Patients' perceptions of improvements after bilateral sagittal split osteotomy advancement surgery: 10 to 14 years of follow-up

Evaluation of social appearance concerns and satisfaction after orthognathic surgery

The main aim of orthognathic surgery is to provide a good occlusion and masticatory function and to achieve positive changes in facial aesthetics. The aim of this study was to determine the reasons behind patients' acceptance of orthognathic surgery and their expectations from this treatment, to assess whether their expectations were met, the change in their self-confidence and their satisfaction, and finally, to use the results obtained to inform future surgical procedures to increase patient satisfaction. The study was designed as a cross-sectional observational study and included 73 people treated with orthognathic surgery (surgery group) and 42 people with minimal crowding who did not require treatment (control group). The study found that the primary reason for requesting orthognathic surgery was to improve facial appearance and that patients had high expectations in this regard. Using the Social Appearance Anxiety Questionnaire and the Expectation and Satisfaction Questionnaire, 73.97 % of patients in our study said the treatment met their expectations and 90.41 % said they were satisfied with the overall results of the surgery. The study also highlighted the importance of surgeon-patient communication and the satisfaction of the patient's environment with the final result in determining patient satisfaction. In conclusion, since patients' high expectations of orthognathic surgery influence treatment success and patient satisfaction, it is important to know and manage patients' expectations before treatment and to have good patient-surgeon communication to increase patient satisfaction after surgery.

Patients' preferences in dental care: A discrete-choice experiment and an analysis of willingness-to-pay

INTRODUCTION

Dental diseases are a major problem worldwide. Costs are a burden on healthcare systems and patients. Missed treatments can have health and financial consequences. Compared to other health services, dental treatments are only covered in parts by statutory health insurance (SHI). Using the example of dental crowns for a cost-intensive treatment, our study aims to investigate whether (1) certain treatment attributes determine patients' treatment choice, and (2) out-of-pocket payments represent a barrier to access dental care.

METHODS

We conducted a discrete-choice-experiment by mailing questionnaires to 10,752 people in Germany. In presented scenarios the participants could choose between treatment options (A, B, or none) composed of treatment attribute levels (e.g., color of teeth) for posterior (PT) and anterior teeth (AT). Considering interaction effects, we used a D-efficient fractional factorial design. Choice analysis was performed using different models. Furthermore, we analyzed willingness-to-pay (WTP), preference of choosing no and SHI standard care treatment, and influence of socioeconomic characteristics on individual WTP.

RESULTS

Out of n = 762 returned questionnaires (response rate of r = 7.1), n = 380 were included in the analysis. Most of the participants are in age group "50 to 59 years" (n = 103, 27.1%) and female (n = 249, 65.5%). The participants' benefit allocations varied across treatment attributes. Aesthetics and durability of dental crowns play most important roles in decision-making. WTP regarding natural color teeth is higher than standard SHI out-of-pocket payment. Estimations for AT dominate. For both tooth areas, "no treatment" was a frequent choice (PT: 25.7%, AT: 37.2%). Especially for AT, treatment beyond SHI standard care was often chosen (49.8%, PT: 31.3%). Age, gender, and incentive measures (bonus booklet) influenced WTP per participant.

CONCLUSION

This study provides important insights into patient preferences for dental crown treatment in Germany. For our participants, aesthetic for AT and PT as well as out-of-pocket payments for PT play an important role in decision-making. Overall, they are willing to pay more than the current out-of-pockt payments for what they consider to be better crown treatments. Findings may be valuable for policy makers in developing measures that better match patient preferences.

Patient satisfaction after orthognathic surgery: a 3 year follow-up of 60 high-angle Class II individuals

BACKGROUND AND OBJECTIVES

High-angle Class II malocclusion is considered challenging to treat to a stable result and, although studies report treatment outcome in terms of morphology, patient satisfaction has not been addressed. The objectives of the present study were to examine patients' motives for treatment and satisfaction with the results.

MATERIAL AND METHODS

A structured questionnaire was distributed 3 years post-operatively to 93 consecutively treated patients with an initial diagnosis of mandibular-plane angle (ML/NSL) ≥34.0 degrees and ANB angle ≥4.0 degrees. Three surgical subsamples were defined: one-piece Le Fort I, bilateral sagittal split osteotomy, or a combination of the two (Bimax). Lateral cephalometric radiographs were used to assess morphological characteristics and post-treatment changes.

RESULTS

Questionnaire participation was 69.8 per cent. The most frequently reported motives for seeking treatment were to improve oral function (85.0 per cent) and dental appearance (71.7 per cent). Thirty per cent were very satisfied, 53.3 per cent were satisfied, and 16.7 per cent were dissatisfied with the overall treatment result. Dissatisfaction was associated with a persisting post-treatment anterior open bite (AOB), horizontal relapse at B point, and with sensory impairment.

CONCLUSIONS AND IMPLICATIONS

A higher rate of dissatisfaction was found than what has usually been reported for othognathic surgical patients, and this was associated with a persisting AOB. In addition, mandibular relapse and impaired sensory function were related to dissatisfaction and are associated with mandibular surgery. Prospective high-angle Class II patients should be comprehensively informed about the unpredictability of treatment outcomes in terms of occlusion and facial appearance.

Impacts of Orthognathic Surgery on Patient Satisfaction, Overall Quality of Life, and Oral Health-Related Quality of Life: A Systematic Literature Review

Several treatments have been suggested to correct dentofacial abnormalities, including orthognathic surgery. The aim of the present systematic review was to assess the impact of orthognathic surgery on patient satisfaction, overall quality of life, quality of life related to oral health—and to orthognathic surgery in particular—among adult patients. Two investigators independently reviewed the available literature in the databases PubMed/MEDLINE, LILACS, SciELO, EMBASE, Trip, and Google Scholar (gray literature) based on the keywords “orthognathic surgery” and “quality of life.” An analysis of bias was performed based on the MINORS (methodological index for nonrandomized studies). A total of 245 relevant studies were retrieved from the databases, and 6 additional studies were located after a manual search of the references. Following selection based on titles, abstracts, and full-text analysis, 30 studies were included in the present systematic review. To evaluate quality of life before and after orthognathic surgery, 12 studies applied the surgery-related Orthognathic Quality of Life Questionnaire (OQLQ), 12 used the Oral Health Impact Profile (OHIP-14), and 4 used the Short Form Health Survey (SF-36). Orthognathic surgery results in improvements in quality of life both physically and psychosocially after surgery and is associated with high rates of patient satisfaction.

Patient satisfaction and oral health-related quality of life 10-15 years after orthodontic-surgical treatment of mandibular prognathism

This study investigated 36 patients at 10-15 years after they had undergone mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) and subsequent intermaxillary fixation for 6 weeks. The patients completed a 37-item structured questionnaire to evaluate patient satisfaction and possible long-term effects of the treatment. Visual analogue scales were used to measure self-perceived changes in seven items concerning oral function and appearance. Oral health-related quality of life was assessed using the Oral Impacts on Daily Performance (OIDP) index. The main reasons for seeking treatment were to improve chewing function and appearance. The treatment had resulted in significant improvements regarding chewing function, appearance, bullying, and self-confidence in social settings (all P<0.05). All patients were either very satisfied (61%) or reasonably satisfied (39%) with the treatment result. The mean OIDP frequency score was 8.49 on a scale from 8 to 40. Seventy-four percent of the patients reported no oral impacts on quality of life. In conclusion, 10-15 years after combined orthodontic and IVRO surgical treatment of mandibular prognathism, the patients were satisfied, and oral health-related quality of life was reported to be good.

Satisfaction with orthognathic surgery of skeletal Class III patients

INTRODUCTION

Class III relationships can be corrected with single-jaw or bimaxillary surgery. The purpose of this research was to assess patient satisfaction after bimaxillary surgery, compared with setback surgery alone, for Class III corrections. Identifying patients' relative levels of satisfaction will provide guidance for the selection of surgical options.

METHODS

The cephalometric outcomes for 25 patients who underwent 2-jaw surgery were compared with the outcomes in 40 patients who had mandibular setback. Soft and hard tissue changes were evaluated using initial and postsurgical lateral cephalograms. The patients were asked to complete self-administered questionnaires after orthognathic treatment. Correlations between cephalometric improvement and patient satisfaction were evaluated.

RESULTS

The patients in the 2-jaw group reported significantly higher satisfaction in the appearance of the mouth (P <0.05), smile (P <0.05), and treatment outcome (P <0.001). These item scores and the changes in ANB, ANS-M, and nasolabial angle showed strong correlations in the 2-jaw group and moderate correlations in the 1-jaw group.

CONCLUSIONS

ANS-M and nasolabial angle should be considered in the conventional diagnosis of skeletal Class III orthognathic surgery to obtain adequate correction of facial esthetics and patient satisfaction. Esthetic needs contribute to surgical decisions when treating patients with skeletal Class III malocclusions and dentofacial deformities such as maxillary deficiency and long facial height that causes a turned-up upper lip.

Psychosocial Outcomes in Orthognathic Surgery: A Review of the Literature

Objective

To identify and critically appraise the literature on the psychosocial outcomes of orthognathic surgery, reflect on the clinical and theoretical implications, and suggest avenues for future research.

Design

A search of the literature was completed using the databases Web of Science, MEDLINE, and PsycINFO to identify English-language articles published since January 2001 that have reported a measure of psychosocial functioning posttreatment.

Results

A total of 38 articles were eligible for inclusion in the review. The studies reported improvements in areas such as satisfaction with facial appearance, self-confidence, self-esteem, anxiety, and social functioning. Small percentages of patients were left dissatisfied or had difficulty adjusting to appearance change despite the absence of treatment complications. Gains in psychosocial functioning were maintained over several years, and satisfaction increased over time.

Conclusions

There are consistent positive outcomes reported as a result of orthognathic surgery, but conclusions are limited by methodological issues in study design such as small sample sizes, limited use of control groups, and measures that fail to tap into relevant areas of psychosocial functioning. In addition, further exploration is required of processes such as adjustment to facial change and the role of psychological support during treatment.

Orofacial functions and quality of life in oral health in subjects with dentofacial deformity

PURPOSE: To investigate the influence of the facial pattern in orofacial functions (OFFs) and quality of life (QoL), and their relationship in individuals with dentofacial deformities (DFD). METHODS: As approved by the Research Ethics Committee, 36 subjects, aged between 18 and 40 years, divided into three groups of seven female and five male participants, i.e., facial pattern I (n=12), pattern II (n=12) and pattern III (n=12), participated in this study. The OFFs were assessed using the MBGR protocol and QoL by the Oral Health Impact Profile (OHIP-14) questionnaire. Comparisons between OFFs and facial patterns were made using the Kruskal-Wallis test, and the correlation between the facial pattern and QoL by means of Spearman's test, considering a 5% significance level. RESULTS: A significant difference (p<0.05) was observed when comparing patterns I and II, and patterns I and III, with no difference between patterns II and III, neither in the OHIP-14 nor in the MBGR. A significant linear correlation (r=0.666; p<0.05) was verified between the MBGR and the OHIP-14, showing that the worse the OFFs, the worse the QoL. CONCLUSION: The facial pattern influenced the performance of the OFFs and the QoL in individuals presenting DFD, with a greater occurrence of changes for patterns II and III, and the worse the OFFs, the worse the QoL in cases with DFD.

Do changes in oral health-related quality-of-life, facial pain and temporomandibular disorders correlate after treatment of severe malocclusion?

INTRODUCTION

The aim was to evaluate the relationships of changes in facial pain, temporomandibular disorders (TMDs) and oral health-related quality-of-life (OHRQoL) in adults who underwent orthodontic or orthodontic/surgical treatment.

METHODS

Sixty-four patients (46 women, 18 men, range 18-64 years) with severe malocclusion and functional problems were treated in Oulu University Hospital. Of these, 44 underwent orthodontic-surgical and 20 orthodontic treatment. Data were collected with questionnaires and clinical stomatognathic examinations before and on average 3 years after treatment. The OHRQoL was measured with OHIP-14 (The Oral Health Impact Profile), the intensity of facial pain with the Visual Analogue Scale (VAS) and the severity of TMD with the Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indices.

RESULTS

A significant improvement was found in facial pain, signs and symptoms of TMD and OHRQoL after the treatment (p < 0.05). The decrease in VAS was associated with improvement in OHIP-14 severity (r = 0.296, p = 0.019). The correlations between changes in OHIP-14 severity and Ai and Di were not statistically significant.

CONCLUSION

Treatment of severe malocclusion seemed to improve OHRQoL via decreased facial pain. Decreased facial pain was associated especially with improved OHRQoL dimensions of physical pain, physical disability and social disability.

[Orthognathic surgery: from the essential to the superfluous]

The majority of adult patients who consult for smile reconstruction or for functional problems can be satisfied by benefitting from orthodontic treatment. This treatment, whatever the orthodontic technique, is carried out following the establishment of a diagnosis and treatment plan taking into account some restrictions of a prosthetic, periodontal or financial nature. There are, however, situations in which the esthetic and functional balance is severely affected or quite simply impossible to correct without modifying the bone structures. Orthognathic surgery is essential in such cases. In this article we will deal in particular with three frequently encountered situations: openbite, Class III and finally Class II skeletal discrepancies. The aim will be to try to define the interest that these so-called ortho-surgical treatments represent and at the same time consider the alternatives.

Satisfaction of skeletal class III patients treated with different types of orthognathic surgery

The aim of this study was to compare the satisfaction of skeletal class III patients following treatment with three different methods of orthognathic surgery. Eighty-two patients were divided into three groups according to the surgical procedure performed to correct their class III dentofacial deformity, and answered a questionnaire designed to determine the patient's opinion of the aesthetic and functional treatment outcomes. Differences in the patterns of responses to questions in the questionnaire related to satisfaction between the three clinical groups were evaluated by χ(2) and Fisher's exact tests (α=5%). Eighty patients (97.6%) reported being satisfied with the treatment received. There was no significant difference in response patterns among clinical groups when assessing the improvement in facial appearance, chewing, speech, and socialization. Maxillary advancement led to higher levels of improvement in breathing (P<0.0003). Class III patients treated by orthognathic surgery had high levels of satisfaction with the aesthetic and functional outcomes of their treatment.