Orthognathic Surgical

Treatment
 Indications for Orthognathic
Surgery
Severity of skeletal and dental malocclusion
When growth modification can not be
achieved
Esthetic and psychosocial considerations
 Timing of Surgery
Usually done when all growth is complete
Assessed by superimposition of serial lat
cephs
Can be performed when growth is not yet
complete in cases of psychosocial
problems or great severity when function
is compromised (i.e. breathing, chewing)
 Orthognathic Surgery
Correction of A-P relationships:
maxillary advancement
retraction of anterior maxillary segment
mandibular advancement
mandibular setback
double jaw surgery
 Orthognathic Surgery
Correction of Vertical Relationships:
maxillary impaction/intrusion
maxillary extrusion
mandibular ramus surgery
 Orthognathic Surgery
Correction of Transverse Relationships:
surgically assisted maxillary expansion
surgically assisted mandibular expansion
 Orthognathic Surgery
Correction of Asymmetries:
maxilla
mandible
maxilla and mandible
 Surgical Techniques
Le Fort III
Le Fort I
Le Fort II
Le Fort III Le Fort II

Le Fort I
 Surgical Techniques
BSSO

Genioplasty
 Pre Surgical Orthodontic
Objectives

To level and align the arches and make

them compatible
to resolve crowding and/or spacing
to establish anteroposterior and vertical
position of incisors (decompensate)
to place teeth relative to their own
supporting bone
Check List for Treatment Planning
A-P relationships maxillary deficiency/protrusion
mand prognathism/deficiency
amount of deficiency
Vertical relationships open bite
deep bite
Transverse relationships crossbites
before surgery expansion
surgically assisted expansion
{ during surgery
Check List for Treatment Planning
Asymmetries cant of occlusal plane
mandible/chin deviation
Occlusal relationships
Missing teeth/ malformed teeth
Genioplasty
Nose/lip relationship - rhinoplasty
 Diagnostic Records

Analysis of pictures
cephalometric analysis
Surgical prediction - STO
model/occlusion analysis
STO-Mandible Only
STO-Maxilla Only
STO-Double Jaw
STO-Double Jaw
 Preparation for Surgery

Removal of third molars 6 months before

mandibular osteotomy
Check for any TMJ problems
Manipulate models mounted in an
articulator to check for interferences and
occlusion
Splint fabrication (1 or 2 splints)
 Mandibular Setback with Maxillary
Advancement and Impaction for Correction
of Prognathism and Open Bite

Prognathic, increased lower facial height, Cl III, open bite,

crowding on the upper arch.
Previous orthodontic treatment with extraction of lower
first premolars.
 Mandibular Advancement for
Correction of Retrognathism

Retrognathic, decreased lower facial height, Cl II, deep bite,

protruded upper incisors, spacing.
Previous orthodontic treatment w/ extraction of upper first
premolars.
Mandibular Setback for with Correction of
Prognathism and Asymmetry
Maxillary Advancement with Le Fort III
for Correction of Maxillary Deficiency
 Maxillary Advancement with Le Fort III
for Correction of Maxillary Deficiency

Additional Le Fort I surgical procedure will be performed

after initial orthodontic treatment has been completed
for correction of maxillary deficiency and open bite.
Post Surgical Orthodontic Treatment
1 week: check occlusion, splint and appliances
4-6 weeks: reinitiate orthodontic tx (after range
of motion and stability are achieved)
remove splint

{ change to light wires and light vertical elastics

treatment usually completed in 4 to 12 months
(average 6 months)
 Relapse and Stability
Rigid fixation has improved stability
Stability is mostly influenced by the pattern
of rotation of the mandible as it is
advanced
Advancement of maxilla and/or mandible
will stretch soft tissues promoting relapse
The more advancement needed, the
greater the probability for relapse
Relapse and Stability
 Distraction Osteogenesis
First described by Ilizarov for limbs
Distraction osteogenesis = callostasis = stretching of a
bone callus
Gradual distraction of bones is accompanied by the
soft tissues = less probability of relapse
Can be performed for the mandible, maxilla, calvarium,
orbit, midpalatal suture and maxillary or mandibular
alveolus
Distraction devices can be internal or external
Internal devices can also be resorbable
Distraction Osteogenesis for the
Mandible
Distraction Osteogenesis for the
Maxilla