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Telha W, Al-Watary MQ, Sakran K, Chen H, Bi R, Zhu S, Jiang N. The effect of different hybrid rigid internal fixation techniques on the postoperative stability following a mandibular advancement using a bilateral sagittal split ramus osteotomy: A retrospective three-dimensional comparative study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101667. [PMID: 38738550 DOI: 10.1016/j.jormas.2023.101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/01/2023] [Accepted: 10/25/2023] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To three-dimensionally evaluate post-operative mandibular stability following bilateral sagittal split ramus osteotomies between hybrid and non-hybrid rigid internal fixation techniques. MATERIALS AND METHOD Seventy adults with skeletal class II deformity who underwent bilateral split sagittal osteotomy with mandibular advancement were included. Patients were divided into four groups based on their fixation techniques: hybrid technique (HT) groups I, II, and IV received a 4-hole 2 mm miniplate with either a bicortical screw (BS), additional 2 mm 4-hole miniplate, or two-hole miniplate, while non-HT group III received a 4-hole 2 mm miniplate with four mini-screws (MS). Measurements were taken pre-operatively (T0), immediately postoperatively (T1), and ≥1 year after surgery (T2) using 3D Slicer software. RESULTS Age, sex, and follow-up period did not correlate significantly with postoperative relapse or stability. Significant differences were observed in the advancement on the right side between groups II, III, and IV and on the left side between groups I, III, and IV. However, the type of surgical intervention showed no significant effect on postoperative relapse and stability. All groups of fixations showed satisfactory stability with irrelevant relapse (< 2 mm or 2°). CONCLUSION The study demonstrated satisfactory and comparable stability among different fixation groups on patients undergoing mandibular advancement following bilateral split sagittal osteotomy. The results highlighted the importance of considering the degree of advancement when planning orthognathic surgery and managing postoperative outcomes.
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Affiliation(s)
- Wael Telha
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Mohammed Qasem Al-Watary
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Karim Sakran
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Yemen
| | - Haozhe Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Nan Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Eckmüller S, Paddenberg E, Hiller KA, Proff P, Knüttel H, Kirschneck C. Relapse in class II orthognathic surgery: a systematic review. BMC Oral Health 2022; 22:605. [PMID: 36517840 PMCID: PMC9753235 DOI: 10.1186/s12903-022-02636-x] [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: 08/06/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Relapse after orthognathic surgery seems to depend on diverse factors. Proffit et al. postulated in 2007 a "hierarchy of stability" (Head Face Med 6:66, 2007), ranking posttreatment stability after various orthognathic procedures, but no systematically reviewed evidence was provided. Therefore, the aim of this review was to investigate the extent of class II relapse in orthognathic surgery of Angle class II patients depending on the surgical procedure used. MATERIALS AND METHODS Seven databases were searched for randomized and controlled clinical trials to compare relapse in surgical procedures for Angle class II patients. After duplicate study selection, data extraction and risk of bias assessment were performed with the ROBINS-I tool as well as data synthesis by frequency distribution, followed by assessment of the quality of evidence with GRADE. RESULTS Four non-randomized cohort-studies with a total of 132 patients were included. Bimaxillary procedures as well mandibular advancement procedures proved to be highly stable. Single jaw interventions at the maxilla achieved mostly stable results at sagittal dimension and problematic stability in the vertical dimension. However, there were only limited data available with low quality of evidence. CONCLUSIONS Limited existing evidence of low quality partly support the postulated hierarchy of stability of Proffit et al. (Head Face Med 6:66, 2007) and indicates that a surgical correction of class II dysgnathia with bimaxillary procedures and mandibular advancement seems to be highly stable. However, additional studies are needed to address the relation between relapse and surgical orthognathic intervention. Trial registration PROSPERO 2019 CRD42019144873.
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Affiliation(s)
- Stephanie Eckmüller
- Department of Orthodontics, University Medical Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Eva Paddenberg
- Department of Orthodontics, University Medical Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Karl-Anton Hiller
- Department of Operative Dentistry, University Medical Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Peter Proff
- Department of Orthodontics, University Medical Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Helge Knüttel
- University Library, University Medical Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University Medical Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Comparison of two surgical techniques (HOO vs. BSSO) for mandibular osteotomies in orthognathic surgery-a 10-year retrospective study. Oral Maxillofac Surg 2022:10.1007/s10006-022-01073-y. [PMID: 35595944 DOI: 10.1007/s10006-022-01073-y] [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: 11/24/2021] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To retrospectively compare the high-angled sagittal split osteotomy (HOO) and the bilateral sagittal split osteotomy (BSSO) for the correction of skeletal dysgnathias regarding intra- and postoperative complications. METHODS The electronic medical records of all patients treated with an orthognathic surgery at the Department for Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Germany, between the years 2009 and 2019 were retrospectively reviewed. RESULTS Two hundred ninety-one patients were included. The overall complication rates were 19.78% (BSSO) compared to 12.5% (HOO) (p = 0.14). Significant differences were found regarding the operation time (HOO < BSSO, p = 0.02), material failure (HOO > BSSO, p = 0.04), and early recurrence requiring revision surgery (HOO < BSSO, p = 0.002). The use of a ramus plate significantly reduced the risk of plate failure (2.8% < 13.6%, p = 0.05). More bad splits (p = 0.08) and early sensory disorders (p = 0.07) occurred in the BSSO group. CONCLUSION The HOO presents a possible alternative to the BSSO since newly developed osteosynthesis material significantly reduces the risk of material failure. The BSSO is accompanied by higher risks of developing complications like a bad split and sensory disorders but, however, remains the standard for large anterior-posterior transpositions of the mandible.
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Do lower third molars increase the risk of complications during mandibular sagittal split osteotomy? Systematic review and meta-analysis. Int J Oral Maxillofac Surg 2021; 51:906-921. [DOI: 10.1016/j.ijom.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
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Intraoperative removal of third molars does not affect the postoperative infections after BSSO - Randomized controlled trial. J Craniomaxillofac Surg 2021; 50:103-106. [PMID: 34802887 DOI: 10.1016/j.jcms.2021.11.001] [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: 10/30/2020] [Revised: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022] Open
Abstract
The goal of this study was to evaluate the incidence of postoperative wound infection and timing of mandibular third molar removal in bilateral sagittal split osteotomy (BSSO). This wis a prospective, single-blinded, randomized, split-mouth clinical trial. All patients were divided into two groups: Group I, where pre-operative removal of the third molars were done 6 months prior to BSSO and Group II, where intra-operative removal of contralateral third molars were done for the same patients during the osteotomy. The primary outcome variable studied was postoperative infection rate and the secondary outcome variable was bad split during BSSO. Among the seventy five patients (150 sites), one site in group II developed infection whereas none of the sites in group I developed infection (p = 1.000). No sites had bad split in both the groups. The results from the present study show that there is no difference between the presence or absence of mandibular third molars on post-operative wound infection following bilateral sagittal split osteotomy, and the authors hence suggest removing third molars during BSSO for patient comfort.
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Rajkumar B, Parameswaran R, Parameswaran A, Vijayalakshmi D. Evaluation of volume change in oral cavity proper before and after mandibular advancement. Angle Orthod 2021; 91:81-87. [PMID: 33289782 DOI: 10.2319/052420-474.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the tongue and oral cavity proper volume in pre- and post-bilateral sagittal split osteotomy (BSSO) patients, and to establish whether there was a correlation between them. MATERIALS AND METHODS A retrospective study that evaluated 12 patients' pre- and post-surgical computed tomography records satisfying the inclusion criteria. Borders were defined for measurement of tongue and oral cavity proper volume. The volume assessment was carried out using 3D slice software. RESULTS The mean difference of tongue volume was 5.7 ± 1.7 cm3, which showed high statistical significance. The mean difference of oral cavity proper volume (OCVP) was 6.9 ± 3.4 cm3 and indicated high statistical significance. A very strong positive correlation existed between pre- and post-surgical tongue volume. Positive correlation was also evident between pre and post - surgical OCVP. Medium positive correlation was noted when the difference between pre- and post-surgical tongue and OCVP were assessed. CONCLUSIONS There was a significant change in volume of tongue and oral cavity proper after BSSO advancement surgery. The space around the tongue, position of tongue, and maxillary and mandibular relationship influence the volume of tongue and oral cavity proper.
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Chen Y, Zhang J, Rao N, Han Y, Ferraro N, August M. Independent risk factors for long-term skeletal relapse after mandibular advancement with bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2019; 49:779-786. [PMID: 31601473 DOI: 10.1016/j.ijom.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/03/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this retrospective cohort study was to identify the independent risk factors for long-term skeletal relapse following mandibular advancement with bilateral sagittal split osteotomy. Univariate and multivariate linear regression analyses were performed including nine common risk factors for relapse as independent variables and horizontal/vertical long-term (≥2 years) skeletal relapse as dependent variables. Ninety-six patients were analyzed; 66 were female (68.8%) and the average age of the patients was 29.7±10.5 years. Over an average follow-up of 3.8±1.8 years after an initial mandibular advancement of 8.8±2.4 mm, long-term skeletal relapse of 1.6±1.0 mm horizontal and 0.9±0.7 mm vertical was found. Multivariate analysis identified age, preoperative mandibular plane angle (MPA), bimaxillary surgery, counterclockwise mandibular rotation, and the magnitude of mandibular advancement to be significantly associated with horizontal long-term skeletal relapse. Preoperative MPA, counterclockwise mandibular rotation, and the magnitude of mandibular advancement were significantly associated with vertical long-term skeletal relapse. Thus preoperative MPA, the magnitude of mandibular advancement, and counterclockwise mandibular rotation of the mandible were found to be independent risk factors for both horizontal and vertical long-term skeletal relapse. Although long-term skeletal relapse cannot be avoided entirely, understanding the independent risk factors and their contributions will optimize treatment planning and long-term stability.
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Affiliation(s)
- Y Chen
- Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China; Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - J Zhang
- Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - N Rao
- Harvard Medical School, Boston, Massachusetts, USA
| | - Y Han
- Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - N Ferraro
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - M August
- Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA.
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Paunonen J, Helminen M, Sipilä K, Peltomäki T. Temporomandibular disorders in Class II malocclusion patients after surgical mandibular advancement treatment as compared to non-treated patients. J Oral Rehabil 2019; 46:605-610. [PMID: 30868620 DOI: 10.1111/joor.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/01/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe malocclusions may cause functional and aesthetic problems and symptoms of temporomandibular disorders (TMD). Studies have investigated association between malocclusions and TMDs and shown controversial findings. OBJECTIVE Purpose of this investigation was to examine the prevalence of TMD sub-diagnoses, using Diagnostic Criteria for the TMD (DC/TMD), in patients with Class II malocclusion and retrognathic mandible who had undergone mandibular advancement surgery 4-8 years previously, and to compare their frequencies with non-treated patients with a similar pre-existing condition. METHODS Study cohort comprised 151 patients who had orthognathic treatment due to mandibular retrognathia in 2007-2011. Seventy-seven (51%) participated in the study (Group 1). Group 2 comprised 22 patients who were planned for orthognathic treatment but had not started their treatment. Patients filled in the Finnish version of the DC/TMD Symptom Questionnaire and were examined using to the DC/TMD Axis I. DC/TMD Symptom Questionnaire were inquired by phone from 24 of the 74 patients who did not participate in the study. RESULTS Results showed that Group 2 had more myalgia (13% vs 50%, P < 0.001) and arthralgia (18% vs 65%, P < 0.001) sub-diagnoses than Group 1. A tendency was noted that Group 2 had more pain-related TMD symptoms than Group 1. No differences were found between Groups 1 and 3 in gender and age distribution or frequency TMD symptoms. CONCLUSION Prevalence of especially pain-related TMD diagnoses was higher in Group 2 compared to Group 1, thus indicating a possible beneficial effect of this treatment for TMD.
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Affiliation(s)
- Jaakko Paunonen
- Department Oral Diseases, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mika Helminen
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Timo Peltomäki
- Field of Dentistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Does Piezosurgery Influence the Severity of Neurosensory Disturbance Following Bilateral Sagittal Split Osteotomy? J Craniofac Surg 2019; 30:1154-1162. [PMID: 30839457 DOI: 10.1097/scs.0000000000005251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present paper aims to evaluate the long-term incidence and severity of the neurosensory disturbance (NSD) of the inferior alveolar nerve following bilateral sagittal split osteotomy (BSSO) of the mandibular ramus performed with piezosurgery. A retrospective study on patients referred to the Maxillofacial Surgery and Dentistry Clinic of the University of Verona for orthognathic surgery between March 2013 and October 2015 was performed. Inclusion criteria were having undergone BSSO with piezosurgery and follow-up lasting at least 24 months. Exclusion criteria were history of surgical infection, osteosynthesis failure or re-do surgery. The extent of mandibular repositioning movements was retrieved and patients underwent 4 clinical neurosensory tests. Descriptive statistical analysis was performed. 52 patients met the inclusion criteria. Average follow-up was 40 months (range 24-75). 83% of the nerves examined have no or slightly altered sensitivity. Seventy-one percent of patients perceive a moderate to none discomfort and none describes the discomfort as serious (Visual Analogue Scale [VAS] >7). The extent of mandibular repositioning did not have significant influence on the development and severity of the NSD. Resulting data led the Authors to infer that using piezosurgery in BSSO, the severity of the NSD of inferior alveolar nerve is reduced, but the incidence of permanent nerve lesions remains unchanged, compared to historical controls.
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王 秀, 张 怡, 周 彦. [Orthodonticorthognathic treatment stability in skeletal class III malocclusion patients]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:86-92. [PMID: 30773550 PMCID: PMC7433550 DOI: 10.19723/j.issn.1671-167x.2019.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate stability of skeletal hard tissues, dental hard tissues and soft tissues after orthodonticorthognathic treatment in a long term. This study reviewed longitudinal changes in orthodontic-orthognathic patients of skeletal class III malocculsion, using lateral cephalometric radiographs in 3-12 years after treatment in comparison to treatment finishing. METHODS Twenty-two patients with skeletal Class III malocclusion following orthodontic-orthognathic surgery in Peking University School and Hospital of Stomatology from January 1, 2000 to January 1, 2009 were observed. The lateral cephalometric radiographs of the following stages were collected: treatment finishing (T1), 3 to 12 years after treatment (T2). Statistical analyses of cephalometrics were evaluated. Paired student t test was performed by SPSS 17.0. RESULTS Data of all the 22 patients were studied in longitudinal timeline after treatment and 3-12 years after treatment. From T1 to T2, we evaluated 11-SN (angle between the upper incisors axis and SN plane), 11-NA angle (angle between the upper incisors axis and NA plane), 11-NA mm (perpendicular distance from upper incisors to NA plane), 11-41 (angle between the upper incisors axis and lower incisors axis), 41-NB angle (angle between lower incisors and NB plane), 41-NB (perpendicular distance from lower incisors to NB plane), 41-MP angle (angle between lower incisors and GoGn plane), and IMPA [angle between lower incisor and mandibular plane (tangent line to submandibular border)]. Most hard tissues of the teeth remained stable but upper anterior teeth angulations decreased, indicating by significantly reducing 11-SN (T1: 110.98°±6.77°; T2: 109.21°±5.80°; P=0.005); reducing 11-NA (T1: 28.31°±6.80°; T2: 26.49°±6.18°; P=0.002); increasing 11-41 (T1: 123.51°±8.14°; T2: 125.7°±10.01°; P=0.035). From T1 to T2, we also evaluated SNA (angle of sella-nasion-A-point), SNB (angle of sella-nasion-B-point), ANB (angle of A-point-nasion-B-point), GoGn-SN (angle between GoGn and SN plane), GoGn-FH (angle between GoGn and Frankfort plane), Y axis (angel between Sella-Gn and Frankfort plane), N-ANS (distance from nasion point to ANS point), ANS-Me (distance from ANS point to Menton point), N-Me (distance from nasion point to Menton point), ANS-Me/N-Me% (proportion of ANS-Me to N-Me), and FMA (angle between Frankfort and mandibular plane), Wits appraisal (horizontal distance between points A and B on functional occlusal plane). Skeletal hard tissues also remained relatively stable, only N-Me value changed significantly with a decreasing facial height (T1: 124.98°±11.98°; T2: 122.4°±11.05°; P=0.024). From T1 to T2, we finally evaluated FH-NsPg angle (angle between NsPg and Frankfort plane), H angle (angel between H line and NB), FH-A'UL angle (angle between A'UL and Frankfort plane), FH-B'LL angle (angle between B'LL and Frankfort plane), UL-LL (angle between UL and LL), UL-EP (distance between UL and E line), LL-EP (distance between LL and E line), Sn-H (perpendicular distance between Sn point and H line), Nls-H (distance of nose-lip-sulcus to H line), Li-H (lower lip to H line), Si-H (lower lip sulcus to H line), and NLA (nasolabial angle, angle of Cm-Sn-UL-point). Soft tissues changes were observed in decreasing UL-EP [T1: (-2.78±2.20) mm; (-3.29±2.44) mm; P=0.02] and H angle (T1: 8.27°±3.71°; 7.32°±3.83°; P=0.006). Other soft tissues remained relatively stable by retruding upper lip position and chin changes with no statistical significance. CONCLUSION Orthodontic-orthognathic treatment can improve esthetics and occlusal function in patients of skeletal class III malocclusion with a stable long-term outcome.
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Affiliation(s)
- 秀婧 王
- 北京大学口腔医学院·口腔医院,门诊部 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081First Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 怡美 张
- 北京大学口腔医学院·口腔医院,门诊部 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081First Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 彦恒 周
- 北京大学口腔医学院•口腔医院正畸科,北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing 100081, China
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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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Paunonen J, Helminen M, Peltomäki T. Long-term stability of mandibular advancement with bilateral sagittal split osteotomy. J Craniomaxillofac Surg 2018; 46:1421-1426. [DOI: 10.1016/j.jcms.2018.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
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Osteotomy Site Grafting in Bilateral Sagittal Split Surgery With Bioactive Glass S53P4 for Skeletal Stability. J Craniofac Surg 2017; 28:1709-1716. [PMID: 28962090 DOI: 10.1097/scs.0000000000003760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In orthognathic surgery, the aim of the treatment is to achieve a good occlusion and a satisfying aesthetic outcome. In large mandibular advancements insufficient healing at the mandibular inferior border may lead to loss of support for the overlaying tissue at the osteotomy site. Augmentation can be performed to improve stability, bone regeneration, and the aesthetic outcome. The purpose of this prospective clinical study was to evaluate the use of a novel material for this indication; granules of the antibacterial, osteoconductive, and slowly resorbing bioactive glass S53P4 as filling material in large mandibular advancement in bilateral sagittal split osteotomies. The authors treated 25 patients who underwent bilateral sagittal split osteotomies due to class II dentoskeletal deformities. The mandibular osteotomy site defects (8-15 mm) were augmented with bioactive glass S53P4. The average clinical follow-up was 33 months and the average radiological follow-up with cone beam computerized tomography was 24 months. The clinical and radiological results were good with regard to healing, bone regeneration, and stability of the osteotomy sites. The recontouring of the inferior mandibular border provided a good soft tissue support followed by an excellent aesthetic outcome in 96% of the osteotomy sites. The occlusion was stable in 88% of the patients. The authors' results show that bioactive glass S53P4 is a safe grafting material for osteotomy site defects in significant mandibular advancements with reliable bone regeneration, providing long-term stability at the osteotomy site and at the inferior mandibular border.
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Tabrizi R, Nili M, Aliabadi E, Pourdanesh F. Skeletal stability following mandibular advancement: is it influenced by the magnitude of advancement or changes of the mandibular plane angle? J Korean Assoc Oral Maxillofac Surg 2017; 43:152-159. [PMID: 28770155 PMCID: PMC5529188 DOI: 10.5125/jkaoms.2017.43.3.152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/04/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives The aim of this study was to investigate the effects of advancement magnitude and changes in mandibular plane angle on the stability of mandibular advancement. Materials and Methods This retrospective cohort study evaluated the postoperative stability of mandibular advancement in class II skeletal subjects who underwent bilateral sagittal split osteotomy. Radiographs taken preoperatively, immediately postoperatively and 1 year postoperatively were traced and analyzed using linear and angular measurements. To determine horizontal and vertical relapse, an X-Y coordinate system was established in which the X-axis was constructed by rotating S-N downward by 7° (approximation of the Frankfort horizontal plane) and the Y-axis was defined as a line perpendicular to the X-axis and passing through the point Sella. For certain reference points including point A, point B, pogonion and menton, the perpendicular distance between each point and both axes was determined and cephalometric variables were recorded as X and Y coordinates. Results Twenty-five subjects were studied. A significant correlation between the amount of mandibular advancement and relapse in the B point (vertical and horizontal) and the pogonion point was observed (vertical and horizontal, P<0.001). Evaluation of data demonstrated a positive correlation between the mandibular plane angle (SN/ML) change and vertical relapse in the B point (P<0.05). A simple regression model demonstrated that 74% of horizontal relapse and 42.3% of vertical relapse in the B point was related to the amount of mandibular advancement. The receiver operating characteristic test showed that 8.5 mm mandibular advancement is related to a relapse rate of 1 mm or more in the pogonion, vertically or horizontally. Conclusion The magnitude of mandibular advancement is a stronger surgical predictor for horizontal rather than vertical relapse at the B point. Changes in mandibular plane angle (SN/ML) during surgery affect vertical, but not horizontal relapse at the B point.
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Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Nili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Aliabadi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereydoun Pourdanesh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Verweij J, Mensink G, Fiocco M, van Merkesteyn J. Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups: a retrospective study of 263 patients. Int J Oral Maxillofac Surg 2016; 45:898-903. [DOI: 10.1016/j.ijom.2016.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/22/2015] [Accepted: 01/18/2016] [Indexed: 11/15/2022]
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Schwartz K, Rodrigo-Domingo M, Jensen T. Skeletal Stability after Large Mandibular Advancement (> 10 mm) with Bilateral Sagittal Split Osteotomy and Skeletal Elastic Intermaxillary Fixation. J Oral Maxillofac Res 2016; 7:e5. [PMID: 27489609 PMCID: PMC4970505 DOI: 10.5037/jomr.2016.7205] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of the present study was to assess the skeletal stability after large mandibular advancement (> 10 mm) with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation and to correlate the skeletal stability with the vertical facial type. MATERIAL AND METHODS A total of 33 consecutive patients underwent bimaxillary surgery to correct skeletal Class II malocclusion with a mandibular advancement (> 10 mm) measured at B-point and postoperative skeletal elastic intermaxillary fixation for 16 weeks. Skeletal stability was evaluated using lateral cephalometric radiographs obtained preoperative (T1), 8 weeks postoperatively (T2), and 18 month postoperatively (T3). B-point and pogonion (Pog) was used to measure the skeletal relapse and the mandibular plane angle (MP-angle) was used to determine the vertical facial type. RESULTS The mean advancement from T1 to T2 were 11.6 mm and 13.5 mm at B-point and Pog, respectively. The mean skeletal relapse from T2 to T3 was -1.3 mm at B-point and -1.6 mm at Pog. The nineteen patients characterized as long facial types, showed the highest amount of skeletal relapse (-1.5 mm at B-point and -1.9 mm at Pog). CONCLUSIONS The present study showed a limited amount of skeletal relapse in large mandibular advancement (> 10 mm) with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation. Bilateral sagittal split osteotomy in combination with skeletal intermaxillary fixation can therefore be an alternative to distraction osteogenesis in large mandibular advancements.
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Affiliation(s)
- Kristoffer Schwartz
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark.
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
| | | | - Thomas Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark.
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Xi T, Schreurs R, van Loon B, de Koning M, Bergé S, Hoppenreijs T, Maal T. 3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies. J Craniomaxillofac Surg 2015; 43:462-8. [DOI: 10.1016/j.jcms.2015.02.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/12/2014] [Accepted: 02/10/2015] [Indexed: 11/28/2022] Open
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Verweij JP, Mensink G, Houppermans PN, Frank MD, van Merkesteyn JR. Investigation of the influence of mallet and chisel techniques on the lingual fracture line and comparison with the use of splitter and separators during sagittal split osteotomy in cadaveric pig mandibles. J Craniomaxillofac Surg 2015; 43:336-41. [DOI: 10.1016/j.jcms.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 11/24/2022] Open
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Verweij JP, Mensink G, Fiocco M, van Merkesteyn JR. Presence of mandibular third molars during bilateral sagittal split osteotomy increases the possibility of bad split but not the risk of other post-operative complications. J Craniomaxillofac Surg 2014; 42:e359-63. [DOI: 10.1016/j.jcms.2014.03.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/15/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022] Open
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Influence of BSSO surgical technique on postoperative inferior alveolar nerve hypoesthesia: A systematic review of the literature. J Craniomaxillofac Surg 2014; 42:976-82. [DOI: 10.1016/j.jcms.2014.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/02/2013] [Accepted: 01/03/2014] [Indexed: 11/20/2022] Open
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Sato FRL, Asprino L, Fernandes Moreira RW, de Moraes M. Comparison of postoperative stability of three rigid internal fixation techniques after sagittal split ramus osteotomy for mandibular advancement. J Craniomaxillofac Surg 2014; 42:e224-9. [DOI: 10.1016/j.jcms.2013.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/16/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022] Open
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