51
|
The Effect of a Condylar Repositioning Plate on Condylar Position and Relapse in Two-Jaw Surgery. Arch Plast Surg 2017; 44:19-25. [PMID: 28194343 PMCID: PMC5300918 DOI: 10.5999/aps.2017.44.1.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/11/2016] [Accepted: 10/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Numerous condylar repositioning methods have been reported. However, most of them are 2-dimensional or are complex procedures that require a longer operation time and a highly trained surgeon. This study aims to introduce a new technique using a condylar repositioning plate and a centric relation splint to achieve a centric relationship. METHODS We evaluated 387 patients who had undergone surgery for skeletal jaw deformities. During the operation, a centric relation splint, intermediate splint, final centric occlusion splint, and condylar repositioning plate along with an L-type mini-plate for LeFort I osteotomy or a bicortical screw for bilateral sagittal split ramus osteotomy were utilized for rigid fixation. The evaluation included: a physical examination to detect preoperative and postoperative temporomandibular joint dysfunction, 3-dimensional computed tomography and oblique transcranial temporomandibular joint radiography to measure 3-dimensional condylar head movement, and posteroanterior and lateral cephalometric radiography to measure the preoperative and postoperative movement of the bony segment and relapse rate. RESULTS A 0.3% relapse rate was observed in the coronal plane, and a 2.8% relapse rate in the sagittal plane, which is indistinguishable from the dental relapse rate in orthodontic treatment. The condylar repositioning plate could not fully prevent movement of the condylar head, but the relapse rate was minimal, implying that the movement of the condylar head was within tolerable limits. CONCLUSIONS Our condylar repositioning method using a centric relation splint and mini-plate in orthognathic surgery was found to be simple and effective for patients suffering from skeletal jaw deformities.
Collapse
|
52
|
Li J, Ryu SY, Park HJ, Kook MS, Jung S, Han JJ, Oh HK. Changes in condylar position after BSSRO with and without Le Fort I osteotomy via surgery-first approach in mandibular prognathism with facial asymmetry. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:661-669. [PMID: 28392230 DOI: 10.1016/j.oooo.2017.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/13/2016] [Accepted: 01/26/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aimed to evaluate changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) with and without Le Fort I osteotomy via the surgery-first approach (SFA) in patients with facial asymmetry. STUDY DESIGN Eighteen patients (36 condyles) who received surgical-orthodontic treatment using the SFA were included and divided into 2 groups depending on the extent of surgery: BSSRO-only group (n = 12) and BSSRO with Le Fort I osteotomy group (n = 6). Using computed tomography images taken preoperatively, immediately postoperatively, and 6 months postoperatively, surgical and postoperative changes of the condylar position were analyzed 3-dimensionally. RESULTS Both groups showed mainly inferolateral displacement with inward rotation immediately after surgery, and superomedial returning movement with outward rotation 6 months after surgery. There was no statistical difference in time-course changes of the condylar position between the 2 groups. In comparing the deviated and nondeviated sides, the deviated side showed significantly greater amount of bodily shift and rotational movement after surgery compared with the nondeviated side in both groups. CONCLUSIONS These results suggest that BSSRO via the SFA, either with or without Le Fort I osteotomy, may cause condylar displacement after surgery and that the displaced condyles return to their original position on both the deviated and the nondeviated sides.
Collapse
Affiliation(s)
- Jiyin Li
- Graduate Dental School, Chonnam National University, Gwangju, Republic of Korea
| | - Sun-Youl Ryu
- 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
| | - Min-Suk Kook
- 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
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea; Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, 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
| |
Collapse
|
53
|
Verweij JP, van Rijssel JG, Fiocco M, Mensink G, Gooris PJJ, van Merkesteyn JPR. Are there risk factors for osseous mandibular inferior border defects after bilateral sagittal split osteotomy? J Craniomaxillofac Surg 2017; 45:192-197. [PMID: 28065728 DOI: 10.1016/j.jcms.2016.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/10/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Bone defects of the inferior mandibular border (osseous inferior border defects) can cause unesthetic postoperative outcomes after bilateral sagittal split osteotomy (BSSO). The aim of this study was to estimate the frequency of osseous inferior border defects after BSSO and to identify risk factors for this complication. MATERIALS AND METHODS This retrospective study included consecutive patients who underwent BSSO for mandibular retrognathia. The primary outcome was the presence/absence of osseous inferior border defects. Predictors included the mandibular movement, rotation of the occlusal plane, postoperative proximal segment position, pattern of lingual fracture, occurrence of bad split, and presence of third molars. RESULTS The study sample consisted of 200 patients and had a mean follow-up of 13 months. The mean mandibular advancement and rotation was respectively 5.8 mm and 5.4° clockwise. Osseous inferior border defects were present in 7.0% of splits and in 12.5% of patients. Significant risk factors for inferior border defects included increased advancement, increased clockwise rotation, cranial rotation of the proximal segment, and a split originating in the lingual cortex. CONCLUSION In conclusion, osseous inferior border defects occur significantly more often in cases with large mandibular advancement, increased clockwise rotation of the occlusal plane, malpositioning of the proximal segment, and a split originating in the lingual cortex.
Collapse
Affiliation(s)
- J P Verweij
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J.P.R. van Merkesteyn), Leiden University Medical Center, Leiden, The Netherlands
| | - J G van Rijssel
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J.P.R. van Merkesteyn), Leiden University Medical Center, Leiden, The Netherlands
| | - M Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands; Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - G Mensink
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J.P.R. van Merkesteyn), Leiden University Medical Center, Leiden, The Netherlands; Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands
| | - P J J Gooris
- Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands
| | - J P R van Merkesteyn
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J.P.R. van Merkesteyn), Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
54
|
Bouletreau P. [Temporo-mandibular joints and orthognathic surgery]. ACTA ACUST UNITED AC 2016; 117:212-6. [PMID: 27481674 DOI: 10.1016/j.revsto.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
Temporo-Mandibular Joints (TMJ) and orthognathic surgery are closely linked. In the past, some authors have even described (with mixed results) the correction of some dysmorphosis through direct procedures on the TMJs. Nowadays, performing orthognathic surgery involves the TMJ in three different occasions: (1) TMJ disorders potentially responsible for dento-maxillary dysmorphosis, (2) effects of orthognathic surgery on TMJs, and (3) condylar positioning methods in orthognathic surgery. These three chapters are developed in order to focus on the close relationships between TMJ and orthognathic surgery. Some perspectives close this article.
Collapse
Affiliation(s)
- P Bouletreau
- Service de chirurgie maxillofaciale, stomatologie et chirurgie plastique de la face, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| |
Collapse
|
55
|
Fukushima S. A controversy with respect to occlusion. JAPANESE DENTAL SCIENCE REVIEW 2016; 52:49-53. [PMID: 28408956 PMCID: PMC5390333 DOI: 10.1016/j.jdsr.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 02/03/2016] [Accepted: 02/17/2016] [Indexed: 11/05/2022] Open
Abstract
There are very little controversies on occlusion in healthy individuals, where centric relation is regarded as the criterion for assessing the present occlusion and also for establishing a new occlusal relationship between the upper and the lower jaws. On the other hand, the occlusal position in patients with deformed condyles still remains to be clarified. In this review, the effectiveness and limits of centric relation in these patients are discussed. In addition, the muscle induced occlusal positions, such as the muscular position and the terminal positions of habitual closing movements, are suggested as a substitution for centric relation. Finally, the importance of a stable intercuspal position, where the habitual closing movements terminate without any premature tooth contact, is emphasized.
Collapse
Affiliation(s)
- Shunji Fukushima
- Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine, 803-2-7-1012 Mamedo-cho, Kohoku-Ku, Yokohama 222-0032, Japan
| |
Collapse
|
56
|
Custom-Machined Miniplates and Bone-Supported Guides for Orthognathic Surgery: A New Surgical Procedure. J Oral Maxillofac Surg 2016; 74:1061.e1-1061.e12. [DOI: 10.1016/j.joms.2016.01.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 11/21/2022]
|
57
|
Takahara N, Kabasawa Y, Sato M, Tetsumura A, Kurabayashi T, Omura K. MRI changes in the temporomandibular joint following mandibular setback surgery using sagittal split ramus osteotomy with rigid fixation. Cranio 2016; 35:38-45. [PMID: 27077250 DOI: 10.1080/08869634.2016.1143167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study examined the changes in temporomandibular joint dysfunction (TMD) symptoms and investigated the variations in the disc position, disc and condylar morphology following sagittal split ramus osteotomy (SSRO) with rigid fixation in patients with mandibular prognathism. Furthermore, the authors examined the correlation between mandibular setback and TMD symptoms. METHODS The study included 24 Japanese patients with jaw deformities who were treated using bilateral SSRO and Le Fort I osteotomy. The clinical and magnetic resonance imaging findings in the temporomandibular joint were evaluated preoperatively and at three and six months postoperatively. RESULTS The preoperative TMD symptoms were significantly associated with the prevalence of TMD symptoms at six months postoperatively. Anterior disc displacement improved in four joints with slight displacement and with no morphological change. There were no postoperative changes in condylar morphology. There was no significant correlation between mandibular setback and the postoperative TMD symptoms. CONCLUSION Postoperative TMD symptoms may be influenced mainly by preoperative TMD symptoms rather than mandibular setback using SSRO with rigid fixation. Therefore, patients with TMD symptoms require physical examination and MRI for appropriate diagnosis preoperatively.
Collapse
Affiliation(s)
- Namiaki Takahara
- a Department of Oral and Maxillofacial Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Yuji Kabasawa
- a Department of Oral and Maxillofacial Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Masaru Sato
- b Department of Dentistry and Oral Surgery , Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Akemi Tetsumura
- c Department of Oral and Maxillofacial Radiology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Tohru Kurabayashi
- c Department of Oral and Maxillofacial Radiology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Ken Omura
- d Department of Dentistry and Oral Surgery , Tokyo General Hospital , Tokyo , Japan
| |
Collapse
|
58
|
Iwai T, Omura S, Honda K, Yamashita Y, Shibutani N, Fujita K, Takasu H, Murata S, Tohnai I. An accurate bimaxillary repositioning technique using straight locking miniplates for the mandible-first approach in bimaxillary orthognathic surgery. Odontology 2016; 105:122-126. [DOI: 10.1007/s10266-016-0236-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
|
59
|
Lee JH, Park TJ, Jeon JH. Unilateral intraoral vertical ramus osteotomy and sagittal split ramus osteotomy for the treatment of asymmetric mandibles. J Korean Assoc Oral Maxillofac Surg 2015; 41:102-8. [PMID: 25922823 PMCID: PMC4411725 DOI: 10.5125/jkaoms.2015.41.2.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/11/2014] [Indexed: 11/23/2022] Open
Abstract
In surgery for facial asymmetry, mandibles can be classified into two types, rotational and translational, according to the required mandibular movements for surgery. During surgery for rotational mandibular asymmetry, a bilateral sagittal split ramus osteotomy (BSSRO) may cause a large bone gap between the proximal and distal segments as well as condylar displacement, resulting in a relapse of the temporomandibular joint disorder, especially in severe cases. The intraoral vertical ramus osteotomy has an advantage, in this respect, because it causes less rotational displacement of the proximal segment on the deviated side and even displaced or rotated condylar segments may return to their original physiologic position. Unilateral intraoral vertical ramus osteotomy (UIVRO) on the short side combined with contralateral SSRO was devised as an alternative technique to resolve the spatial problems caused by conventional SSRO in cases of severe rotational asymmetry. A series of three cases were treated with the previously suggested protocol and the follow-up period was analyzed. In serial cases, UIVRO combined with contralateral SSRO may avoid mediolateral flaring of the bone segments and condylar dislocation, and result in improved condition of the temporomandibular joint. UIVRO combined with contralateral SSRO is expected to be a useful technique for the treatment of rotational mandibular asymmetry.
Collapse
Affiliation(s)
- Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| | - Tae-Jun Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| | - Ju-Hong Jeon
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| |
Collapse
|
60
|
Lee J, Kim YI, Hwang DS, Kim KB, Park SB. Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities. Am J Orthod Dentofacial Orthop 2014; 146:612-9. [PMID: 25439212 DOI: 10.1016/j.ajodo.2014.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purposes of this study were to investigate the relationship between occlusal vertical dimension (VD) changes and postsurgical skeletal changes in the surgery-first approach and to derive regression models for the final mandibular setback at B-point. METHODS This retrospective study included 40 patients (16 men, 24 women; ages, 22.6 ± 4.0 years) who had undergone a bimaxillary surgery-first approach. Using cephalograms generated from cone-beam computed tomography representing the presurgical, postsurgical, and posttreatment stages, skeletal landmarks in the maxilla and mandible were investigated to derive multivariate linear regression-based prediction models. Additionally, a patient classification based on the VD was established and verified to generate regression models for the classified groups. RESULTS For the nonincreased VD group, the surgical setback of B-point was its predictor for the final mandibular setback (R(2) at 92%). Meanwhile, the final mandibular setback of the increased VD group was predicted according to the surgical upward movement of pogonion, the postsurgical horizontal position of A-point, and the postsurgical vertical position of the coronoid process (R(2) at 94%). CONCLUSIONS The results of this study support the clinical observation that the more increased the vertical occlusal dimension after surgery, the less predictable the position of B-point at the posttreatment stage.
Collapse
Affiliation(s)
- Jihyun Lee
- Postgraduate student, Department of Orthodontics, Pusan National University Hospital, Busan, South Korea
| | - Yong-Il Kim
- Assistant professor, Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Busan, South Korea.
| | - Dae-Seok Hwang
- Assistant professor, Department of Oral & Maxillofacial Surgery, Pusan National University Hospital, Busan, South Korea
| | - Ki Beom Kim
- Associate professor, Department of Orthodontics, Center for Advanced Dental Education, St Louis University, St Louis, Mo
| | - Soo-Byung Park
- Professor, Department of Orthodontics, Pusan National University Dental Hospital, Yangsan, South Korea
| |
Collapse
|
61
|
Zafar H, Choi DS, Jang I, Cha BK, Park YW. Positional change of the condyle after orthodontic-orthognathic surgical treatment: is there a relationship to skeletal relapse? J Korean Assoc Oral Maxillofac Surg 2014; 40:160-8. [PMID: 25247145 PMCID: PMC4170660 DOI: 10.5125/jkaoms.2014.40.4.160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/07/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the condylar position in relation to the glenoid fossa before and after orthodontic-orthognathic surgical treatment and to investigate the relationship with skeletal relapse. Materials and Methods Lateral cephalograms and temporomandibular joint tomograms from 19 patients with mandibular prognathism who received orthodontic-orthognathic surgery were included in this study. Samples were divided into two groups based on skeletal change during the retention period. The relapse group consisted of 7 patients (3 females and 4 males; mean age, 21.9 years) whose pogonion or menton displaced more than 1 mm during the retention period and the stable group consisted of 12 patients (5 females and 7 males; mean age, 21.7 years). Anterior joint space, posterior joint space, superior joint space, and anteroposterior index were measured on tomograms at pretreatment and posttreatment timepoints. Condyle position and frequency of the positional change were compared between both groups. Results In the relapse group and stable group, 42.9% and 45.8% of the condyles, respectively, showed forward or backward displacement at posttreatment. However, the changes were small and the mean anterior, posterior, superior joint spaces and frequencies of the positional changes did not differ statistically between both groups. Conclusion Our results suggest that small positional changes of the condyle, which may occur after orthodontic-orthognathic surgery treatment, may not be related to skeletal relapse after removal of the orthodontic appliances.
Collapse
Affiliation(s)
- Husanov Zafar
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Dong-Soon Choi
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea. ; Research Institute for Dental Engineering, Gangneung-Wonju National University, Gangneung, Korea
| | - Insan Jang
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea. ; Research Institute for Dental Engineering, Gangneung-Wonju National University, Gangneung, Korea
| | - Bong-Kuen Cha
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea. ; Research Institute for Dental Engineering, Gangneung-Wonju National University, Gangneung, Korea
| | - Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| |
Collapse
|
62
|
Adolphs N, Liu W, Keeve E, Hoffmeister B. RapidSplint: virtual splint generation for orthognathic surgery - results of a pilot series. ACTA ACUST UNITED AC 2014; 19:20-8. [PMID: 24720495 PMCID: PMC4075251 DOI: 10.3109/10929088.2014.887778] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Within the domain of craniomaxillofacial surgery, orthognathic surgery is a special field dedicated to the correction of dentofacial anomalies resulting from skeletal malocclusion. Generally, in such cases, an interdisciplinary orthodontic and surgical treatment approach is required. After initial orthodontic alignment of the dental arches, skeletal discrepancies of the jaws can be corrected by distinct surgical strategies and procedures in order to achieve correct occlusal relations, as well as facial balance and harmony within individualized treatment concepts. To transfer the preoperative surgical planning and reposition the mobilized dental arches with optimal occlusal relations, surgical splints are typically used. For this purpose, different strategies have been described which use one or more splints. Traditionally, these splints are manufactured by a dental technician based on patient-specific dental casts; however, computer-assisted technologies have gained increasing importance with respect to preoperative planning and its subsequent surgical transfer. Methods : In a pilot study of 10 patients undergoing orthognathic corrections by a one-splint strategy, two final occlusal splints were produced for each patient and compared with respect to their clinical usability. One splint was manufactured in the traditional way by a dental technician according to the preoperative surgical planning. After performing a CBCT scan of the patient’s dental casts, a second splint was designed virtually by an engineer and surgeon working together, according to the desired final occlusion. For this purpose, RapidSplint®, a custom-made software platform, was used. After post-processing and conversion of the datasets into .stl files, the splints were fabricated by the PolyJet procedure using photo polymerization. During surgery, both splints were inserted after mobilization of the dental arches then compared with respect to their clinical usability according to the occlusal fitting. Results Using the workflow described above, virtual splints could be designed and manufactured for all patients in this pilot study. Eight of 10 virtual splints could be used clinically to achieve and maintain final occlusion after orthognathic surgery. In two cases virtual splints were not usable due to insufficient occlusal fitting, and even two of the traditional splints were not clinically usable. In five patients where both types of splints were available, their occlusal fitting was assessed as being equivalent, and in one case the virtual splint showed even better occlusal fitting than the traditional splint. In one case where no traditional splint was available, the virtual splint proved to be helpful in achieving the final occlusion. Conclusions In this pilot study it was demonstrated that clinically usable splints for orthognathic surgery can be produced by computer-assisted technology. Virtual splint design was realized by RapidSplint®, an in-house software platform which might contribute in future to shorten preoperative workflows for the production of orthognathic surgical splints.
Collapse
Affiliation(s)
- Nicolai Adolphs
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Zentrum für rekonstruktive und plastisch-ästhetische Gesichtschirurgie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum , Berlin , and
| | | | | | | |
Collapse
|
63
|
Condylar Positional Changes Up to 12 Months After Bimaxillary Surgery for Skeletal Class III Malocclusions. J Oral Maxillofac Surg 2014; 72:145-56. [DOI: 10.1016/j.joms.2013.07.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/15/2022]
|
64
|
General Anesthesia in Orthognathic Surgeries: Does It Affect Horizontal Jaw Relations? J Oral Maxillofac Surg 2013; 71:1752-6. [DOI: 10.1016/j.joms.2013.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 05/08/2013] [Accepted: 05/10/2013] [Indexed: 11/19/2022]
|
65
|
Condylar repositioning in bilateral sagittal split ramus osteotomy with centric relation bite. J Craniofac Surg 2013; 24:1535-8. [PMID: 24036721 DOI: 10.1097/scs.0b013e31829028be] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Changes in the condylar position after bilateral sagittal split ramus osteotomy (BSSO) can cause many complications, such as condylar dysfunction and increased risk of relapse. This study evaluated a simple approach for condylar repositioning in BSSO as a method to rapidly obtain the patient's centric relation (CR) bite position without prefabricated equipment. METHODS The study subjects included 9 patients (5 men and 4 women; mean age, 23.7 years) who underwent BSSO in the Department of Oral and Maxillofacial Surgery in Hallym University hospital between December 2009 and March 2012. We performed BSSO with the condylar-repositioning method according to the patient's CR bite. RESULTS Measurements of changes in the condylar position via radiographic images (lateral cephalometric radiographs) did not indicate significant differences after surgery (P < 0.05). In surveys of temporomandibular joint symptoms, the scores for categories (sound, pain, mouth opening limitation) also did not show any increases after surgery. CONCLUSIONS Within a standard operating time, the condyle was effectively repositioned using the condylar-repositioning method described in this study. These results indicate this new repositioning method is simple and eliminates the need for any additional device.
Collapse
|
66
|
Seeberger R, Asi Y, Thiele OC, Hoffmann J, Stucke K, Engel M. Neurosensory alterations and function of the temporomandibular joint after high oblique sagittal split osteotomy: an alternative technique in orthognathic surgery. Br J Oral Maxillofac Surg 2013; 51:536-40. [DOI: 10.1016/j.bjoms.2012.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
|
67
|
Yang HJ, Hwang SJ. Contributing factors to intraoperative clockwise rotation of the proximal segment as a relapse factor after mandibular setback with sagittal split ramus osteotomy. J Craniomaxillofac Surg 2013; 42:e57-63. [PMID: 23830770 DOI: 10.1016/j.jcms.2013.05.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 11/28/2022] Open
Abstract
The aims of this study were to analyze possible contributing factors to intraoperative clockwise rotation (CWR) of the proximal segment (PS), which is known to be a primary factor for relapse after mandibular setback with sagittal split ramus osteotomy (SSRO) and to evaluate the correlation between the CWR of the PS and relapse tendency. The sample was comprised of 47 patients who underwent SSRO for mandibular setback. Lateral cephalograms were analyzed. The vertical difference between the inferior borders of the PS and the distal segment at the vertical osteotomy line for SSRO after setback of the distal segment (vertical bony step, VBS) was the most predictable factor for CWR of the PS (p < 0.001), and it correlated significantly with the gonial angle, the surgical change in SNB, and the downward movement of the maxilla (p < 0.05). Patients with large CWR of the PS showed a greater tendency in horizontal relapse than patients with small CWR of the PS (p < 0.05). Such relapse patterns could be prevented with adequate surgical planning designed to reduce the VBS, such as maxillary posterior impaction or the intentional guidance of the PS to maintain the original position of the PS without CWR.
Collapse
Affiliation(s)
- Hoon Joo Yang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Soon Jung Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
68
|
Lee CY, Jang CS, Kim JW, Kim JY, Yang BE. Condylar repositioning using centric relation bite in bimaxillary surgery. Korean J Orthod 2013; 43:74-82. [PMID: 23671832 PMCID: PMC3650216 DOI: 10.4041/kjod.2013.43.2.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 11/07/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to evaluate displacement of the mandibular condyle after orthognathic surgery using a condylar-repositioning device. Methods The patient group comprised 20 adults who underwent bimaxillary surgery between August 2008 and July 2011. The degree of condylar displacement was measured by pre- and postoperative tomographic analysis using centric relation bite and a wire during surgery. A survey assessing temporomandibular joint (TMJ) sound, pain, and locking was performed. The 20 tomographs and surveys were analyzed using the Wilcoxon signed-rank test and McNemar's test, respectively. Results No significant changes were observed in the anterior, superior, or posterior joint space of the TMJ (p > 0.05). In addition, no significant change was observed in TMJ sound (p > 0.05). However, TMJ pain and locking both decreased significantly after surgery (p < 0.05). Conclusions Due to its simplicity, this method may be feasible and useful for repositioning condyles.
Collapse
Affiliation(s)
- Chang-Youn Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University College of Medicine, Anyang, Korea
| | | | | | | | | |
Collapse
|
69
|
Omura S, Iwai T, Kimizuka S, Tohnai I. Response to the comments on 'An accurate maxillary superior repositioning technique without intraoperative measurement in bimaxillary orthognathic surgery'. Int J Oral Maxillofac Surg 2013; 42:420-1. [PMID: 23313284 DOI: 10.1016/j.ijom.2012.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 12/12/2012] [Indexed: 11/16/2022]
|
70
|
Righesso LAR, Wicki B, Heitz C. A discussion of an accurate maxillary superior repositioning technique without intraoperative measurement in bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 2013; 42:419-20. [PMID: 23313285 DOI: 10.1016/j.ijom.2012.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/12/2012] [Indexed: 11/28/2022]
|
71
|
Ueki K, Moroi A, Sotobori M, Ishihara Y, Marukawa K, Takatsuka S, Yoshizawa K, Kato K, Kawashiri S. A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:567-76. [DOI: 10.1016/j.oooo.2011.12.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 12/08/2011] [Indexed: 10/28/2022]
|
72
|
An accurate maxillary superior repositioning technique without intraoperative measurement in bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 2012; 41:949-51. [DOI: 10.1016/j.ijom.2012.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/23/2012] [Indexed: 11/21/2022]
|
73
|
Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry. J Craniomaxillofac Surg 2012; 40:821-7. [PMID: 22507292 DOI: 10.1016/j.jcms.2012.03.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to examine the changes in the temporomandibular joint (TMJ) and ramus after sagittal split ramus osteotomy (SSRO) with and without Le Fort I osteotomy. The subjects consisted of 87 Japanese patients diagnosed with mandibular prognathism with and without asymmetry. They were divided into 2 groups (42 symmetric patients and 45 asymmetric patients). The TMJ disc tissue was assessed by magnetic resonance imaging (MRI) and the TMJ space, condylar and ramus angle were assessed by computed tomography (CT) preoperatively and postoperatively. Medial joint space on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0043), and coronal ramus angle on the non-deviation side in the asymmetry group was significantly larger than that in the symmetry group preoperatively (P = 0.0240). The horizontal condylar angle on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0302), posterior joint space on the non-deviation side in the symmetry group was significantly larger than that in the asymmetry group postoperatively (P = 0.00391). The postoperative anterior joint space was significantly larger than the preoperative value on both sides in both groups (the deviation side in the symmetry group: P = 0.0016, the non-deviation side in the symmetry group: P < 0.0001, the deviation side in the asymmetry group: P = 0.0040, the non-deviation side in the asymmetry group: P = 0.0024). The preoperative disc position could was not changed in either group. These results suggest that significant expansion of anterior joint space could occur on the deviation side and non-deviation side in the asymmetry group as well as on both sides in the symmetry group, although disc position did not change in either group.
Collapse
|
74
|
Affiliation(s)
- Jean-Luc Béziat
- Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69317 Lyon Cedex 04, France.
| |
Collapse
|
75
|
Condylar resorption and functional outcome after unilateral sagittal split osteotomy. ACTA ACUST UNITED AC 2011; 112:315-21. [PMID: 21292514 DOI: 10.1016/j.tripleo.2010.10.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 10/07/2010] [Accepted: 10/28/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the radiological and functional results of unilateral sagittal split osteotomy (USSO) of the mandible. STUDY DESIGN Between January 2001 and December 2008, 26 patients underwent USSO to correct laterognathia (isolated USSO in 3 patients and Le Fort I osteotomies in combination with USSO in 23 patients). Radiographs of 23 patients were evaluated for signs of condylar resorption or loss of ramus height; 16 patients were clinically examined and the movement of both condyles was measured with a nontouch device. RESULTS Unilateral condylar resorption was observed in 1 patient and bilateral signs of resorption with loss of ramus height were observed in a further patient. Mouth opening and protrusion were significantly reduced after surgery (6.06 ± 6.91 mm, P = .005/0.63 ± 0.89 mm, P = .020). The selected surgical site, whether left or right, had no influence on laterotrusion or retrusion (P > .05), but patients operated on the right side showed higher values of protrusion on the left side than patients who were operated on the left (mean difference: 3.13 ± 1.24 mm; P = .038). CONCLUSIONS USSO appears to be a procedure that can be used in orthognathic surgery, if applied to a certain extent. In this study, there was no evidence of adverse results in terms of condylar resorption or functional outcome when compared with the results of regular bilateral sagittal split osteotomy (BSSO) reported in the literature. To our best knowledge this is the first study in the literature investigating the impact of USSO in orthognathic surgery.
Collapse
|
76
|
Three-dimensional regional displacements after mandibular advancement surgery: one year of follow-up. J Oral Maxillofac Surg 2011; 69:1447-57. [PMID: 21256643 DOI: 10.1016/j.joms.2010.07.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 06/05/2010] [Accepted: 07/03/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the association of 3-dimensional changes in the position of the condyles, rami, and chin at splint removal and 1 year after mandibular advancement surgery. PATIENTS AND METHODS This prospective observational study used preoperative and postoperative scans of 27 subjects presenting with a skeletal Class II jaw relationship with a normal or deep overbite. An automatic technique of cranial base superimposition was used to assess the positional and/or remodeling changes in the anatomic regions of interest. The displacements were visually displayed and quantified using 3-dimensional color maps. The positive and negative values of surface distances in the color maps indicated the direction of the displacements. Pearson correlation coefficients and a linear model for correlated data were used to evaluate the association between the regional displacements. RESULTS The postoperative adaptations in the chin position between splint removal and 1 year after surgery were significantly negatively correlated with changes in the borders of the posterior ramus (left, r = -0.73, P ≤ .0001; and right, r = -0.68, P = .00) and the condyles (left, r = -0.53, P = .01; and right, r = -0.46, P = .02), indicating that these structures tended to be displaced in the same direction. Even though the mean condylar displacement with surgery was less than 1 mm, individual displacements greater than 2 mm with surgery were observed for 24% of the condyles. The condylar displacements were maintained at 1 year after surgery for 17% of the condyles. CONCLUSIONS The surface distance displacements indicated that the postoperative adaptations at different anatomic regions were significantly related.
Collapse
|
77
|
Motta ATSD, Carvalho FDAR, Cevidanes LHS, Almeida MADO. Deslocamentos esqueléticos associados à cirurgia de avanço mandibular: avaliação quantitativa tridimensional. Dental Press J Orthod 2010. [DOI: 10.1590/s2176-94512010000500010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: avaliar através de imagens tridimensionais os deslocamentos dos ramos, côndilos e mento resultantes da cirurgia de avanço mandibular. MÉTODOS: este estudo prospectivo utilizou tomografias computadorizadas de feixe cônico das fases pré-cirúrgica e pós-cirúrgica de 27 indivíduos apresentando Classe II esquelética com padrão normocefálico ou braquicefálico. Uma técnica de superposição automatizada da base do crânio permitiu a avaliação de alterações esqueléticas em regiões anatômicas de interesse, e os deslocamentos foram visualizados e quantificados a partir da técnica dos mapas coloridos de superfícies. A estatística descritiva consistiu de valores médios, mínimo e máximo, e desvios-padrão. Mudanças maiores do que 2mm foram consideradas clinicamente relevantes e classificadas através de categorização dos valores. As tendências direcionais dos movimentos estruturais foram exibidas em valores positivos ou negativos. Coeficientes de correlação de Pearson foram aplicados com nível de significância de 95%, testando se deslocamentos em determinadas regiões foram associados com outras áreas. RESULTADOS: o mento apresentou deslocamento anteroinferior médio de 6,81±3,2mm, enquanto a porção inferior dos ramos apresentou movimento lateral com a cirurgia (esquerdo = 2,97±2,71mm; direito = 2,34±2,35mm). Outras regiões anatômicas mostraram deslocamento médio menor que 2mm, mas com evidente variabilidade individual. Correlações estatisticamente significativas foram positivas e moderadas. Os côndilos, bordo posterior e porção superior dos ramos apresentaram correlação bilateral, enquanto as porções superior e inferior dos ramos mostraram correlação ipsilateral. CONCLUSÃO: o método 3D utilizado permitiu uma precisa visualização e quantificação dos resultados cirúrgicos, destacando-se o movimento anteroinferior do mento e o deslocamento lateral da porção inferior dos ramos mandibulares, mas com considerável variabilidade individual em todas as regiões anatômicas avaliadas.
Collapse
|
78
|
Lee JH, Lee IW, Seo BM. Clinical analysis of early reoperation cases after orthognathic surgery. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.1.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ju-Hwan Lee
- Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Korea
| | - In-Woo Lee
- Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Korea
| | - Byoung-Moo Seo
- Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Korea
- Dental Research Institute, Graduate School, Seoul National University, Korea
- BK 21, Graduate School, Seoul National University, Korea
- Biotooth Engineering Lab, Graduate School, Seoul National University, Korea
| |
Collapse
|
79
|
Kim YK, Yun PY, Ahn JY, Kim JW, Kim SG. Changes in the temporomandibular joint disc position after orthognathic surgery. ACTA ACUST UNITED AC 2009; 108:15-21. [DOI: 10.1016/j.tripleo.2009.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 01/10/2009] [Accepted: 02/05/2009] [Indexed: 11/27/2022]
|