Long-term dentofacial stability after bimaxillary surgery in skeletal Class III open bite patients

The purpose of this study was to evaluate long-term dentofacial stability after bimaxillary surgery in skeletal Class III open bite patients. Twenty-three Japanese adults (5 males, 18 females) were randomly selected as the experimental group from the files of Tohoku University Dental Hospital according to the following criteria: (1) skeletal Class III malocclusion with anterior open bite, (2) simultaneous Le Fort I and sagittal split ramus osteotomies, and (3) complete set of cephalograms taken at predetermined intervals until 5 years after debonding. Based on the manner of maxillary surgical repositioning, they were divided into the following 2 groups: (1) impaction group of 13 subjects (2 males, 11 females) who had maxillary superior repositioning without rotation of the palatal plane, and (2) rotation group of 10 subjects (3 males, 7 females) who had maxillary repositioning with clockwise rotation of the palatal plane. These patients were compared to a control group of 11 adults (1 male, 10 females) with skeletal Class III malocclusion without open bite who underwent bimaxillary surgery by the same techniques. Our data showed that overbite stability in the rotation group was better than that in the impaction group. This suggests that clockwise rotation of the palatal plane, which moves the anterior maxillary structures down, is an effective way to produce a reasonably stable correction of the anterior open bite. In contrast, superior repositioning of the maxilla that significantly rotates the mandible in the closing direction should be applied with caution.     

成人骨性安氏Ⅱ类1分类错(牙合)的正颌-正畸联合治疗

目的采用正畸-正颌手术联合治疗骨性安氏Ⅱ类Ⅰ分类错(牙合)患者,介绍手术前后正畸及术前的准备工作.方法11例成人骨性安氏Ⅱ类Ⅰ分类错(牙合)患者,均经术前正畸-正颌手术-术后正畸的治疗过程.手术前后正畸目的是矫正上下颌前牙前突,排齐牙列,协调上下牙弓,平整牙(牙合)曲线,建立正颌术后良好的咬合关系.术前准备包括术前电脑模拟手术、模型外科、(牙合)板制作.结果11例患者建立了良好的咬合关系及协调的上下颌骨关系,面容美观改善.结论骨性错(牙合)畸形患者采用正畸-正颌联合治疗,能获得功能和美观的满意效果,术前正畸、电脑模拟手术、模型外科、(牙合)板制作及术后正畸,每一操作步骤的精确到位均十分重要.     

Three-part bi-maxillary osteotomy: a case report involving resorbable plates

This case report describes a patient who presented with a severe class 2 skeletal discrepancy together with a Class II malocclusion and a large anterior open bite. The malocclusion and skeletal discrepancy were managed with a combination of orthodontic and orthognathic treatment. The orthognathic surgery was undertaken following orthodontic decompensation using sectional mechanics to allow a segmental bimaxillary osteotomy and genioplasty to be performed. Although the discrepancy was severe using this combination of treatment, a successful outcome, both facially and occlusally, was achieved.     

常见正颌手术后咬合关系的维护和调整

目的 探讨临床常见的正颌手术后,如何很好的维护和调整上下牙列的咬合关系,为临床提供有益的参考.方法 选择骨性Ⅰ类双颌前突行根尖下截骨后徙术、Ⅱ类下颌后缩行下颌升支矢状劈开前徙术、Ⅲ类骨性反骀行下颌升支骨切开后退及合并上颌前徙术各6例患者,共18例患者.正颌手术后依据分类分别行3种不同的牵引模式进行咬合调整.结果 18例...     

Skeletal Class III and open bite treated with bilateral sagittal split osteotomy and molar intrusion using titanium screws

Two-jaw surgery has been performed for the treatment of severe skeletal open bite cases to obtain stability of occlusion after treatment. If molar intrusion with titanium screws could be performed instead of surgical superior repositioning of the maxilla, the incidence of surgical invasion would be reduced. However, there have been few reports of such a therapy. This case report describes treatment for skeletal Class III and open bite with bilateral sagittal split osteotomy and intrusion of the molars using titanium screws. The patient had a concave profile, a long lower facial height, Class III malocclusion, and excessive anterior open bite following mandibular protrusion and a high mandibular plane angle. The mandible autorotated closed 3.5° following intrusion of the upper and lower molars using titanium screws during the presurgical orthodontic treatment phase. After the autorotation of the mandible, a mandibular setback with a bilateral sagittal split osteotomy was performed. The posttreatment records showed a good facial profile and occlusion. The mandible was stable 1 year after surgery. These results demonstrate that surgical orthodontic treatment combined with bilateral sagittal split osteotomy and intrusion of the molars using titanium screws can reduce the need for surgical invasion by avoidance of maxillary surgery and was effective for correcting the facial profile and occlusion in a skeletal Class III and open bite patient.     

Orthodontic treatment of anterior open bite: a review article—is surgery always necessary?

Introduction

Anterior open bite cases are very difficult to treat satisfactorily because of their multifactorial aetiology and their very high relapse rate. Dependent on the origin of the anterior open bite malocclusion and the patient’s age, there are several treatment possibilities ranging from deterrent appliances, high-pull headgear, fixed appliances with and without extractions to orthognathic surgery, and skeletal anchorage with miniplates or miniscrews.

Methods

The gold standard treatment of skeletal anterior open bite cases is the combined approach of orthodontic treatment with fixed appliances and orthognathic surgery. In recent years, temporary anchorage devices (TAD) have been developed to correct anterior open bites orthodontically. With the introduction of TAD as an effective treatment modality, orthognathic surgery may be avoidable in selected anterior open bite cases.

Conclusion

This is a relatively new technique and to date there remains a lack of evidence of long-term stability of anterior open bite closure with TAD.     

Obwegeser II osteotomy (transoral angle osteotomy) for open bite with skeletal class III deformity

IntroductionThis study evaluated postoperative stability after Obwegeser II osteotomy (transoral angle osteotomy, first reported by Obwegeser 1973) for severe open bite with mandibular prognathism.Patients and methodsThis retrospective study reviewed 20 consecutive patients who underwent only mandibular Obwegeser II osteotomy to correct open bite and mandibular prognathism. Lateral cephalograms were evaluated preoperatively (T1), immediate postoperatively (T2) and at least 6 months after the surgery (T3). Surgical and postsurgical changes in cephalometric measurements were evaluated statistically.ResultsOpen bite with skeletal class III malocclusion was corrected by the Obwegeser II osteotomy alone. After an average of 9.9 ± 5.2 mm of mandibular setback with open bite closure (T2–T1, over-bite change, 5.7 ± 2.4 mm) by counter-clockwise rotation of the mandible, the patients showed 0.8 ± 1.7 mm of horizontal relapse (p > 0.05), 1.1 ± 1.7 mm of vertical relapse at the B point (p = 0.011) and −0.2 ± 1.6 mm of over-bite change postoperatively (T3–T2).DiscussionWith the adequate control of the condylar position with rigid internal fixation, Obwegeser II osteotomy showed acceptable stability after the correction of open bite with mandibular prognathism without a simultaneous maxillary osteotomy. An isolated Obwegeser II osteotomy can be considered a reliable option in cases with moderate to severe open bite with mandibular prognathism when the maxillary osteotomy is not needed if the patients have a well-positioned maxilla.     

Three-part bi-maxillary osteotomy: a case report involving resorbable plates

Abstract

This case report describes a patient who presented with a severe class 2 skeletal discrepancy together with a Class II malocclusion and a large anterior open bite. The malocclusion and skeletal discrepancy were managed with a combination of orthodontic and orthognathic treatment.

The orthognathic surgery was undertaken following orthodontic decompensation using sectional mechanics to allow a segmental bimaxillary osteotomy and genioplasty to be performed. Although the discrepancy was severe using this combination of treatment, a successful outcome, both facially and occlusally, was achieved.     

Open bite: stability after bimaxillary surgery--2-year treatment outcomes in 58 patients

Stability after bimaxillary surgery to correct open bite malocclusion and mandibular retrognathism was evaluated on lateral cephalograms before surgery, 8 weeks post-operatively, and after 2 years. The 58 consecutive patients were treated to a normal occlusion and good facial aesthetics. Treatment included the orthodontic alignment of teeth by maxillary and mandibular fixed appliances, Le Fort I osteotomy, and bilateral sagittal split ramus osteotomy. Twenty-six patients also had a genioplasty. Intra-osseous wires or bicortical screws were used for fixation. Twenty-three patients had maxillo-mandibular fixation (MMF) for 8 weeks or more, six for 4-7 weeks, 14 for 1-3 weeks, and 15 had no fixation. At follow-up 2 years later, the maxilla remained unchanged and the mandible had rotated on average 1.4 degrees posteriorly. Seventeen patients had an open bite. Among them, eight patients had undergone segmental osteotomies. The relapse was mainly due to incisor proclination. The most stabile overbite was found in the group with no MMF after surgery.     

Orthodontic-surgical treatment of Class III malocclusion with mandibular asymmetry

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.     

骨性Ⅲ类错He正畸—外科联合治疗后牙齿长期稳定性研究

目的探讨口腔正畸-正颌外科联合治疗前后不同阶段牙齿的变化和术后的稳定性.方法选取31例在北京大学口腔医学院进行口腔正畸-正颌外科联合治疗的骨性安氏Ⅲ类错(牙合)患者,对其不同阶段X线头影测量片进行研究.结果牙齿在术前正畸阶段有明显的去代偿,下切牙平均唇倾7.08°.在术中,上切牙随颌骨的旋转有直立,下切牙有后移.术后,上切牙有唇向复发,下切牙相对于基骨稳定.术后牙齿保持良好的咬合,而且主要变化发生在术后正畸阶段.结论Ⅲ类错(牙合)患者在术前正畸阶段牙齿明显去代偿,术后上前牙稍有复发,下前牙相对保持稳定.     

Maxillary stability in patients with skeletal class III malocclusion treated by bimaxillary orthognathic surgery: comparison of mandible-first and maxilla-first approaches in a randomised controlled study

The maxilla-first approach has been the standard orthognathic sequence for many years, however, with the evolution of rigid internal fixation and to eliminate any errors that could be encountered during preoperative bite registration, the mandible-first approach has become an effective treatment modality for bimaxillary orthognathic surgery. Would the maxilla-first or mandible-first orthognathic sequence in bimaxillary orthognathic surgery result in more maxillary stability in patients with skeletal class III malocclusion? Twenty-four patients with skeletal class III malocclusion were selected from the outpatient clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. Patients were randomly divided into two equal-sized groups: the maxilla-first approach (group I), and the mandible-first approach (group II). All patients underwent cone-beam computed tomography before, immediately after (P1), and 6 months after surgery (P2). Virtual planning included designing the virtual cuts and the intermediate and final splints. Both splints were three-dimensionally printed. In both approaches, hard and soft tissue landmarks were used as reference points to evaluate maxillary stability, which was calculated by subtracting P2 values from P1 values. All measures were statistically evaluated as numerical values of means and standard deviations. The differences between the radiographic measurements of the two groups were not statistically significant except for the soft tissue inclination at the nasal tip. The mandible-first approach in bimaxillary orthognathic surgery is a reliable method for achieving high maxillary stability.     

Stability of orthodontic-maxillofacial surgical treatment of anterior open bite deformities]

A sample of 267 patients with maxillary hyperplasia, a Class I or Class II occlusion and anterior open bite, collected from three different institutions, was analysed regarding stability after Le Fort I intrusion osteotomies or bimaxillary osteotomies. Skeletal and dento-alveolar stability of the maxilla, postional changes of the mandible and of incisors were evaluated on cephalometric radiographs. The stability of maxillary arch dimensions after correction of the open bite is measured on dental casts. Patients with anterior open bite, treated with a Le Fort I osteotomy in one-piece or in multi-segments, with or without bilateral sagittal split osteotomy exhibited good skeletal stability of the maxilla. Rigid internal fixation showed better maxillary and mandibular stability than intraosseous wire fixation. Considerable relapse of transverse dimensions, however, was measured after orthodontic and surgical expansion. The mean overbite at the 69 months follow-up was 1.24 mm and lacking of overlap between opposing incisors was present in 19%.     

Orthodontic and orthognathic surgical correction of a Class III open bite: a case report

A significant Class III skeletal discrepancy with open bite and excessive lower facial height is presented. The malocclusion was treated with a combination of orthodontics and orthognathic surgery.     

Stability of skeletal class III malocclusion after combined maxillary and mandibular procedures: rigid internal fixation versus wire osteosynthesis of the mandible.

PURPOSE: The aim of this study was to evaluate skeletal stability after double-jaw surgery for correction of skeletal Class III malocclusion to assess whether there were any differences between wire and rigid fixation of the mandible. PATIENTS AND METHODS: Thirty-seven Class III patients had Le Fort I osteotomy stabilized with plate and screws for maxillary advancement. Bilateral sagittal split osteotomy for mandibular setback was stabilized with wire osteosynthesis and maxillomandibular fixation for 6 weeks in 20 patients (group 1) and with rigid internal fixation in 17 patients (group 2). Lateral cephalograms were taken before surgery, immediately after surgery, 8 weeks after surgery, and 1 year after surgery. RESULTS: Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. One year after surgery, maxillary sagittal stability was excellent in both groups, and bilateral sagittal split osteotomy accounted for most of the total horizontal relapse observed. In group 1, significant correlations were found between maxillary advancement and relapse at the posterior maxilla and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. In group 2, significant correlations were found between mandibular setback and intraoperative clockwise rotation of the ramus and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. No significant differences in postoperative skeletal and dental stability between groups were observed except for maxillary posterior vertical position. CONCLUSIONS: Surgical correction of Class III malocclusion after combined maxillary and mandibular procedures appears to be a fairly stable procedure independent of the type of fixation used to stabilize the mandible.     

The stability of bilateral sagittal ramus osteotomy and vertical ramus osteotomy after bimaxillary correction of class III malocclusion

Introduction

The purpose of this retrospective cephalometric study was to compare the stability of bilateral sagittal split osteotomy (BSSO) with extra-oral vertical ramus osteotomy (VRO) after correction of class III malocclusion by means of bimaxillary orthognathic surgery.

Methods

The sample comprised 51 consecutively treated patients, 38 females and 13 males, with a mean age of 19.1 years. All had a one-piece Le Fort I osteotomy with maxillary advancement and mandibular setback. VRO was performed in 30 cases, and BSSO was performed in 21 cases. Lateral cephalograms were obtained before surgery, within 1 week of surgery and 1 year after surgery.

Results

The mean forward movement of the maxilla was 5.6 mm in both groups (p < 0.001). The mean horizontal surgical change in the VRO group was 4.4 mm (p < 0.001), and in the BSSO group it was 5.4 mm (p < 0.001). In the VRO group, the horizontal relapse was 1.2 mm (p < 0.001), and in the BSSO group, it was 1.4 mm (p < 0.001).

Conclusion

There was no difference in the stability between the BSSO and VRO groups. The average relapse in the whole sample was 26% of the surgical movement.     

Orthognathic bimaxillary surgery in two patients with osteogenesis imperfecta and a review of the literature

Orthognathic surgery in patients with osteogenesis imperfecta is rare. Most cases result in a successful outcome with stable and good occlusion. Two patients with, probably severe types III and IV, and malocclusion class III with retrognathic maxilla and prognathic mandible, were treated with orthodontic treatment and bimaxillary surgical correction. The surgical outcome and follow up are presented together with a review of published cases of orthognathic surgery in patients with different types of osteogenesis imperfecta. The authors conclude that it is possible to perform combined orthodontic and orthognathic surgery in patients with osteogenesis imperfecta despite the greater risk of complications. The treatments were successful with follow up times of 5-6 years.     

Long-term stability of anterior open bite closure corrected by surgical-orthodontic treatment

In adults, superior repositioning of posterior maxilla with or without mandibular surgery has become the treatment method of choice to close anterior open bite. Study aim was to examine the long-term stability of anterior open bite closure by superior repositioning of maxilla or by combining maxillary impaction with mandibular surgery. The sample comprised 24 patients who underwent anterior open bite closure by superior repositioning of maxilla (maxillary group, n = 12, mean age 29.3 years) or by maxillary impaction and mandibular osteotomy (bimaxillary group, n = 12, mean age 30.8 years). Lateral cephalograms were studied prior to surgery (T1), the first post-operative day (T2) and in the long term (T3, maxillary group mean 3.5 years; bimaxillary group mean 2.0 years). Paired and two-sample t-tests were used to assess differences within and between the groups. The vertical incisal bite relations were -2.6 and -2.2 mm at T1; 1.23 and 0.98 mm at T2; and 1.85 and 0.73 mm at T3 in the maxillary and bimaxillary groups. At T3, all subjects had positive overbite in the maxillary group, but open bite recurred in three subjects with bimaxillary surgery. For both groups, the maxilla relapsed vertically. Significant changes in sagittal and vertical positions of the mandible occurred in both groups. In the bimaxillary group, the changes were larger and statistically significant. In general, the maxilla seems to relapse moderately vertically and the mandible both vertically and sagittally, particularly when both jaws were operated on. Overbite seems to be more stable when only the maxilla has been operated on.     

Evidence-based orthodontics

Abstract

We describe a 28-year-old man who sought orthodontic treatment complaining about the esthetics of his smile and difficulties associated with masticatory function. The patient had a straight facial profile, skeletal and dental class III relationship, anterior open bite and posterior crossbite. He refused orthognathic surgery and was therefore treated with camouflage orthodontics supplemented with the placement of one mini-implant in each side of the mandible to facilitate movement of the lower dentition distally, tooth-by-tooth. At the end of treatment, a class I molar relationship was obtained, with an ideal overjet and overbite and excellent intercuspation. Furthermore, the open bite and crossbite were corrected. Analysis 2 years after treatment revealed good stability of treatment outcome.     

The impact of Le Fort I advancement and bilateral sagittal split osteotomy setback on ventilation during sleep

The impact of orthognathic surgery for class III malocclusion on ventilation during sleep was examined using a comparison of pre- and post-surgical respiratory parameters. 21 patients with both maxillary hypoplasia and mandibular excess underwent Le Fort I osteotomy and advancement together with bilateral sagittal split osteotomy (BSSO) setback. Respiratory parameters, ECG and position of the body were monitored before surgery and postoperatively after the fixation removal (mean 8.5 months). Average Le Fort I advancement was 4.44 mm, BSSO setback was 4.96 mm. Generally, the orthognathic procedure worsened breathing function during sleep, as reflected in significant increase of index of flow limitations and decrease in oxygen saturation. The posterior airways space decreased to 75% of its original volume, the distance between mandibular plane and hyoid bone increased to 133%. The results indicate that bimaxillary surgery for class III malocclusion increased upper airway resistance. A young person would probably be able to balance such a decline in respiratory function using different adaptive mechanisms, but the potential impact of orthognathic surgery on the upper airways should be incorporated in a treatment plan.