Relapse related to pushing and rebounding action in maxillary anterior downgraft with mandibular setback surgery

Early and 1-year postsurgical stability and its factors in patients with complicated skeletal Class Ⅲ malocclusion treated by conventional and surgery-first approach: A prospective cohort study

INTRODUCTION

This study aimed to compare postsurgical stability between conventional (CSA) and surgery-first (SFA) approaches and investigate its prognostic factors in patients with a skeletal Class Ⅲ extraction.

METHODS

Twenty and 19 patients treated with LeFort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) with premolar extraction were enrolled in SFA and CSA groups, respectively. Serial cone-beam computed tomography images obtained before surgery, immediately after surgery (T1), 3 months after surgery, and 12 months after surgery were used for 3-dimensional quantitative analysis. The condyle was segmented for analyzing volumetric changes. Repeated measures analysis of variance, independent t test, and chi-square test were used to compare time-course and intergroup differences. Pearson and Kendall correlation and multivariate linear regression analyses were used to explore prognostic factors affecting skeletal stability.

RESULTS

In both CSA and SFA, postsurgical relapse mainly occurred in the mandible sagittal and vertical dimensions and during the first 3 months after surgery. Stability in SFA was significantly less than that in CSA. Intraoperatively, inferolateral condylar displacement with proximal segment inwards, clockwise rotation, and return movements after surgery were observed regardless of the treatment approach. The condylar volume remained stable over time. Multivariate regression analysis showed that posterior vertical dimension (VD) at T1 (-1.63 mm), surgical amount of mandibular setback (-10.33 mm), surgical condylar downwards displacement (-1.28 mm), and anterior overjet at T1 (6.43 mm) were the most important predictors of early mandibular relapse (r2 = 0.593).

CONCLUSIONS

The risk of early relapse could be reduced by controlling the anterior, middle, and posterior constraints provided by the prediction model.

Complications on maxilar impaction: A systematic review and meta-analysis

OBJECTIVES

Maxillary impactions are seen as an orthognathic surgical movement that increases the number of complications. The aim of this paper is to research literature on this topic, with special attention to avoiding of complications.

METHODS

A systematic review was carried out according to the PRISMA guidelines. The PROSPERO registration has been performed. A risk of bias assessment was carried out with RevMan and graphics were created. A total of 20 articles were included in this systematic review.

RESULTS

Some interesting and conclusive facts about maxillary impactions. Relapses are not common due to the higher bone contact. Bleeding is a common complication due to the location of palatal artery. Aesthetic and functional complications can arise, especially in the nasal region. Bimaxillary orthognathic surgeries has a higher incidence of complications.

CONCLUSIONS

Today it is not possible to confirm that maxillary impactions alone are responsible for a higher incidence of complications due to the complexity of the three-dimensional movements. Some surgical steps could be safer and cause fewer complications.

Implant-supported provisional prosthesis facilitated the minor revision of occlusion and incisor exposure after orthognathic surgery of extended oligodontia in maxilla

Background

The congenital oligodontia in maxilla could result in a significant skeletal jaw malformation such as atrophic maxilla and severe skeletal class III malocclusion. Since there is no referable dentition in anterior maxilla, the orthognathic surgery and oral rehabilitation for those patients becomes more challenging and less predictable.

Materials and methods

We hereby present a new sequencing of interdisciplinary treatments, including calvarial bone grafting, installation of implant-supported provisional prosthesis, bimaxillary orthognathic surgery, and the final installation of dental implants and the fixed prosthesis.

Results

The facial esthetics and function of the permanent prosthesis were satisfactory, with a remarkable improvement in the maxillomandibular relation, adequate horizontal and vertical repositioning of the maxilla, and appropriate incisor exposure.

Conclusion

Although more surgeries and longer treatment period may be required due to the interdisciplinary treatment plan, better aesthetic and functional outcomes may be acquired by this reported procedure in the long-term for young patients.