclusion is challenging for orthodontists, and orthognathic-orthodontic treatment is usually required. This report presents the successful nonsurgical treatment of a 20-year-old man who had a skeletal Class III malocclusion with anterior open bite, anterior and posterior crossbite, hyperdivergent growth pattern, steep occlusal plane, early loss of three first molars, and an uncommon convex profile with a retruded chin. An orthodontic camouflage treatment plan was chosen based on the etiology and the patient's complaints. Tooth #37 was extracted. Miniscrews were used for uprighting and intruding of the lower molars, distalization of the lower dentition, and flattening of the occlusal plane. After 34 months of active treatment, Class I relationships, proper anterior overjet and overbite, flat occlusal plane, and an esthetic facial profile were achieved. The results demonstrated that the biomechanics involved in the nonsurgical treatment assisted with miniscrews to distalize the mandibular dentition and flatten the occlusal plane while keeping the mandibular plane stable was effective for treating this hyperdivergent skeletal Class III patient with a convex profile and anterior open bite.

Effects of autologous concentrated growth factor on gingival thickness in periodontal accelerated osteogenic orthodontics: a 6-month randomized controlled trial

Background

Earlier studies have not given clear results of concentrated growth factor (CGF) on gingival thickness (GT) in periodontal accelerated osteogenic orthodontics (PAOO). This randomized controlled trial aimed to evaluate the effects of CGF on GT in patients with thin gingival phenotype undergoing PAOO.

Methods

Forty four patients presenting 264 anterior mandibular teeth were recruited and randomly allocated to one of the groups: test—positioning of autologous CGF after PAOO or control—positioning of a collagen membrane after PAOO. GT, gingival height (GH), buccal alveolar bone thickness (BT), and buccal alveolar bone height (BH) were evaluated depending on cross-sectional CBCT images at t0 (before surgery) and t1(6 months after surgery).

Results

GT were increased in both groups at t1 compared to t0. Yet, higher values were observed in the test group (from 0.94 ± 0.23 to 1.31 ± 0.33 mm) compared to the control group (from 0.94 ± 0.19 to 1.02 ± 0.16 mm) (p < 0.05). Moreover, in the intergroup comparison, GT at t1 in the test group was significantly higher compared to the control group (p < 0.01). Furthermore, the GT of central incisors, lateral incisors and canine teeth all showed significantly changes compared with baseline and the test group showed higher increase (p < 0.01). No statistically significant difference were found in GH, BT, BH and all clinical parameters between two groups at t1 (p > 0.05).

Conclusions

Within the limitation of this study, gingival thickness could be increased by using CGF in PAOO for the patients with thin gingival phenotype.

Trial registration The study was registered in Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) under the number ChiCTRINR17013346, Registered 11 November 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01967-5.

Three-Dimensional Outcome Assessments of Surgical Correction in Cleft and Noncleft Patients with Class III Skeletal Relation: A Case-Control Study

Background

The orthognathic strategies to treat patients with a concave profile but different tissue conditions remain controversial. The aim of this case-control study was to investigate the outcome predictability of orthognathic surgery in cleft lip and palate (CLP) patients and matched controls.

Methods

Fifty consecutive CLP and 45 matched non-CLP patients who received whole-piece Le Fort I and bilateral sagittal split osteotomy to correct class III skeletal relations were enrolled. The outcome discrepancies (ODs) from simulations among all groups were evaluated with consideration of the possible influences from planned surgical movements (PSM). Receiver operating characteristic curves were used to determine threshold values of PSMs that yielded clinically relevant OD.

Results

Unilateral CLP (UCLP) patients had comparable postsurgical OD to non-CLP patients in both jaws, whereas bilateral CLP (BCLP) patients had greater deviations from predicted results. Vertical movement of the A − point > 1.33 mm and yaw correction > 1.65° in the BCLP patients was associated with clinically relevant maxillary OD.

Conclusions

The OGS outcomes of BCLP patients were less predictable than those of the UCLP and noncleft patients. Vertical movements of the A − point > 1.33 mm and yaw correction > 1.65° in BCLP patients increased OD to a clinically relevant extent.

Three-Dimensional Evaluation on Cortical Bone During Orthodontic Surgical Treatment

Adult patients' severe malocclusions, especially the skeletal ones, cannot be exclusively solved by the orthodontic treatment and therefore a combined orthodontic-surgical treatment is necessary. Today, numerous software allows to plane and to visualize the final treatment results simulating the best therapeutic option. This is a retrospective experimental study that aims to analyze the changes in the buccal cortical bone in patients undergoing orthodontics surgeries and to evaluate the correlation between the dental movement and the changes in the relative bone cortex. The study sample consists of 32 subjects. By applying the CBCT radiographic examinations, the measurements were made in well-defined points of reference. The 3D study of the dental changes of position and the cortical buccal bone related variation, suggests how the determined orthodontic movement of the dental element does not achieve an easily predictable bone variation. Therefore, it also suggests that there is no direct proportionality relationship between the extent of bone apposition/reabsorption and dental movement.

Surgery-first for a patient with mild hemifacial microsomia: A case report and review of literature

BACKGROUND

Hemifacial microsomia (HFM) is the second most common craniofacial congenital anomaly following cleft lip and palate. Because of the various phenotypic spectra and the severity of the deformity, a wide range of treatment approaches have been proposed. Recently, the surgery-first approach (SFA) was introduced to treat mild to moderate HFM, and it yielded a balanced facial appearance. The SFA not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.

CASE SUMMARY

A female patient, aged 25 years old, sought orthodontic treatment with the chief complaint of dental and facial asymmetry. After a comprehensive physical examination and imaging analysis were performed, the patient was diagnosed with mild HFM that was primarily attributed to unilateral abnormal development of the maxilla-mandibular. The SFA was carried out to correct the skeletal deformity. The palatal suture was used as the midline of the maxilla in the surgical plan to center the maxilla, and the chin was also properly positioned to obtain a relatively symmetrical facial appearance. Four weeks after the surgery, the patient was referred for postsurgical orthodontics to decompensate the dentition and stabilize the occlusion. After 20 mo of treatment, all orthodontic appliances were removed. The posttreatment photographs of the patient and her smile confirmed good aesthetic and occlusal results.

CONCLUSION

Mild HFM can be corrected by SFA, which not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.

Evaluation of the Therapeutic Effect of Bi-Maxillary Osteotomy Using the Stress Distribution on the Temporomandibular Joint When Doing Anterior Teeth Occlusion

The purpose of this study was to investigate how sagittal split ramus osteotomy (SSRO) and Le Fort 1 osteotomy affected the stress distribution of the temporomandibular joint (TMJ) during an anterior teeth bite using the three-dimensional (3D) finite element (FE) method. Fourteen orthognathic surgery patients were examined with mandibular prognathism, facial asymmetry, and mandibular retraction. They underwent Le Fort 1 osteotomy in conjunction with SSRO. In addition, ten asymptomatic subjects were recruited as the control group. The 3D models of the mandible, disc, and maxilla were reconstructed according to cone-beam computed tomography (CBCT). Contact was used to simulate the interaction of the disc-condyle, disc-temporal bone, and upper-lower dentition. Muscle forces and boundary conditions corresponding to the anterior occlusions were applied on the models. The stresses on the articular disc and condyle in the pre-operative group were significantly higher than normal. The contact stress and minimum principal stress in TMJ for patients with temporomandibular disorder (TMD) were abnormally higher. The peak stresses of the TMJ of the patients under anterior occlusions decreased after bimaxillary osteotomy. No postoperative TMD symptoms were found. Maxillofacial deformity led to excessive stress on the TMJ. Bimaxillary osteotomy can partially improve the stress distributions of the TMJ and relieve the symptoms of TMD.

Combined Orthodontic-Surgical Treatment May Be an Effective Choice to Improve Oral Health-Related Quality of Life for Individuals Affected With Severe Dentofacial Deformities

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Effect of conventional combined orthodontic-surgical treatment on oral health-related quality of life: A systematic review and meta-analysis. Yi J, Lu W, Xiao J, Li X, Li Y, Zhao Z. Am J Orthod Dentofacial Orthop 2019; 156:29-43.

SOURCE OF FUNDING

Government National Natural Science Foundation of China (grant 81801018) and Orthodontic National Key Clinical Specialty Program of China, West China Hospital of Stomatology, Sichuan University.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Orthodontic and surgical management of a patient with severe mandibular deficiency and asymmetry with condylar hypoplasia using 3-dimensional surgical planning in combination with a modified surgery-first approach

Progressive improvements in digital technology and surgical techniques have synergized the speed, predictability, and favorable outcomes for patients undergoing surgical-orthodontic treatment with handicapping dentofacial deformities. This case report will demonstrate the management of a patient with severe mandibular hypoplasia, condylar hypoplasia, and mandibular asymmetry. The dentofacial deformity, and consequently, the unaesthetic facial appearance, led to psychosocial stress, symptoms of excessive daytime sleepiness, and functional limitations, especially related to mandibular movements. A modified surgery-first approach was used, which was successfully performed using computer-assisted surgical planning. Postsurgical orthodontics was accomplished with the aid of temporary skeletal anchorage mini-plates. An additional alloplastic enhancement of the chin addressed the severe microgenia, which the osseous advancement could not achieve. This resulted in a total advancement of the pogonion by 26 mm yielding a remarkable improvement in the patient's facial esthetics. Furthermore, a considerable improvement in mandibular function and reduction in daytime sleepiness occurred. The severe malocclusion with a discrepancy index value of 47 was treated to a successful final occlusion in 21 months of treatment time.

Surgically Facilitated Orthodontic Therapy (SFOT): Diagnosis and Indications in Interdisciplinary Dentofacial Therapy Involving Tooth Movement

FOCUSED CLINICAL QUESTION

What are the key considerations for the interdisciplinary dentofacial therapy (IDT) team in the diagnostic process to evaluate a patient for surgically facilitated orthodontic therapy (SFOT)?

SUMMARY

SFOT creates a demineralized bone matrix and augments dentoalveolar deficiencies in the management of dentofacial disharmony malocclusion. Numerous indications and contraindications exist which are essential to the periodontal surgeon for proper case selection. A collaboratively focused workup by an IDT team is equally essential. Cone beam computed tomography (CBCT) and orthodontic simulation software which identifies changes in the dentoalveolar complex influenced by tooth movement are critical in providing transparency to the patient and IDT team during the treatment planning process. Such transparency can aid the team in assessing goals and outcomes that consider and respect foundational dentoalveolar parameters while contributing to sustainable outcomes.

CONCLUSIONS

The SFOT IDT decision making process is complex, yet full of opportunities. Embracing SFOT IDT with innovative and novel 3D technology can optimize conditions leading to long-term outcomes that align with periodontal stability as well as patient goals and preferences which permeate beyond the achievement of "straightening teeth". Transparency of complex IDT through 3D CBCT and orthodontic simulation software engenders "collaborative accountability" and can improve patient communication which is critical to developing meaningful and essential treatment plans.

Trends in surgical-orthodontic management of Class III malocclusions in Western Australia

Aim

The aim of this retrospective cohort study was to identify trends in the surgical-orthodontic management of skeletal Class III malocclusions in Western Australia between 1985 and 2016.

Methods

The records of 225 patients (132 females, 93 males) who received combined surgical-orthodontic correction of their Class III malocclusion between 1985 and 2016 were retrospectively assessed. The subjects were divided into three groups according to surgery type: Group (1) maxillary advancement only; Group (2) mandibular setback only; Group (3) two-jaw surgery.

Results

A trend towards two-jaw surgery for Class III correction was observed. Between 1985 and 2016, 123 patients (55%) were treated via two-jaw surgery; 97 patients (43%) were treated via maxillary advancement alone and five patients (2%) were treated via mandibular setback alone. Between 2011 and 2016, 61% were treated via two-jaw surgery; 37% were treated via maxillary advancement surgery; 2% were treated via mandibular setback surgery. Gender affected surgery type: two-jaw surgery (60% female); maxillary advancement (62% female); mandibular setback (17% female). A greater proportion of females received Class III surgical management in comparison with males (59:41).

Conclusion

Two-jaw surgery is the most common procedure for the surgical correction of skeletal Class III malocclusions in Western Australia. Of the single jaw procedures, isolated maxillary advancement surgery is more common than mandibular setback procedures.

Open bite in adult patients

Anterior open bite (AOB) is characterized by the lack of overlap or contact between maxillary and mandibular incisors, while the posterior teeth are in occlusion. Correction of this malocclusion is challenging due to difficulties in determining and addressing the etiologic factors, and the high relapse rate. A multidisciplinary approach may be necessary, with participation of Orthodontics, Surgery and Speech Therapy, to achieve adequate esthetic and functional results for long term stability. The present paper discusses the treatment options for AOB, their advantages and implications.

What characteristics do orthodontists desire in orthognathic surgeons?

OBJECTIVE

The purpose of our study was to report and rank orthognathic surgeon characteristics as valued by referring orthodontists.

STUDY DESIGN

This was a cross-sectional study surveying orthodontists registered with the American Academy of Orthodontists' Partners in Research program. Survey items gathered information on both orthodontist characteristics and perceptions across 9 surgeon characteristics. Descriptive statistics were computed for all survey items, and linear regression models were used to evaluate the association between orthodontist characteristics and number of orthognathic surgeries performed.

RESULTS

Among the 1300 surveyed orthodontists, there were 172 respondents (13% response rate). The majority of orthodontists (66.9%) had had at least 15 years of practice experience, completed between 1 and 5 surgical cases in the past year (55.6%), and referred their orthognathic cases to an oral and maxillofacial surgeon (99.4%). Among orthodontists, only practice experience (P < .01) was independently associated with the number of surgeries performed. An understanding of preoperative and nonoperative orthodontics was the most highly valued surgeon characteristic, and 50% of all respondents listed it as one of the most important characteristics. The next most valued surgeon characteristics were the ability to lead surgical treatment planning, acceptance of patient insurance plans, and sharing of strong personal and professional relationships.

CONCLUSIONS

The most desirable characteristic in an orthognathic surgeon, as stated by the surveyed orthodontists, was an understanding of both preoperative and nonoperative orthodontics. Surgeons seeking to increase orthognathic referrals should work to increase insurance coverage and actively initiate strong personal and professional relationships with orthodontists.

Cone beam computed tomography evaluation of tooth injury after segmental Le Fort I osteotomy

The purpose of this study was to explore the incidence of injuries to the teeth at the vertical osteotomy line after segmental Le Fort I osteotomy by examination of postoperative cone beam computed tomography (CBCT) images. Data for this retrospective case study were collected using CBCT images of 132 patients with an indication for Le Fort I osteotomy with three-piece segmentation of the maxilla. Twenty-two patients (17%, 95% confidence interval 10-23%) had dental injuries. No patient had more than one dental injury. Thirty-three patients (25%, 95% confidence interval 18-32%) had bone dehiscence of the teeth (defined as the osteotomy line passing through the periodontal ligament). Six patients had bone dehiscence involving two teeth and one patient had bone dehiscence involving three teeth. In the group in which dental injuries occurred, the preoperative interdental distance at the vertical osteotomy line was significantly shorter than the interdental distance in the group without dental injuries. In conclusion, this study demonstrated that a preoperative interdental distance of more than 2.5mm significantly reduced the possibility of tooth injuries adjacent to the vertical osteotomy line during Le Fort I osteotomy with three-piece segmentation of the maxilla.

Conventional surgical-orthodontic approach with double-jaw surgery for a patient with a skeletal Class III malocclusion: Stability of results 10 years posttreatment

This case report presents the treatment of a young man with a skeletal Class III malocclusion. He was treated with a conventional surgical-orthodontic approach in which 2 jaw surgeries were performed. The esthetic facial profile, pleasant smile, appropriate occlusion, and overall good treatment outcome remained stable 10 years after active orthodontic treatment.

Virtual Surgical Planning Assisted Management for Three-Dimensional Dentomaxillofacial Deformities

OBJECTIVE

Treatment of 3-dimensional dentomaxillofacial deformities remains a significant clinical challenge. This retrospective study aims to present the modalities of management for complex 3-dimensional dentomaxillofacial deformities with the assistance of virtual surgical planning (VSP) and 3-dimensional printed navigation templates.

STUDY DESIGN

Ten patients diagnosed with complex 3-dimensional dentomaxillofacial deformities received treatment of combined orthodontics and orthognathic surgery. Various surgical techniques as well as bone graft and distraction osteogenesis were used under the guidance of VSP and 3-dimensional printed navigation templates according to the characteristics of each patient. Follow-up included clinical examination and studies of spiral computed tomography preoperatively and for an average of 12 months postoperatively.

RESULT

The clinical outcomes of patients showed that VSP was successfully transferred to actual surgery in all the 10 patients. Three-dimensional dentomaxillofacial deformities were corrected significantly. Satisfactory profiles and occlusion were achieved.

CONCLUSION

The management of 3-dimensional dentomaxillofacial deformities required comprehensive consideration and detailed surgical planning. Virtual surgical planning serves as a reliable assistance in the management of 3-dimensional dentomaxillofacial deformities.

Versatile facial osteotomies

Facial Osteotomy techniques have evolved enormously over the past 20 years providing significant and often life-changing benefits to our dental patients with skeletal malocclusions. Advancements in technology and refined surgical techniques have resulted in improvements in surgical outcomes, a reduction in post-operative complications and a quicker recovery for today's patients undergoing orthognathic surgery. This paper aims to an update on the contemporary approach to the correction of skeletal malocclusions with facial osteotomies.

The Surgical Management of Skeletal Disproportion with Lingual Orthodontics and Three-dimensional Planning

This case report describes the successful treatment of a 26-year-old Caucasian male with skeletal and dental Class III malocclusion associated with mild maxillary and mandibular crowding. The patient had anteroposterior and transverse discrepancies with a reverse overjet and bilateral posterior crossbites. The nonextraction treatment plan included aligning and leveling of the teeth in both arches, Le Fort I and bilateral sagittal split osteotomies, and postsurgical correction of the malocclusion. Orthodontic treatment was initiated with custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Treatment was concluded with detailed orthodontic finishing, achieving optimum esthetics and function.

Duration of orthognathic-surgical treatment

OBJECTIVE

The objective of this study was to determine the duration of orthognathic-surgical treatment conducted with conventional pre- and post-surgical orthodontic treatment phases.

MATERIAL AND METHODS

The study material was comprised of the files of 185 consecutive patients treated in Oral and Maxillofacial Unit, Tampere University Hospital, Finland, in 2007-2014. The files were reviewed and the following data was obtained: gender and age of patients, ICD-10 diagnosis, type of malocclusion, duration of pre- and post-surgical orthodontic treatment and type of operation.

RESULTS

Total treatment duration (median) from placement of separating rings for banding until fixed orthodontic appliances were removed and retention period started was 31.1 months, of which pre-surgical orthodontics took 24.4 months and postsurgical 6.4 months. Treatment duration (median) was in BSSO was 32.1, LeFort 1 30.1 and bimaxillary osteotomy 29.7 months. Orthodontic extractions were performed in 35 patients (19%). If the orthodontic treatment included tooth extraction, the duration of pre-surgical treatment was on average 10 months longer, which is a statistically highly significant difference (p < .001, linear regression).

CONCLUSIONS

Tooth extractions (excluding 3rd molars) included in pre-surgical orthodontic treatment prolong treatment time by an average of 8-9 months.