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Buyukcavus MH, Findik Y. Short-term treatment of skeletal class III malocclusion by surgery-first approach with SDU protocol. BMJ Case Rep 2024; 17:e255880. [PMID: 38782430 DOI: 10.1136/bcr-2023-255880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
The aim of this case series is to present the successful treatments and long-term results of three adult skeletal class III patients treated with the surgery-first (SF) approach by applying the SDU (Suleyman Demirel University) protocol and to discuss the differences, advantages and disadvantages compared with other methods. Although there were differences in the treatment planning and surgical procedures of the three patients in the case series, the same protocol was followed in all three patients. The desired aesthetic result and functional occlusion were achieved with the SF approach. Significant improvement was observed in the patients' profile and facial appearance in a short time. The total duration of treatment for all cases was less than a year.
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Affiliation(s)
| | - Yavuz Findik
- Oral and Maxillofacial Surgery, Suleyman Demirel University, Isparta, Turkey
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2
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Saghafi H, Benington P, Ju X, Ayoub A. The surgery-first approach for orthognathic correction of maxillary deficiency-is it stable? Three-dimensional assessment of CBCT scans and digital dental models. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00055-9. [PMID: 38448352 DOI: 10.1016/j.ijom.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
The aim of this study was to determine the skeletal stability of Le Fort I maxillary advancement following the surgery-first approach, by three-dimensional (3D) assessment of cone beam computed tomography (CBCT) scans and digital dental models. CBCT scans of 25 class III patients obtained 1 week preoperatively (T0) and 1 week (T1) and 6 months (T2) postoperatively were superimposed to measure surgical movements (T0-T1) and skeletal relapse (T1-T2). The distorted dentition of the CBCT scans at T1 was replaced with 3D images of the dental models to assess the postoperative occlusion. Surgical movements of the maxilla (mean ± standard deviation values) were 6.79 ± 2.30 mm advancement, 1.28 ± 1.09 mm vertically, and 0.71 ± 0.79 mm mediolaterally. Horizontal rotation (yaw) was 1.56° ± 1.21°, vertical rotation (pitch) 1.86° ± 1.88°, and tilting (roll) 1.63° ± 1.54°. At T2, the posterior relapse was 0.72 ± 0.43 mm (P = 0.001) and relapse in pitch was 1.56° ± 1.42° (P = 0.007). There was no correlation between the size of the surgical movements and the amount of relapse. A weak correlation was noted between the number of teeth in occlusal contact immediately following surgery and relapse of maxillary roll (r = - 0.434, P = 0.030). The stability of maxillary advancement with the surgery-first approach was satisfactory and was not correlated with the quality of the immediate postoperative occlusion.
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Affiliation(s)
- H Saghafi
- Glasgow University Dental Hospital and School, Glasgow, UK
| | - P Benington
- Glasgow University Dental Hospital and School, Glasgow, UK
| | - X Ju
- Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Hospital, Glasgow, UK
| | - A Ayoub
- Glasgow University Dental Hospital and School, Glasgow, UK.
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3
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Li M, Shen S, Huang J, Wang Y, Bao J, Wang B, Yu H. The Skeletal Stability of Combined Surgery First Approach and Clear Aligners in Skeletal Class III Malocclusion Correction: A Randomized Controlled Trial. J Clin Med 2024; 13:872. [PMID: 38337567 PMCID: PMC10856092 DOI: 10.3390/jcm13030872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/13/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
The surgery first approach (SFA) and clear aligners technique can address traditional treatment defects, such as prolonged waiting times for surgery and a less desirable facial appearance due to wire aligners. However, the curative effect of the combination remains uncertain. The randomized controlled study aimed to evaluate the skeletal stability of the SFA compared to the conventional orthodontic first approach (OFA), both of which were applied with clear aligners. A total of 74 participants were randomly allocated to two groups: the SFA group (experimental) and the OFA group (control). The skeletal deviation was calculated using reconstruction models from computed tomography scans taken immediately and 6 months after surgery. The largest median deviations were detected in the y-axis of the mandible for both two groups, separately 1.36 mm in the experimental group and 1.19 mm in the control group. Apart from the maxillary yaw dimension (p = 0.005), there were no significant differences between the two groups in terms of linear and angular deviation. The experimental group had an overall treatment time of 18.05 ± 2.53 months, while the control group took 22.83 ± 3.60 months (p < 0.05). Therefore, the combined surgery-first and clear aligners treatment can achieve comparable skeletal stability to the conventional approach, while also saving significant time.
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Affiliation(s)
- Meng Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Jingyang Huang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Yiming Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Jiahao Bao
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Bo Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
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Barone S, Muraca D, Averta F, Diodati F, Giudice A. Qualitative and quantitative assessment of condylar displacement after orthognathic surgery: A voxel-based three-dimensional analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:685-690. [PMID: 34763135 DOI: 10.1016/j.jormas.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/17/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to evaluate the morphometric changes in the position of the mandibular condyles before and after orthognathic surgery. METHODS A retrospective single-center cohort study was conducted and included patients with a presurgical (T1) and postsurgical (T2) Cone Beam computed tomography (CBCT). The primary predictor variable was the orthognathic surgical treatment. Pre-operative and post-operative CBCT scans were superimposed using voxel-based registration. Semitransparent overlays of the models of condylar regions at T1 and T2 were created for the qualitative analysis. The primary outcome variable was the quantitative displacement of condyles (CoR; CoL) analyzed in X, Y, Z axis and the 3D distances. Descriptive and bivariate statistical analysis was performed, setting α=0.05. RESULTS The study sample included 33 patients (mean age: 25.33±2.49 years) affected by skeletal class III malocclusion with or without skeletal asymmetry. The X-axis showed a mean movement of 0.25 ± 0.17 mm for CoR, and 0.52 ± 0.51 mm for CoL. The Y-axis showed a mean movement of 0.29 ± 0.2 mm for CoR, and 0.51 ± 0.8 mm for CoL. The Z-axis was 0.33 ± 0.2 mm for CoR, and 0.5 ± 0.49 mm for CoL. No statistically significant difference was calculated comparing the movement of condylar surface between asymmetric and not asymmetric patients (p = 0.26 for CoR; p = 0.13 for CoL). No statistically significant difference was found in intercondylar distance between T1 and T2 (p = 0.39). CONCLUSION No statistically nor clinically significant condylar displacement are recorded in orthognathic surgery patients at 12 to 18 months of follow-up.
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Affiliation(s)
- Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Danila Muraca
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Fiorella Averta
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Federica Diodati
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Oral and Maxillofacial Surgeon, Professor, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa 88100 Catanzaro, Italy.
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Liao YF, Atipatyakul P, Chen YH, Chen YA, Yao CF, Chen YR. Skeletal stability after bimaxillary surgery with surgery-first approach for class III asymmetry is not related to virtual surgical occlusal contact. Clin Oral Investig 2022; 26:4935-4945. [PMID: 35313356 DOI: 10.1007/s00784-022-04462-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Surgery-first orthognathic surgery is rarely used in class III asymmetry due to concerns of reduced skeletal stability from unstable surgical occlusion. This study aimed to evaluate if skeletal stability after surgery-first orthognathic surgery is related to virtual surgical occlusal contact or surgical change. MATERIALS AND METHODS We studied 58 adults with class III asymmetry, consecutively corrected by Le Fort I osteotomy and bilateral sagittal split osteotomy using a surgery-first approach. Dental casts were manually set to measure virtual surgical occlusal contact including contact distribution, contact number, and contact area. Cone-beam computed tomography taken before treatment, 1-week post-surgery, and after treatment was used to measure surgical change and post-surgical stability of the maxilla and mandible in translation (left/right, posterior/anterior, superior/inferior) and rotation (pitch, roll, yaw). The relationship between skeletal stability and surgical occlusal contact or surgical change was evaluated with correlation analysis. RESULTS Significant instability was found in the mandible but not in the maxilla. No correlation was found between the maxillary or mandibular stability and surgical occlusal contact (all p > 0.01). However, a significant correlation was found between the maxillary (roll and yaw) or mandibular (shift, roll and pitch) stability and its surgical change (all p < 0.001). CONCLUSIONS In correction of class III asymmetry with surgery-first bimaxillary surgery, the skeletal stability is not related to the virtual surgical occlusal contact, but surgical skeletal change. CLINICAL RELEVANCE Planned over-correction is a reasonable option for correction of severe shift or roll mandibular asymmetry in bimaxillary surgery for class III deformity.
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Affiliation(s)
- Yu-Fang Liao
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Guishan District, Taoyuan, 333, Taiwan. .,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Piengkwan Atipatyakul
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsuan Chen
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Guishan District, Taoyuan, 333, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-An Chen
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chuan-Fong Yao
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Ray Chen
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Skeletal Stability after Mandibular Setback via Sagittal Split Ramus Osteotomy Verse Intraoral Vertical Ramus Osteotomy: A Systematic Review. J Clin Med 2021; 10:jcm10214950. [PMID: 34768470 PMCID: PMC8584578 DOI: 10.3390/jcm10214950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose: The purpose of present study was to review the literature regarding the postoperative skeletal stability in the treatment of mandibular prognathism after isolated sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO). Materials and Methods: The articles were selected from 1980 to 2020 in the English published databases (PubMed, Web of Science and Cochrane Library). The articles meeting the searching strategy were evaluated based on the eligibility criteria, especially at least 30 patients. Results: Based on the eligibility criteria, 9 articles (5 in SSRO and 4 in IVRO) were examined. The amounts of mandibular setback (B point, Pog, and Me) were ranged from 5.53–9.07 mm in SSRO and 6.7–12.4 mm in IVRO, respectively. In 1-year follow-up, SSRO showed the relapse (anterior displacement: 0.2 to 2.26 mm) By contrast, IVRO revealed the posterior drift (posterior displacement: 0.1 to 1.2 mm). In 2-year follow-up, both of SSRO and IVRO presented the relapse with a range from 0.9 to 1.63 mm and 1 to 1.3 mm respectively. Conclusion: In 1-year follow-up, SSRO presented the relapse (anterior displacement) and IVRO posterior drift (posterior displacement). In 2-year follow-up, both of SSRO and IVRO showed the similar relapse distances.
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Park YW, Kwon KJ, Kang YJ, Jang IS. Surgery-first approach reduces the overall treatment time without damaging long-term stability in the skeletal class III correction: a preliminary study. Maxillofac Plast Reconstr Surg 2021; 43:27. [PMID: 34273017 PMCID: PMC8286210 DOI: 10.1186/s40902-021-00304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/10/2021] [Indexed: 12/04/2022] Open
Abstract
Background Compared to the conventional approach, including preoperative orthodontic preparation, the so-called surgery-first approach (SFA) seems to reduce the overall treatment time in the correction of skeletal class III dentofacial deformity. However, there have been controversies about postoperative skeletal stability with SFA. Therefore, we investigated the long-term stability and the overall treatment time after maxillomandibular surgery for skeletal class III correction with or without preoperative orthodontic preparation. Methods This retrospective study included eight patients who underwent maxillomandibular surgery for class III correction with the SFA (SFA group) and 20 patients who underwent the conventional approach (CA group). A comparative study of the change in the maxillary and mandibular position on preoperative (T1), 1-day (T2), 6-month (T3), and 2-year (T4) postoperative lateral cephalograms. We calculated the overall treatment time for each group. Results At the presurgical stage (T1), there was no bias in the skeletal features between the two groups. In the surgical change from T1 to T2, the mandible (point B) of the CA group was significantly moved superiorly. Short-term changes from T2 to T3 revealed that the mandible moved forward in both groups, whereas the maxillary position showed no significant changes. Long-term changes from T3 to T4 demonstrated that none of the measured parameters showed any significant differences. Finally, the average of overall treatment time was 15.1 months in the SFA group and 26.0 months in the CA group. Conclusions These findings suggest that SFA in bimaxillary orthognathic surgery for skeletal class III correction leads to predictable long-term skeletal stability, similar to surgery with CA. Furthermore, SFA reduced the overall treatment time compared to CA.
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Affiliation(s)
- Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7, Jukheon-gil, Gangneung-si, Gangwon-do, 25457, South Korea.
| | - Kwang-Jun Kwon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7, Jukheon-gil, Gangneung-si, Gangwon-do, 25457, South Korea
| | - Yei-Jin Kang
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7, Jukheon-gil, Gangneung-si, Gangwon-do, 25457, South Korea
| | - In-San Jang
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
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Vamvanij N, Chinpaisarn C, Denadai R, Seo HJ, Pai BCJ, Lin HH, Lo LJ. Maintaining the space between the mandibular ramus segments during bilateral sagittal split osteotomy does not influence the stability. J Formos Med Assoc 2021; 120:1768-1776. [PMID: 33775535 DOI: 10.1016/j.jfma.2021.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/PURPOSE Three-dimensional computer-assisted orthognathic surgery allows to simulate the space between the mandibular ramus segments, i.e. intersegmental gap, for the correction of facial asymmetry. The purposes of the study were to estimate the screws- and mandible bone-related changes from the early postoperative period to the period after the debonding and to measure the association between the intersegmental gap volume and the screws- and mandible bone-related changes. METHODS This cone-beam computed tomography (CBCT)-assisted retrospective study assessed the stability of the bicortical positional screw fixations in maintaining the space between the mandibular ramus segments after bilateral sagittal split osteotomy in correction of 31 patients with malocclusion and facial asymmetry. The primary predictor variable was the CBCT-based intersegmental gap volume at early postoperative period (T1). The primary outcome variables were CBCT-based screws- and bone-related measurement changes between the T1 and T2 (at debonding) periods. RESULTS No significant differences were observed in screws-related linear and angular measurements between T1 and T2 virtual models. Some of mandible bone-related linear and angular measurements had significant differences (P < 0.05) between the T1 and T2 images, but with no clinical repercussion such as need of revisionary surgery. The gap volume and the screws- and bone-related changes had no significant correlations. CONCLUSION This study contributes to the multidisciplinary-related literature by demonstrating that the bicortical positional screws-based fixation technique in maintaining the three-dimensional-simulated space between the mandibular ramus segments is a stable and clinically acceptable option for correction of facial asymmetry associated with malocclusion, regardless of intersegmental gap size.
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Affiliation(s)
- Natthacha Vamvanij
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chatchawarn Chinpaisarn
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty C J Pai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Lin CL, Chen YA, Yao CF, Chang CS, Liao YF, Chen YR. Comparative stability and outcomes of two surgical approaches for correction of class III asymmetry with lip or occlusal cant. Clin Oral Investig 2021; 25:5449-5462. [PMID: 33641063 DOI: 10.1007/s00784-021-03853-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess and compare the stability and outcomes of the two surgical approaches for patients with roll asymmetry. MATERIALS AND METHODS A total of 50 adult patients were consecutively recruited for this prospective study. Patients with class III asymmetry and lip or occlusal cant who underwent bimaxillary surgery were grouped according to surgical approach: asymmetric posterior impaction on both sides (API, n = 31) and posterior impaction on one side and posterior extrusion on the other side (PIE, n = 19). Postsurgical stability and outcomes between groups were determined with cone-beam computed tomography for facial midline, lip, and occlusal cant at 1 week (T1), and at least 12-month postsurgery (T2, completion of orthodontic treatment). RESULTS Presurgery, the upper anterior occlusal cant and lip cant were significantly greater for the PIE group (p < 0.05). Postsurgery (T2), the mandible moved upward and rotated upward in both groups. However, the upward rotation was significantly greater in the PIE group compared with the API group. Although the two approaches resulted in significant improvements in facial symmetry, the deviation in the facial midline remained under-corrected for most API patients. CONCLUSIONS Patient outcomes for mandibular stability and facial symmetry differed between the two surgical approaches for correction of class III asymmetry with lip or occlusal cant. CLINICAL RELEVANCE The findings of this study suggest that planned over-correction is a reasonable option for the approach of asymmetric posterior impaction on both sides.
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Affiliation(s)
- Chih-Ling Lin
- New Taipei City Municipal TuCheng Hospital (Chang Gung Memorial Hospital, TuCheng), Taipei, Taiwan.,Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ying-An Chen
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chuan-Fong Yao
- New Taipei City Municipal TuCheng Hospital (Chang Gung Memorial Hospital, TuCheng), Taipei, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Shin Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Fang Liao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road Guishan District, Taoyuan City, 333, Taiwan.
| | - Yu-Ray Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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10
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Furtado L, Borges T, Sol I, de Castro Rodrigues C, Peres Lima FG, Silva C. Surgery first approach in orthognathic surgery - Considerations and clinical case report. Ann Maxillofac Surg 2021; 11:349-351. [PMID: 35265514 PMCID: PMC8848694 DOI: 10.4103/ams.ams_8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/13/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
The Rationale: The surgery first approach is a safe and stable procedure for the correction of dentofacial deformities that requires little orthodontic correction, leading to a faster return of functions. Patient Concerns: Patient with facial discrepancies seeks treatment that returns function and aesthetics, requiring a less prolonged treatment with adequate results. Diagnosis: Clinical, facial, and radiological image analysis was used for diagnosis and treatment plan. Treatment: Surgery first approach was performed in a patient with facial pattern II dolichocephalic, vertical maxillary excess, mandibular growth deficiency, aesthetic, and functional complaints, with the completion of the orthodontic treatment in 15 months. Outcomes: Follow-up of 36 months showed no evidence of recurrence of the initial condition and occlusal stability was maintained. The patient had no more functional and aesthetic complaints. Take-away Lessons: Aesthetic and functional improvements were observed more rapidly due to the correction of the skeletal deformity, with improvement in behavior and self-esteem.
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11
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Insawak R, Lin CH, Chen YA, Ko EWC. Comparison of 3-dimensional postoperative dental movement in Class III surgical correction with and without presurgical orthodontic treatment. Biomed J 2020; 44:S282-S295. [PMID: 35292268 PMCID: PMC9068748 DOI: 10.1016/j.bj.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/11/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background Surgery-first approach (SFA) is an emerging concept that surgically reposition the jaw bones without presurgical orthodontic treatment phase. The study investigated 3D dental movement in the postoperative orthodontic phase with orthodontic-first (OF) and SFA in orthognathic surgery (OGS). Methods This study included consecutive 40 patients (20, SF group; 20, OF group) skeletal Class III who underwent 2-jaw OGS correction. The data of cone-beam computed tomography were acquired at 3 stages with the scan of dental models to replace the dentition of the craniofacial images; at before OGS (T0), 1 week after OGS (T1) and at the completion of treatment (T2). The skeletal changes were obtained by overall superimposition. The post-operative dental movement was measured by 3D regional superimposition between T1 and T2. Results There were no significant difference in the postsurgical orthodontic movement in both groups except significant upper and lower molars extrusion by 2 mm in the SF group. Both groups exhibited no significant difference in mandibular stability in sagittal and vertical directions. The amount of extrusion in the molars was correlated with a postoperative sagittal mandibular forward movement. The total treatment duration was significantly shorter 230 days in the SF group. Conclusion The completion of the orthodontic treatment after OGS in the SFA was mainly accomplished through molar extrusive movement in both arches. The surgical setup of dental occlusion with 4 mm posterior open bite could be corrected during the postsurgical orthodontics in SFA through molar extrusion. The dental occlusion outcome was no different between OF and SFA.
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Affiliation(s)
- Rutapakon Insawak
- Graduate Institute of Craniofacial and Oral Science, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hui Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ying-An Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ellen Wen-Ching Ko
- Graduate Institute of Craniofacial and Oral Science, Chang Gung University, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Postsurgical changes of mandible based on vertical dimension increase in Skeletal Class III deformities. J Craniomaxillofac Surg 2020; 48:1100-1105. [PMID: 33191113 DOI: 10.1016/j.jcms.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/29/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate the postsurgical mandibular changes after surgery based on vertical dimension increase in skeletal Class III deformities. Patients who underwent mandibular setback surgery for skeletal Class III malocclusion correction with surgery-first orthognathic treatment were enrolled in the study. Lateral cephalograms were obtained at initial visit, immediately after surgery, 6 months after surgery, and at post-treatment. Postsurgical change of the mandible based on the vertical dimension increase was estimated using a diagrammatic method before surgery and this amount was compared with the actual amount of mandibular forward movement at 6 months after the surgery, using a paired t-test and Bland-Altman plot. Thirty patients (16 men and 14 women; mean age, 22.6 years) with skeletal Class III deformities had undergone mandibular setback surgery with the surgery-first orthognathic treatment. Immediately after surgery, the mandible setback was 9.4 ± 3.7 mm at pogonion. Six months after surgery, the mandible moved forward at an average of 2.3 ± 1.5 mm which corresponded to the estimated value of 2.2 ± 0.9 mm. The estimated amount of postsurgical movement did not show a statistically significant difference from the actual value on paired t-test (p = 0.349). The Bland-Altman analysis showed that the difference between the two values was within the limits of agreement. The postsurgical changes based on vertical dimension increase in surgery-first orthognathic treatment might be predicted by using a diagrammatic method.
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13
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Hosseinzadeh Nik T, Gholamrezaei E, Keshvad MA. Facial asymmetry correction: From conventional orthognathic treatment to surgery-first approach. J Dent Res Dent Clin Dent Prospects 2019; 13:311-320. [PMID: 32190216 PMCID: PMC7072083 DOI: 10.15171/joddd.2019.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The surgery-first approach (SFA), which proceeds without presurgical orthodontic treatment, is assumed to shorten the treatment course because the direction of post-surgical orthodontic tooth movement conforms to the normal muscular forces.
Moreover, the regional acceleratory phenomenon (RAP), evoked by surgery, helps in tooth alignment and compensation in a
faster way. Although SFA has definite advantages, especially in class III individuals, there is a lack of data about its indications
in patients with facial asymmetry. In this article, we reviewed recently published articles on the treatment of asymmetric
patients using the SFA. Different aspects, including the three-dimensional assessment of stability in different planes, approaches for fabrication of a surgical splint, predictability of the results, skills needed for bimaxillary surgery, indications as
the treatment of choice for condylar hyperplasia, and combination with distraction osteogenesis in candidates with severe
asymmetries were found to be the main topics discussed for patients presenting with facial asymmetry
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Affiliation(s)
- Tahereh Hosseinzadeh Nik
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Gholamrezaei
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Keshvad
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Jeyaraj P, Chakranarayan A. Rationale, Relevance, and Efficacy of "Surgery First, Orthodontics Later" Approach in the Management of Cases of Severe Malocclusion with Skeletal Discrepancy. Ann Maxillofac Surg 2019; 9:57-71. [PMID: 31293931 PMCID: PMC6585223 DOI: 10.4103/ams.ams_272_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A good esthetic outcome and optimal functional occlusion is the goal of management of any dentofacial anomaly. Conventional orthognathic surgery, as commonly practiced, entails a rather long-drawn management protocol comprising a triphasic treatment approach, with the surgical procedure being both preceded and followed by pre- and post-surgical orthodontics, respectively. This has numerous well-known drawbacks such as an uncertain and unpredictable patient compliance and poor motivation due to the inevitably long duration of orthodontic therapy; a transient and temporary worsening of the facial appearance brought about by presurgical orthodontic decompensation of occlusal relationships; and the inevitably prolonged time frame involved in ultimately achieving the desired esthetic and functional results. Further, unforeseen interruptions along the course of the long treatment period can result in unfavorable and even disastrous outcomes. The newer concept and technique of “Surgery First Orthodontics After” (SFOA) approach or “surgery-first approach” (SFA) entails first performing orthognathic surgery, thereafter following it up and finishing the case with postsurgical orthodontic settling and correction of the occlusion. It has two very distinct advantages over the erstwhile approach, first, an immediate and early correction of the facial deformity resulting in a remarkable improvement in facial appearance, which in most cases was what had prompted the patient to seek treatment for, in the first place. The patient, encouraged and motivated by the obvious and appreciable esthetic results, complies willingly and well with the subsequent postsurgical orthodontic treatment, even if it is lengthy or inconvenient, thus ensuring an optimal ultimate occlusion with complete functional rehabilitation as well. The second advantage of SFA is a markedly reduced overall treatment time, which is greatly appreciated by the patients. This article presents three cases of severe malocclusion with associated skeletal discrepancies, treated expeditiously and effectively using the SFA protocol. The overviews of SFA, including its rationale and relevance, indications, general and specific guidelines, different protocol variations, clinical outcome and success rate, as well as possible complications and potential problems encountered with this novel treatment protocol are also discussed.
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Affiliation(s)
- Priya Jeyaraj
- Military Dental Centre, Secunderabad, Telangana, India
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15
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Skeletal stability in orthognathic surgery with the surgery first approach: a systematic review. Int J Oral Maxillofac Surg 2019; 48:930-940. [DOI: 10.1016/j.ijom.2019.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/20/2018] [Accepted: 01/08/2019] [Indexed: 11/21/2022]
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16
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Sun L, Lee KM. Three-Dimensional Evaluation of the Postsurgical Stability of Mandibular Setback With the Surgery-First Approach: Comparison Between Patients With Symmetry and Asymmetry. J Oral Maxillofac Surg 2019; 77:1469.e1-1469.e11. [DOI: 10.1016/j.joms.2019.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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17
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Lo SH, Chen YA, Yao CF, Liao YF, Chen YR. Is skeletal stability after bimaxillary surgery for skeletal class III deformity related to surgical occlusal contact? Int J Oral Maxillofac Surg 2019; 48:1329-1336. [PMID: 30954332 DOI: 10.1016/j.ijom.2019.03.895] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
A stable occlusion at the time of surgery is considered important for post-surgical stability after orthognathic surgery. The aim of this study was to determine whether skeletal stability after bimaxillary surgery using a surgery-first approach for skeletal class III deformity is related to the surgical occlusal contact or surgical change. Forty-two adult patients with a skeletal class III deformity corrected by Le Fort I osteotomy and bilateral sagittal split osteotomy with a surgery-first approach were studied. Dental models were set and used to measure the surgical occlusal contact, including contact distribution, contact number, and contact area. Cone beam computed tomography was used to measure the surgical change (amount and rotation) and post-surgical skeletal stability. The relationship between skeletal stability and surgical occlusal contact or surgical change was evaluated. No relationship was found between maxillary or mandibular stability and surgical occlusal contact. However, a significant relationship was found between maxillary and mandibular stability and the amount and rotation of surgical change. The results suggest that in the surgical-orthodontic correction of skeletal class III deformity with a surgery-first approach, the post-surgical skeletal stability is not related to the surgical occlusal contact but is related to the surgical change.
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Affiliation(s)
- S H Lo
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-A Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - C-F Yao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Y-F Liao
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Y-R Chen
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
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18
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Choi TH, Kim SH, Yun PY, Kim YK, Lee NK. Factors Related to Relapse After Mandibular Setback Surgery With Minimal Presurgical Orthodontics. J Oral Maxillofac Surg 2019; 77:1072.e1-1072.e9. [PMID: 30707985 DOI: 10.1016/j.joms.2018.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/08/2018] [Accepted: 12/25/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The aims of this study were to compare the presurgical conditions, surgical changes, and postsurgical changes in patients with skeletal Class III malocclusion with different degrees of horizontal relapse after mandibular setback surgery (MS) with minimal presurgical orthodontics (MPO) and to identify the factors contributing to this relapse. MATERIALS AND METHODS For this retrospective study, 33 consecutive patients who underwent MS-MPO were selected. Lateral cephalograms were taken preoperatively (T0), 1 month after surgery (T1), and at orthodontic debonding (T2). Patients were divided into low relapse (LR; n = 18; relapse, <1 mm) and high relapse (HR; n = 15; relapse, >2 mm) groups based on the cephalometric distance of mandibular horizontal relapse. Paired t test, independent t test, and Pearson correlation analysis were used to evaluate surgical (T0 to T1) and postsurgical (T1 to T2) changes in the skeletodental variables and to explore the relation between surgical changes and horizontal relapse. RESULTS Compared with the LR group, the HR group exhibited more upward movement with counterclockwise rotation of the mandible from T1 to T2. The HR group presented at T0 with a more prognathic mandible, greater vertical facial height, and a positive overbite. In addition, the HR group presented more posterior movement with clockwise rotation of the mandible, increased overjet, and decreased overbite from T0 to T1. Horizontal relapse of the mandible was positively correlated with the amount of setback and clockwise rotation of the mandible and the change in overjet and was negatively correlated with the change in overbite. CONCLUSIONS Mandibular instability was related to the extent of setback and clockwise rotation of the mandible, decreased overbite, and increased overjet during MS-MPO.
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Affiliation(s)
- Tae-Hyun Choi
- Clinical Assistant Professor, Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So-Hyun Kim
- Resident, Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pil-Young Yun
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Kim
- Professor, Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nam-Ki Lee
- Professor, Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Korea.
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19
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Relapse tendency after BSSO surgery differs between 2D and 3D measurements: A validation study. J Craniomaxillofac Surg 2018; 46:1893-1898. [PMID: 30301651 DOI: 10.1016/j.jcms.2018.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022] Open
Abstract
Bilateral sagittal split ramus osteotomy (BSSO) surgery is used to correct various dento-skeletal deformities. Clinical outcomes are critically dependent on accurate and proper positioning of skeletal units created by BSSO. Monitoring skeletal changes postoperatively is a major part of follow-up. Between January 2015 and December 2015, 24 patients underwent BSSO surgery without any other segmental osteotomy (mean age, 29.9 ± 14.2 [range, 17-67] years; 18 females). Cephalometric X-rays and cone-beam computed tomography scans were performed 6 weeks and 12 months postoperatively. We compared the position displacement at three mandibular points at both postoperative time points using 2- and 3-dimensional analysis separately and examined the relationship between these methods. Horizontally in at least in 14/24 patients, the difference between 2-dimensional and 3-dimensional measurements was >1 mm. Vertically in at least in 16/24 patients, the difference between 2-dimensional and 3-dimensional measurements was >1 mm. A scatter plot with orthogonal regression indicated the relationships between the 2-dimensional measurement and the corresponding 3-dimensional measurement in the horizontal and vertical directions. Skeletal relapse with 2-dimensional-measurements differed significantly from the 3-dimensional measurements. There was no evidence of a relationship between the two types of measurements regarding the direction and the location of the landmarks.
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20
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Relapse related to pushing and rebounding action in maxillary anterior downgraft with mandibular setback surgery. J Craniomaxillofac Surg 2018; 46:1336-1342. [PMID: 29859817 DOI: 10.1016/j.jcms.2018.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Maxillary downgraft (MD) and mandibular setback (MS) are problematic procedures in terms of postoperative stability. While the amount of intraoperative clockwise rotation (CWR) of the proximal segment (PS) after MS combined with MD has a positive correlation with the amount of MD, mandibular relapse after MS with MD in relation to intraoperative CWR of the PS has not been reported. Moreover, the effect of mandibular relapse on maxillary stability after MS with MD remains unclear. The purpose of this study is to evaluate mandibular and maxillary stability after MS with MD in relation to intraoperative CWR of the PS and amount of MD. MATERIALS AND METHODS The study included 57 patients who underwent bimaxillary orthognathic surgery. Patients were classified into two groups according to whether MD was performed or not performed: Group I had 2 mm or more MD; and Group II had less than 2 mm MD including vertical impaction or no vertical changes. The amount of surgical movement and postoperative relapse were cephalometrically evaluated and statistically analyzed. RESULTS There was no significant difference in MS between Groups I and II, however, the vertical movement of the maxilla was different significantly (p < 0.001). In Group I, the intraoperative CWR and postoperative CCWR of the PS was greater than that of Group II (p = 0.010; p < 0.001, respectively). Consequently, the anterior relapse of the mandible was greater in Group I than in Group II despite the same amount of MS in Groups I and II. In Group I, with direct bone contact using Le Fort I inclined osteotomy, vertical relapse at point A showed no statistical correlation with anterior relapse at point B, while the vertical and horizontal dental relapse at U1 showed significant correlations with anterior relapse at point B (r = -0.403, p = 0.030; r = 0.581, p < 0.001, respectively). CONCLUSION For more stable results, Le Fort I inclined osteotomy is recommended to obtain direct bone contact when moving the maxilla inferiorly. The PS must also be fixed while maintaining vertical bone step to prevent CWR.
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Wei H, Liu Z, Zang J, Wang X. Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:107-116. [PMID: 29631986 DOI: 10.1016/j.oooo.2018.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/09/2018] [Accepted: 02/25/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE There are conflicting views on the postoperative stability of surgery-first and surgery-early approaches in orthognathic surgery. We systematically reviewed the literature to compare the difference in postoperative stability between a surgery-first/early orthognathic approach (SFEA) and a conventional orthodontics-first approach (COA). STUDY DESIGN PubMed, Embase, and Cochrane Library were searched for studies related to the postoperative stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted mean differences with 95% confidence intervals were pooled using a random-effects model. RESULTS We analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifested less postoperative stability than COA group (weighted mean difference, 1.50; P < .00001), with moderate heterogeneity (I2 = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis conducted by omitting one study at a time further validated the robustness of the result. CONCLUSIONS Based on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postoperative stability than in the COA group. Patient screening and treatment plans should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.
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Affiliation(s)
- Hongpu Wei
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Zhixu Liu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiajie Zang
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
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Guo J, Wang T, Han JJ, Jung S, Kook MS, Park HJ, Oh HK. Corrective outcome and transverse stability after orthognathic surgery using a surgery-first approach in mandibular prognathism with and without facial asymmetry. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:S2212-4403(18)30053-1. [PMID: 29545077 DOI: 10.1016/j.oooo.2018.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/06/2017] [Accepted: 01/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate corrective outcome and transverse stability after orthognathic surgery via a surgery-first approach (SFA) in mandibular prognathism with and without facial asymmetry using 3-dimensional analysis. STUDY DESIGN Twenty-nine patients who received mandibular setback surgery using SFA were divided into 2 groups according to the menton deviation (4 mm): symmetry group (n = 17) and asymmetry group (n = 12). Using computed tomography images obtained before (T0), immediately after (T1), and 6 months after (T2) surgery, time-dependent changes in variables related to facial asymmetry, including maxillary height, ramal length, frontal and lateral ramal inclination, mandibular body length, and mandibular body height, were evaluated. RESULTS Immediately after surgery, the asymmetry group showed significantly decreased discrepancies between the longer and non-longer sides for all variables (P < .05); there were no significant differences in discrepancies between the 2 groups. During the postoperative period, no significant changes in discrepancies were found in any variable in either group. Compared with T0, the asymmetry group showed significantly decreased discrepancies in ramal length, frontal and lateral ramal inclination, and mandibular body length at T2. CONCLUSIONS Variables related to facial asymmetry showed significant improvement after surgical-orthodontic treatment using SFA, and corrected outcomes showed good postoperative stability in both the symmetry and asymmetry groups.
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Affiliation(s)
- Jinyuan Guo
- Graduate Dental School, Chonnam National University, Gwangju, Republic of Korea
| | - Tongyue Wang
- Department of Oral and Maxillofacial Surgery, Dalian Medical University, Dalian, PR China
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea.
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
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