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Cha J, Park K, Ryu J, Jung S, Park HJ, Oh HK, Kook MS. Does mandible ramus height asymmetry affect postoperative skeletal stability in orthognathic surgery patients? Maxillofac Plast Reconstr Surg 2024; 46:32. [PMID: 39222303 DOI: 10.1186/s40902-024-00442-9] [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: 04/09/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Relapses following orthognathic surgery have been reported to exceed 2% to 50%, depending on multiple factors. This study aimed to analyze the stability after orthognathic surgery in patients with mandibular ramus height asymmetry through 3D reconstruction using Cone-beam CT. METHODS This retrospective cohort study investigated patients who underwent mandibular setback surgery using bilateral sagittal split ramus osteotomy. Three-dimensional CT scans were taken at three different time points. Evaluation of the postoperative stability involved measuring changes in the x, y, and z axes as well as roll and yaw rotations of the mandible at specific landmarks (B point, mental foramen) on 3D CT scans obtained immediately after surgery and 6-12 months postoperatively. They were categorized into four groups based on bilateral mandibular height asymmetry through Asymmetry index (AI). The one-way ANOVA was implemented to compare the intergroup differences and Tukey's post hoc test was employed. Additionally, the Pearson correlation coefficient was also calculated. RESULTS A total of 24 patients were included in this study. The corresponding AI, representing the degree of asymmetry in both mandibles, were calculated as Group 1 was 1.25 ± 0.64%, Group 2 was 2.89 ± 0.47%, Group 3 was 5.03 ± 0.51%, and Group 4 was 9.40 ± 1.99%. The x-axis change in Group 4 was significantly larger at 1.71 mm compared to Group 1 at 0.64 mm. The mandibular roll, Group 4 showed a statistically significant increase at 1.33° compared to Group 1 at 0.35°. And there was a significant positive correlation observed between x-axis change and AI (p = 0.019), as well as between mandibular roll and AI (p = 0.025). CONCLUSION After orthognathic surgery, stability was influenced by numerous factors, with the findings of this study suggesting that the degree of ramus height asymmetry in the mandible can be considered one contributing factor.
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Affiliation(s)
- Jihun Cha
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-Ro, Dong-Gu, Gwangju, 61469, Republic of Korea
| | - Kyuwon Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-Ro, Dong-Gu, Gwangju, 61469, Republic of Korea
| | - Jaeyoung Ryu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-Ro, Dong-Gu, Gwangju, 61469, Republic of Korea
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-Ro, Dong-Gu, Gwangju, 61469, Republic of Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-Ro, Dong-Gu, Gwangju, 61469, Republic of Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-Ro, Dong-Gu, Gwangju, 61469, Republic of Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-Ro, Dong-Gu, Gwangju, 61469, Republic of Korea.
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Zhang X, Guo N, Cheng J, Xi W. Three-Dimensional Evaluation of Changes in Condylar Position After Orthognathic Surgery With Different Types of Jaw Deformities. J Oral Maxillofac Surg 2024; 82:1052-1066.e1. [PMID: 38901470 DOI: 10.1016/j.joms.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Assessing condyle position postorthognathic surgery is pivotal for optimizing surgical accuracy, sustaining postoperative stability, and ensuring predictable treatment outcomes. PURPOSE The aim of this study was to analyze the changes of condyle position after orthognathic surgery with different types of jaw deformity and to analyze whether the changes of condyle position are different. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was designed and conducted, involving adults who underwent orthognathic surgery for jaw deformities at the affiliated Stomatological Hospital of Nanchang University between 2019 and 2022. Patients with incomplete computerized tomography data were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable was time (preoperative and postoperative) and types of jaw deformities (skeletal Class III, skeletal Class II, and mandibular deviation). MAIN OUTCOME VARIABLE(S) The main outcome variables were the three-dimensional linear and rotational positional changes of the condyle. COVARIATES Evaluated covariates included sex and age. ANALYSES MIMICS 20.0 software measured all data, and SPSS 22.0 software facilitated statistical analyses. Intragroup and intergroup correlation analyses employed paired t-tests and independent t-tests, with statistical significance set at P < .05. RESULTS The study sample was composed of 32 subjects with a mean age of 22.43 ± 1.6 and 9 were male. The analysis of changes of condylar position from virtual surgical planning to the immediate postoperative period showed that the maximum condylar displacement was 1.74 mm and the maximum angular change was 3.92°. The analysis of changes in condylar position from the immediate postoperative period to 1 year postoperatively showed no statistically significant changes for the same type of jaw deformity. But patients with Class II malocclusion exhibited distinct condylar displacement and rotation patterns compared to those with Class III malocclusion and mandibular deformity. CONCLUSION AND RELEVANCE The application of virtual surgical planning in orthognathic surgery ensures a high degree of consistency in achieving the desired condylar position. Moreover, no significant change in condylar position was observed after orthognathic surgery for the same type of jaw deformity. However, patients with Class II deformities exhibited a higher susceptibility to rotational displacement of the condyles compared to those with other types of jaw deformities.
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Affiliation(s)
- Xue'e Zhang
- PhD student, Resident, School of Stomatology, Jiangxi Medical College, Nanchang University Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Nan Guo
- Master student, Resident, School of Stomatology, Jiangxi Medical College, Nanchang University Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Jialong Cheng
- Master, Attending, Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University. Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Weihong Xi
- PhD, Professor, Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China.
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Podcernina J, Jakobsone G, Urtane I, Salms G, Radzins O. Long-term evaluation of condylar positional and volumetric parameters and skeletal stability in Class III bimaxillary orthognathic surgery patients. Int J Oral Maxillofac Surg 2024; 53:707-714. [PMID: 38383213 DOI: 10.1016/j.ijom.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
This retrospective study examined long-term (4-5 years) condylar positional and volumetric changes and skeletal stability after bimaxillary orthognathic surgery in skeletal Class III patients. Pre-surgical (T0: 0.9 ± 1.1 months) and post-surgical (T1: 0.6 ± 0.7 months; T2: 12.8 ± 3.1 months; T3: 56.5 ± 6.5 months) cone beam computed tomography (CBCT) images of 22 patients were obtained. CBCT multiplanar reformation (MPR) images were generated, and three-dimensional (3D) condylar models were constructed and superimposed to compare changes in condylar volume from pre- to postoperative. Condylar position in the sagittal and coronal planes altered immediately after surgery; however at long-term follow-up, the condyles had returned to their pre-surgical position. The condyles remained slightly inwardly rotated at short-term (-2.6°, 95% confidence interval -3.5° to -1.7°) and long-term (-1.9°, 95% confidence interval -2.8° to -1.0°) follow-up. Changes in condylar volume were insignificant after surgery. Condylar positional changes had no effect on skeletal stability. However, patients with an increased face height prior to surgery and more retrusive jaw position postoperatively were more prone to condylar resorption. Surgical changes remained stable 4-5 years after surgery. In conclusion, condylar position changed insignificantly following surgical correction in Class III patients provided that the correct surgical technique was employed.
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Affiliation(s)
- J Podcernina
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia.
| | - G Jakobsone
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
| | - I Urtane
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
| | - G Salms
- Department of Oral and Maxillofacial Surgery, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
| | - O Radzins
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
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Tabrizi R, Amini E, Hormozi B, Behnia P, Aboul Hosn Centenero S. The Evaluation of Condylar Position Change in the Asymmetric Mandible Following Sagittal Split Osteotomy. J Craniofac Surg 2024; 35:e367-e371. [PMID: 38578104 DOI: 10.1097/scs.0000000000010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/26/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The change of condyle position following orthognathic surgery affects the stability of treatments. This study aims to assess the correlation between the amount of condyles' position change and the severity of mandibular asymmetry following BSSO. MATERIALS AND METHODS This is a cross-sectional study. Subjects with asymmetric mandibular prognathism following BSSO were studied. Subjects were classified into 2 groups: group 1, subjects had mandibular asymmetry without occlusal cant and underwent BSSO. Group 2, subjects had mandibular asymmetry with occlusal cant and underwent BSSO+ Lefort I osteotomy. The condyle position was evaluated using cone-beam computer tomography (CBCT). Pearson's correlation test was used to assess any correlation between the condyle changes and the change in the mandible in sagittal and anterior-posterior directions. RESULTS A total of 44 subjects were studied. In group 1, the condyle tilted outward in the deviated condyle and inward in the non-deviated condyle immediately after osteotomy. After 12 months, both condyles showed a rotation relative to the original position. In group 2, the condyles of the deviated sides and non-deviated sides moved inferiorly after surgery (condylar sagging), which was more significant in the non-deviated sides. The condyle rotation was similar to group 1. The severity of asymmetry and occlusal cant correlate with the condylar position change in the two groups. CONCLUSION The severity of mandibular asymmetry correlates with the amount of condyles' position change immediately after BSSO. However, the condyles tend to return to their original position 12 months later.
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Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran
| | - Ehsan Amini
- Departement of Oral and Maxillofacial Surgery, North Khorasan UNiversity of Medical Science, Bojnurd, Iran
| | - Behnoush Hormozi
- Departement of Oral and Maxillofacial Surgery, North Khorasan UNiversity of Medical Science, Bojnurd, Iran
| | - Parsa Behnia
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran
| | - Samir Aboul Hosn Centenero
- Oral and Maxillofacial Department, Hospital Clinic de Barcelona, International University of Catalunya. Barcelona, Spain
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Barone S, Cevidanes L, Miranda F, Gurgel ML, Anchling L, Hutin N, Bianchi J, Goncalves JR, Giudice A. Enhancing skeletal stability and Class III correction through active orthodontist engagement in virtual surgical planning: A voxel-based 3-dimensional analysis. Am J Orthod Dentofacial Orthop 2024; 165:321-331. [PMID: 38010236 PMCID: PMC10923113 DOI: 10.1016/j.ajodo.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Skeletal stability after bimaxillary surgical correction of Class III malocclusion was investigated through a qualitative and quantitative analysis of the maxilla and the distal and proximal mandibular segments using a 3-dimensional voxel-based superimposition among virtual surgical predictions performed by the orthodontist in close communication with the maxillofacial surgeon and 12-18 months postoperative outcomes. METHODS A comprehensive secondary data analysis was conducted on deidentified preoperative (1 month before surgery [T1]) and 12-18 months postoperative (midterm [T2]) cone-beam computed tomography scans, along with virtual surgical planning (VSP) data obtained by Dolphin Imaging software. The sample for the study consisted of 17 patients (mean age, 24.8 ± 3.5 years). Using 3D Slicer software, automated tools based on deep-learning approaches were used for cone-beam computed tomography orientation, registration, bone segmentation, and landmark identification. Colormaps were generated for qualitative analysis, whereas linear and angular differences between the planned (T1-VSP) and observed (T1-T2) outcomes were calculated for quantitative assessments. Statistical analysis was conducted with a significance level of α = 0.05. RESULTS The midterm surgical outcomes revealed a slight but significantly less maxillary advancement compared with the planned position (mean difference, 1.84 ± 1.50 mm; P = 0.004). The repositioning of the mandibular distal segment was stable, with insignificant differences in linear (T1-VSP, 1.01 ± 3.66 mm; T1-T2, 0.32 ± 4.17 mm) and angular (T1-VSP, 1.53° ± 1.60°; T1-T2, 1.54° ± 1.50°) displacements (P >0.05). The proximal segments exhibited lateral displacement within 1.5° for both the mandibular right and left ramus at T1-VSP and T1-T2 (P >0.05). CONCLUSIONS The analysis of fully digital planned and surgically repositioned maxilla and mandible revealed excellent precision. In the midterm surgical outcomes of maxillary advancement, a minor deviation from the planned anterior movement was observed.
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Affiliation(s)
- Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Luc Anchling
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Nathan Hutin
- Chemistry and Chemical Engineering School - Digital Sciences School Lyon, Lyon, France
| | - Jonas Bianchi
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, Calif
| | - Joao Roberto Goncalves
- Department of Pediatric Dentistry, School of Dentist, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Jeong BJ, Ohe JY, Ryu JI, Choi BJ, Jung J. The effect of tongue reduction for preventing adverse effects in patients undergoing class III orthognathic surgery: a three-dimensional comparative analysis. Clin Oral Investig 2024; 28:162. [PMID: 38383912 DOI: 10.1007/s00784-024-05554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES This study aims to evaluate the potential benefits of combining tongue reduction with mandibular setback surgery in patients undergoing class III orthognathic surgery. Specifically, we investigated whether this combined approach reduced the risk of surgical relapse, condylar resorption, and airway space reduction by mitigating tongue pressure on the mandible. MATERIAL AND METHODS The study retrospectively enrolled patients who had undergone bilateral sagittal split ramus osteotomy (BSSRO) with at least 5 mm of setback and met the criteria of a body mass index > 20 kg/m2 and tongue volume > 100 mm3. The study included 20 patients with 10 in the tongue reduction group (TR, n = 10) and 10 in the BSSRO only group (SO, n = 10). RESULTS The volumetric changes of the total airway space were significantly different between the TR and SO groups (p = 0.028). However, no significant differences were observed in the condylar resorption and postoperative relapse between the groups (p = 0.927 and 0.913, respectively). The difference between the resorption of the anterior and posterior segments of the condyle was also statistically insignificant (p = 0.826). Postoperative counterclockwise rotation of the proximal segment only demonstrated a significant correlation with postoperative relapse (p = 0.048). CONCLUSIONS The reduction in tongue volume demonstrated a preventive effect on the reduction of the airway space after mandibular setback, although it did not yield statistical significance concerning surgical relapse and condylar volume. The counterclockwise rotation of the proximal segment might be responsible for the forward displacement of the distal segment and postoperative relapse. However, the clinical implications of this finding should be interpreted with caution owing to the limited sample size CLINICAL RELEVANCE: Tongue reduction could potentially serve as a preventive measure in preserving the airway space and might be beneficial in mitigating the risk of obstructive sleep apnea in patients with class III deformity.
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Affiliation(s)
- Bong-Jin Jeong
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Joo-Young Ohe
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, College of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Byung-Joon Choi
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Junho Jung
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea.
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Shi Y, Luo S, Wang H, Yao Q, Shi Y, Cheng J. Three-dimensional bone remodelling of glenoid fossa in patients with skeletal Class III malocclusion after bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 2024; 53:133-140. [PMID: 37442687 DOI: 10.1016/j.ijom.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
This study aimed to characterize three-dimensional quantitative morphological changes of glenoid fossa in patients with skeletal Class III malocclusion treated with bimaxillary orthognathic surgery. Ninety-five eligible patients (50 male, 45 female; mean age 22.09 years) were enrolled retrospectively. Cone beam computed tomography obtained at 1 week preoperatively (T0), immediately after surgery (T1), and at ≥ 12 months postoperatively (T2) were registered based on cranial base using voxel-based registration in 3D Slicer. Glenoid fossa surface was divided spatially into four regions, and bone modelling in these regions was visualized with color maps. Our data revealed that the mean surface variations of glenoid fossa were small, with modest bone formation as a whole. No significant associations between anteroposterior or vertical mandibular displacement and overall glenoid fossa remodeling were found (P > 0.05). Moreover, bone deposition was frequently observed in the anterior-lateral region of glenoid fossa in patients with a larger mandibular movement during T0-T1 (P < 0.001). Paired bone formation in the anterior-lateral region of glenoid fossa and bone resorption in the anterior-lateral region of condylar head was frequently observed. Collectively, our results revealed that glenoid fossa underwent complex but modest bone remodeling after bimaxillary surgery in skeletal Class III patients.
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Affiliation(s)
- Y Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China
| | - S Luo
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China; Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, PR China
| | - H Wang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - Q Yao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - Y Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - J Cheng
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China.
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Atipatyakul P, Chen YF, Yao CF, Chen YA, Chen YH, Liao YF, Chen YR. Three-dimensional evaluation of skeletal stability after surgery-first bimaxillary surgery for class III asymmetry in 70 consecutive patients. J Dent Sci 2024; 19:532-541. [PMID: 38303824 PMCID: PMC10829717 DOI: 10.1016/j.jds.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/21/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Skeletal stability after orthognathic surgery is essential for positive treatment outcome. This study evaluated the stability of osteotomy segments after surgery-first bimaxillary surgery for class III asymmetry. Materials and methods Seventy adults with class III asymmetry consecutively corrected through surgery-first Le Fort I and bilateral sagittal split osteotomies were investigated. Cone-beam computed tomography before treatment (T0), 1-week after surgery (T1), and after all treatment (T2, ≥1-year after surgery) was used to assess surgical movement (T0 to T1) and skeletal stability (T1 to T2) regarding the translation and rotation of the maxillary, mandibular distal, and proximal segments. Results At T1, the maxillary segment had moved forward and upward, turned to the deviated side, and rotated downward (all P < 0.01). The distal segment of mandible had moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment had moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment had moved upward and tilted to the deviated side (both P < 0.01). At T2, significant relapse occurred in the mandible. The distal segment moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment moved upward and tilted to the deviated side (both P < 0.01). Conclusion Clinically significant relapse of class III asymmetry was discovered on the mandibular distal and opposite proximal segments.
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Affiliation(s)
- Piengkwan Atipatyakul
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Fang Chen
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chuan-Fong Yao
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ying-An Chen
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Hsuan Chen
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Fang Liao
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ray Chen
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Lyu H, Ma H, Wang X, Xu L, Hou J, Zhao Y, Li W, Li X. Three-dimensional assessment of periodontal support of lower incisors for skeletal Class II malocclusion undergoing presurgical orthodontic treatment with different vertical skeletal patterns. Prog Orthod 2023; 24:45. [PMID: 38105288 PMCID: PMC10725860 DOI: 10.1186/s40510-023-00495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The aim of the present study was to compare periodontal support changes during retraction of mandibular anterior teeth for skeletal Class II malocclusion with different facial divergence and to analyze relevant factors influencing bone remodeling by applying three-dimensional (3D) cone-beam computed tomography (CBCT) reconstruction technology. METHODS Forty-eight patients with Class II malocclusion requiring surgical orthodontic treatment enrolled in the study were divided into the hyperdivergent group (n = 16), normodivergent group (n = 16) and hypodivergent group (n = 16) according to their vertical skeletal patterns. Cone-beam computed tomography (CBCT) scans were obtained before treatment (T1) and after presurgical orthodontic treatment (T2). The two-dimensional (2D) alveolar bone morphology, movement of mandibular central incisors and volume of the alveolar bone around incisors were measured on the labial and lingual sides by 3D CBCT reconstruction technology. Statistical analyses were performed with one-way ANOVA, paired t tests and multiple linear regression. RESULTS During presurgical orthodontic treatment, the alveolar bone height on the labial side of the hyperdivergent group decreased significantly (P ≤ 0.05), but was maintained in the normodivergent and hypodivergent groups (P > 0.05). However, the alveolar bone volume, alveolar bone thickness at each level and alveolar bone height on the lingual side decreased significantly for all the groups. Apart from the initial morphometric measurements at T1, the morphology of lingual alveolar bone at T2 was significantly influenced by the direction and amount of tooth movement. Horizontal retraction and vertical protrusion of the root apex were negatively related to the alveolar bone on the lingual side after presurgical orthodontic treatment. CONCLUSION For Class II malocclusion patients undergoing presurgical orthodontic treatment, the changes in the periodontal support of the lower central incisors varied in different vertical skeletal patterns. There exists a great periodontal risk of alveolar bone resorption on the lingual side for various vertical types. To avoid alveolar bone deterioration, it is essential to investigate the bone remodeling of patients with different alveolar bone conditions and cautiously plan tooth movement prior to orthodontic treatment. Moreover, 3D measurements based on CBCT construction can provide complementary information to traditional 2D measurements.
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Affiliation(s)
- Hangmiao Lyu
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081, People's Republic of China
| | - Huimin Ma
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081, People's Republic of China
| | - Xiaoxia Wang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081, People's Republic of China
| | - Li Xu
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, 100081, People's Republic of China
| | - Jianxia Hou
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, 100081, People's Republic of China
| | - Yijiao Zhao
- Center of Digital Dentistry, Peking University School and Hospital of StomatologyNational Engineering Laboratory for Digital and Material Technology of StomatologyResearch Center of Engineering and Technology for Digital Dentistry of Ministry of HealthBeijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081, People's Republic of China
| | - Weiran Li
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081, People's Republic of China.
| | - Xiaotong Li
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081, People's Republic of China.
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10
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Jiang Y, Yang Z, Qi Y, Peng J, Li Z, Liu X, Yi B, Wang X, Chen G, Han B, Xu T, Jiang R. Early and 1-year postsurgical stability and its factors in patients with complicated skeletal Class Ⅲ malocclusion treated by conventional and surgery-first approach: A prospective cohort study. Am J Orthod Dentofacial Orthop 2023; 164:728-740. [PMID: 37516951 DOI: 10.1016/j.ajodo.2023.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION This study aimed to compare postsurgical stability between conventional (CSA) and surgery-first (SFA) approaches and investigate its prognostic factors in patients with a skeletal Class Ⅲ extraction. METHODS Twenty and 19 patients treated with LeFort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) with premolar extraction were enrolled in SFA and CSA groups, respectively. Serial cone-beam computed tomography images obtained before surgery, immediately after surgery (T1), 3 months after surgery, and 12 months after surgery were used for 3-dimensional quantitative analysis. The condyle was segmented for analyzing volumetric changes. Repeated measures analysis of variance, independent t test, and chi-square test were used to compare time-course and intergroup differences. Pearson and Kendall correlation and multivariate linear regression analyses were used to explore prognostic factors affecting skeletal stability. RESULTS In both CSA and SFA, postsurgical relapse mainly occurred in the mandible sagittal and vertical dimensions and during the first 3 months after surgery. Stability in SFA was significantly less than that in CSA. Intraoperatively, inferolateral condylar displacement with proximal segment inwards, clockwise rotation, and return movements after surgery were observed regardless of the treatment approach. The condylar volume remained stable over time. Multivariate regression analysis showed that posterior vertical dimension (VD) at T1 (-1.63 mm), surgical amount of mandibular setback (-10.33 mm), surgical condylar downwards displacement (-1.28 mm), and anterior overjet at T1 (6.43 mm) were the most important predictors of early mandibular relapse (r2 = 0.593). CONCLUSIONS The risk of early relapse could be reduced by controlling the anterior, middle, and posterior constraints provided by the prediction model.
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Affiliation(s)
- Yiran Jiang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhongpeng Yang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yuhan Qi
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jiale Peng
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zili Li
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaojing Liu
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Biao Yi
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoxia Wang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gui Chen
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Bing Han
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tianmin Xu
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.
| | - Ruoping Jiang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.
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11
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Ravelo V, Olate G, de Moraes M, Huentequeo C, Sacco R, Olate S. Condylar Positional Changes in Skeletal Class II and Class III Malocclusions after Bimaxillary Orthognathic Surgery. J Pers Med 2023; 13:1544. [PMID: 38003858 PMCID: PMC10672009 DOI: 10.3390/jpm13111544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023] Open
Abstract
Orthognathic surgery is indicated to modify the position of the maxillomandibular structure; changes in the mandibular position after osteotomy can be related to changes in the position of the mandibular condyle in the articular fossa. The aim of this study was to determine changes produced in the mandibular condyle 6 months after orthognathic surgery. A cross-sectional study was conducted that included subjects who had undergone bimaxillary orthognathic surgery to treat dentofacial deformity of Angle class II (group CII) or Angle class III (group CIII). Standardized images were taken using cone-beam computed tomography 21 days before surgery and 6 months after surgery; measurement scales were used to identify the condylar position and its relations with the anterior, superior, and posterior joint spaces. The results were analyzed using the Shapiro-Wilk and Student's t-tests, while considering a value of p < 0.05 as indicating a significant difference. Fifty-two joints from 26 patients, with an average age of 27.9 years (±10.81), were analyzed. All subjects in both group CII and group CIII showed a significant change in the anterior, superior, and posterior joint spaces. However, postoperative changes in the position of the condyle in the articular fossa were not significant in the anteroposterior analysis. We conclude that orthognathic surgery causes changes in the sagittal position of the mandibular condyle in subjects with mandibular retrognathism and prognathism.
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Affiliation(s)
- Víctor Ravelo
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
- PhD Program in Morphological Sciences, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile
| | - Gabriela Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
| | - Marcio de Moraes
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba 13414-903, SP, Brazil
| | - Claudio Huentequeo
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
| | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
- Oral Surgery Department, King's College Hospital NHS Trust, London SE5 9RW, UK
| | - Sergio Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
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12
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Ren R, Li Y, Telha W, Zhu S, Jiang N. Effect of the magnitude of condylar head displacement on the TMJ function in skeletal class II patients undergoing different degrees of mandibular advancement: A retrospective comparative study. J Plast Reconstr Aesthet Surg 2023; 84:241-249. [PMID: 37352620 DOI: 10.1016/j.bjps.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE This study aimed to compare the condylar head displacement (CHD) after bilateral sagittal split ramus osteotomy (BSSO) between different degrees of mandibular advancement in skeletal class II patients and to evaluate whether the temporomandibular joint (TMJ) function would be affected. PATIENTS AND METHODS Fifty-nine patients (118 condyles) were included in this retrospective study and were divided into three groups based on the distance of mandibular advancement. The CHD in three directions, x (sagittal direction), y (coronal direction), and z (axial direction), was measured before operation (T0), immediately after operation (T1), and at least 6 months after operation (T2), and the TMJ function of patients was followed up and scored using the Helkimo index system. All the abovementioned data were statistically analyzed, and p < 0.05 was considered the statistical difference standard. RESULT During the BSSO surgery, the condyle was predominantly displaced in a lateral, posterior, and superior direction whenever in T1 and T2, even though the degree of CHD was different. Regarding the amount of CHD, the large advancement group was higher than the other two groups in T1 and T2 (p<0.01). The Helkimo index scores of the three groups were evaluated, and there was no significant statistical difference between the Ai and Di index of the three groups. CONCLUSION In our center, CHD occurred in lateral, posterior, and superior directions following mandibular advancement in skeletal class II patients, with a positive correlation between the CHD and the mandibular advancement; however, the TMJ function of the three groups did not show significant differences.
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Affiliation(s)
- Rong Ren
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Yibo Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Wael Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China.
| | - Nan Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China.
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13
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Wang Z, Shi Y, Wang Y, Chen W, Jiang H, Cheng J. Three-dimensional quantitative changes of condyle in patients with skeletal class III malocclusion after bimaxillary orthognathic surgery with 5-year follow-up. Clin Oral Investig 2023:10.1007/s00784-023-05032-z. [PMID: 37145152 DOI: 10.1007/s00784-023-05032-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The present study aimed to characterize three-dimensional (3D) long-term quantitative condyle change including positional, surface, and volumetric alterations in patients with skeletal class III malocclusion treated with bimaxillary orthognathic surgery. MATERIAL AND METHODS Twenty-three eligible patients (9 males, 14 females, mean age: 28.28 years old) treated from Jan. 2013 to Dec. 2016 with postoperative follow-up over 5 years were retrospectively enrolled. Cone-beam computed tomography scan for each patient was conducted at 4 stages: 1 week preoperatively (T0), immediately after surgery (T1), 12 months postoperatively (T2), and 5-year postoperatively (T3). Positional changes, surface, and volumetric remodeling of condyle were measured in segmented visual 3D models and statistically compared between stages. RESULTS Our 3D quantitative calibrations revealed that the condylar center shifted in anterior (0.23 ± 1.50 mm), medial (0.34 ± 0.99), and superior (1.11 ± 1.10 mm) directions and rotated outward (1.58 ± 3.11°), superior (1.83 ± 5.08°), and backward (4.79 ± 13.75°) from T1 to T3. With regard to condylar surface remodeling, bone formation was frequently observed in the anteromedial areas, while bone resorption was commonly detected in the anterolateral area. Moreover, condylar volume remained largely stable with a minimal reduction during the follow-up. CONCLUSION Collectively, although condyle undergoes positional changes and bone remodeling after bimaxillary surgery in patients with mandibular prognathism, these changes largely fall in the range of physical adaptations in the long run. CLINICAL RELEVANCE These findings advance the current understanding of long-term condylar remodeling after bimaxillary orthognathic surgery in skeletal class III patients.
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Affiliation(s)
- Ziyu Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Jiangsu, 210029, People's Republic of China
| | - Yijin Shi
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, 210029, People's Republic of China
| | - Yi Wang
- Department of Oral and Maxillofacial Surgery, Anhui Provincial Hospital/The Affiliated Hospital of University of Science and Technology of China, He Fei, 230031, People's Republic of China
| | - Wenjing Chen
- Jiangsu Province Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, 210029, People's Republic of China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Jiangsu, 210029, People's Republic of China
| | - Hongbing Jiang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
- Jiangsu Province Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, 210029, People's Republic of China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
- Jiangsu Province Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, 210029, People's Republic of China.
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Jiangsu, 210029, People's Republic of China.
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14
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Ma H, Lyu H, Xu L, Hou J, Wang X, Li W, Li X. Augmented corticotomy-assisted presurgical orthodontic treatment to prevent alveolar bone loss in patients with skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop 2023; 163:210-221. [PMID: 36328904 DOI: 10.1016/j.ajodo.2021.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The objective of this study was to explore the effect of augmented corticotomy (AC) on anterior alveolar bone morphology in presurgical orthodontic treatment for skeletal Class III malocclusion. METHODS Thirty-six surgical patients with skeletal Class III malocclusion with high-angle were included: 18 (AC group) accepted AC surgery during presurgical orthodontic treatment, and 18 (control group) accepted traditional presurgical orthodontic treatment. Cone-beam computed tomography scans were obtained before treatment (T0) and after presurgical orthodontic treatment (T1). The alveolar bone morphology, root length, dehiscence, and movement of mandibular central incisors were measured by cone-beam computed tomography using Dolphin software. Statistical analyses were performed with independent-sample t tests, paired t tests, and multiple linear regression. RESULTS After presurgical orthodontic treatment, the whole alveolar bone thickness at each level, alveolar bone area, and alveolar bone height decreased significantly in the control group but increased or remained unchanged in the AC group. In the AC group, the lower the labial alveolar bone height at T0 was, the greater the increase after T1; the change in alveolar bone thickness was related to ΔL1-MP and sex. At T0, the incidences of dehiscence were similar in the 2 groups, ranging from 11.11% to 16.67%. At T1, the labial and lingual incidences of dehiscence in the AC group were 0% and 27.78%, compared with 55.56% and 66.67% in the control group. CONCLUSIONS During presurgical orthodontic treatment, AC is effective in preventing alveolar bone resorption and dehiscence without additional root resorption. AC can be recommended for high-angle skeletal Class III patients with thin alveolar bone around anterior teeth during presurgical orthodontic treatment.
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Affiliation(s)
- Huimin Ma
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hangmiao Lyu
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Li Xu
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jianxia Hou
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoxia Wang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Weiran Li
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Xiaotong Li
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
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15
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Kaur A, Rattan V, Rai S, Singh SP, Kalra P, Sharma S. Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD)- a prospective study. J Craniomaxillofac Surg 2022; 50:915-922. [PMID: 36621385 DOI: 10.1016/j.jcms.2022.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/16/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
The aim of the study was to assess the changes in the condylar position after orthognathic surgery (OGS) and its effect on temporomandibular disorders (TMD). A total of 37 dentofacial deformity patients included in the study who had undergone OGS were divided into three groups: Group I, Le Fort I maxillary advancement; Group II, bilateral sagittal split osteotomy (BSSO) mandibular advancement ± Le Fort I; and Group III, BSSO mandibular setback ± Le Fort I. Patients were evaluated clinically using Diagnostic Criteria for TMD and by radiography preoperatively and 6 months postoperatively. The positional changes in condyle were correlated with signs and symptoms of TMD. A total of 37 patients in three groups (Group I, 8 patients; Group II, 10 patients; and Group III, 19 patients) were evaluated. Overall, condyles had anterio-medio-inferior movement with 7 of 8 patients in Group I, 6 of 10 patients in Group II and 13 of 19 patients in Group III having ≤2 mm displacement. In angular changes, inward-anterio-medial movement was observed with 6 of 8 patients in Group I; about 5 of 10 patients, and 10 of 19 patients in Group II and III respectively had ≤5° change. Intragroup and intergroup comparisons showed insignificant changes in TMD and linear/angular movement (p ≥ 0.05). Pearson correlation coefficient was found to be nonsignificant on the radiographic and clinical comparison (p ≥ 0.05). Intrarater reliability (Kappa value) was found to be 0.83, confirming the results. Within the limitations of the study it seems that there are minimal linear and angular changes in condyle after orthognathic surgery that were not responsible for the development of temporomandibular disorders in the postoperative course.
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Affiliation(s)
- Amanjot Kaur
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Vidya Rattan
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Sachin Rai
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Satinder Pal Singh
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Parveen Kalra
- Centre of Excellence in Industrial and Product Design, Punjab Engineering College, Chandigarh, India.
| | - Shagun Sharma
- Centre of Excellence in Industrial and Product Design, Punjab Engineering College, Chandigarh, India.
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16
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Roman R, Almășan O, Hedeșiu M, Băciuț M, Bran S, Popa D, Ban A, Dinu C. Evaluation of the Mandibular Condyle Morphologic Relation before and after Orthognathic Surgery in Class II and III Malocclusion Patients Using Cone Beam Computed Tomography. BIOLOGY 2022; 11:biology11091353. [PMID: 36138832 PMCID: PMC9495726 DOI: 10.3390/biology11091353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
Simple Summary In individuals with severe malocclusions, orthognathic surgery seeks to rebalance the relationships between the jaws by providing a stable occlusion, a healthy muscle balance, and the functioning of the temporomandibular joint. Cone beam computed tomography may be used to determine the position of the mandibular condyle in the glenoid fossa. This study aimed to assess how the position of the mandibular condyle varies in class II and III malocclusions before and after bimaxillary orthognathic surgery. Before and after orthognathic surgery, 56 TMJs from 28 patients were studied. Following surgery, both class II and class III patients experienced changes in the anterior joint space, posterior joint space, condyle position, and condyle angle. The preliminary findings are promising for determining changes in condyle position and joint spaces that might guide oral and maxillofacial surgeons to address a debilitating clinical affliction. Abstract This study aimed at evaluating the mandibular condyle position changes before and after bimaxillary orthognathic surgery in class II and III malocclusion patients. CBCT scans from patients who underwent bimaxillary orthognathic surgery were analyzed: Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). Both condyles were independently assessed for their largest anterior and posterior joint spaces, smallest medial joint spaces, and condyle angles concerning the transverse line. In the sagittal plane, the minimum size of the anterior and posterior joint spaces was measured. In the coronal plane, the smallest medial joint space was measured. The position of the condyle within the glenoid fossa was determined before and after surgery. A total of 56 TMJs from 28 patients were studied. Following orthognathic surgery, the anterior and posterior space in class II increased. Postoperatively, the anterior joint space in class III decreased. In 42.85% of malocclusion class II patients and 57.14% of malocclusion class III patients, the pre-and post-surgical position of the condyle changed, the condyle was anteriorly positioned (42.85%) in class II patients and centrically positioned (71.4%) in class III patients. Significant changes in the joint space, condylar position, and condyle angle were found in the class II and class III subjects.
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Affiliation(s)
- Raluca Roman
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
- Correspondence:
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Daiana Popa
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Alina Ban
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
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Kazemian M, Ghadiri Moghaddam N, Anbiaee N, Kermani H, Samiee Rad S. The Clinical and Radiographic Changes of Temporomandibular Joint (TMJ) Following Mandibular Set Back Surgery by Bilateral Sagittal Split Osteotomy (BSSO). World J Plast Surg 2022; 11:110-116. [PMID: 36117893 PMCID: PMC9446119 DOI: 10.52547/wjps.11.2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Bilateral Sagittal Split Osteotomy (BSSO) is one of the treatment options for Class III maxillary deficiency which may affect the condylar position and the patient's occlusion. We aimed to evaluate the clinical and radiographic changes of temporomandibular joint (TMJ) following mandibular set back surgery by BSSO. Methods In this retrospective study, All Class III patients, aged between 18-30 years old who underwent bimaxillary orthognathic surgery in the Oral and Maxillofacial Surgery Ward of Ghaem Hospital, Mashhad, Iran from January 2018- January 2020 were enrolled. Radiographic changes of joint space, condylar position and clinical changes for maximal mouth opening and joint sound were examined before and 6 months after surgery. Data were analyzed by SPSS16 software and the significance level of the data was set at P-value < 0.05. Results Twenty-five patients were recruited. The axial angle of the left and right condyle and condylar inclination on both sides reduced but this reduction was not statistically significant. While the anterior joint space was reduced and posterior joint space was increased in both sides, the changes on the right side were only significant (P = 0.039). In clinical examinations maximum mouth opening, lateral and protrusive movements were also decreased but this reduction was not statistically significant. Conclusion The mandibular set back with BSSO surgery in class III skeletal patients had no significant effect on the position of the condyle in the glenoid fossa as well as clinical symptoms.
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Affiliation(s)
- Mozhgan Kazemian
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nafiseh Ghadiri Moghaddam
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Anbiaee
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Kermani
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahand Samiee Rad
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Dadgar S, Sobouti F, Hadian H, Pakravan A, Rahimi Z, Rakhshan V. Short-term and long-term alterations of condylar position after bilateral sagittal split ramus osteotomy for mandibular setback: A preliminary before-after clinical trial. Dent Res J (Isfahan) 2022; 19:19. [PMID: 35308442 PMCID: PMC8927962 DOI: 10.4103/1735-3327.338782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/02/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Materials and Methods: Results: Conclusion:
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Three-dimensional condylar displacement and remodelling following correction of asymmetric mandibular prognathism with maxillary canting. Int J Oral Maxillofac Surg 2021; 51:813-822. [PMID: 34924271 DOI: 10.1016/j.ijom.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/11/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023]
Abstract
The aim of this study was to investigate the three-dimensional condylar displacement and long-term remodelling following the correction of asymmetric mandibular prognathism with maxillary canting. Thirty consecutive patients (60 condyles) with asymmetric mandibular prognathism >4 mm and occlusal canting >3 mm, treated by Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, were included. Spiral computed tomography scans obtained at different periods during long-term follow-up (mean 17 ± 7.2 months) were gathered and processed using ITK-SNAP and 3D Slicer. The condyles were subjected to translational and rotational displacements immediately after the surgery (T2), which had not fully returned to the original preoperative positions at the last follow-up (T3). Condylar remodelling was observed at the last follow-up (T3), with the shorter side condyles subjected to higher surface resorption and overall condylar volume loss. The overall condylar volume on the shorter side was significantly reduced compared to the volume on the elongated side (-11.9 ± 90.6 vs -131.7 ± 138.2 mm3; P = 0.001). About 73%, 87%, 53%, and 54% of the shorter side condyles experienced resorption on the posterior, superior, medial, and lateral surfaces, respectively; in contrast, only 50% of the elongated side condyles showed resorption on the superior surface. Higher preoperative asymmetry was significantly correlated with increased postoperative condylar displacement (P < 0.05). The vertical asymmetry and the vector of condylar displacement were associated with the resultant remodelling process. It is concluded that condylar resorption of the shorter side condyle, which may affect the long-term surgical stability, has to be considered.
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Abotaleb BM, Bi R, Liu Y, Jiang N, Telha W, Zhu S. Three-dimensional condylar displacement and remodelling in patients with asymmetrical mandibular prognathism following bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2021; 51:509-517. [PMID: 34446294 DOI: 10.1016/j.ijom.2021.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/25/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023]
Abstract
This study aims to assess the postoperative condylar displacement and the long-term condylar remodelling in patients with mandibular prognathism with transverse asymmetry after bilateral sagittal split ramus osteotomy (BSSRO). Forty-one consecutive patients (82 condyles) with a transverse mandibular asymmetry of more than 4 mm without occlusal canting treated by BSSRO were included. The preoperative (T1), immediate postoperative (T2) and long-term follow-up of an average of 16.2 months (T3) spiral computed tomography scans were gathered and processed to measure the condylar displacement and remodelling based on cranial base voxel-based and rigid regional registrations. The statistical analysis revealed that the majority of condyles (T1-T2) were transitionally displaced forwards, downwards and laterally, and were not fully returned to the preoperative position at T3. Condylar lateral displacement was significantly higher on the deviated side (DS) (P = 0.035). Non-deviated side (NDS) condyles were mainly subjected to upward pitch, medial yaw and medial roll compared with downward pitch, lateral yaw and lateral roll on DS. Condylar remodelling at T3 was observed, with the superior and posterior surfaces commonly subjected to bone resorption, whereas the anterior and medial surfaces were commonly subjected to bone apposition. Condylar volumetric changes were relatively comparable on NDS (3 ± 85.2 mm3) and DS (8.3 ± 111.7 mm3) condyles. Age, amount of preoperative asymmetry and follow-up period were not correlated with the condylar remodelling. Transitional and rotational displacements were to some extent significantly correlated with the condylar remodelling on both sides. Consequently, passive condylar seating without torque might prevent the long-term unfavourable condylar remodelling.
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Affiliation(s)
- B M Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - R Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Y Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - N Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - W Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - S Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Changes in Condylar Position Within 12 Months After Bilateral Sagittal Split Ramus Osteotomy With and Without Le Fort I Osteotomy by Using Cone-Beam Computed Tomography. J Oral Maxillofac Surg 2021; 80:162-173. [PMID: 34547267 DOI: 10.1016/j.joms.2021.08.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to evaluate the condylar position changes in 12 months after bilateral sagittal split ramus osteotomy (BSSO) with and without a Le Fort I osteotomy in patients with Class III malocclusion and the influence of the 2 surgical approaches on the condylar position. METHODS In this prospective cohort study, patients with skeletal Class III malocclusion who underwent orthognathic surgery between 2017 and 2019 were included. The main predictive variable is the effect of increasing Le Fort I osteotomy on condyle position, which is divided into BSSO-only group and BSSO + Le Fort I osteotomy group. The main outcome variables were the displacement of the condylar head and the rotation/inclination of the condylar long axis before and after surgery. Other study variables were according to the degree of asymmetry of the left and right side of the mandible, the measured values of both sides were divided into mandibular deviation and nondeviation. The cone-beam volumetric imaging images were obtained before surgery (T1) and immediately after surgery (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after surgery by computerized tomography (CT). One-way ANOVA and Tukey test was used for correlation analysis. The p-value is set to 0.05. RESULTS Twenty-four adult patients diagnosed with skeletal Class III malocclusion were included in this study, 12 patients (male/female = 6:6, mean age 21.8 years) who underwent BSSO + Le Fort I osteotomy and 12 patients (male/female = 6:6, mean age 19.8 years) who underwent BSSO-only. The position of the bilateral condylar head in both surgery groups was adjusted continuously during the 12 months after the operation. Immediately and 12 months after surgery, both sides of the condylar long axis in the BSSO with Le Fort I osteotomy group and the BSSO-only surgery group rotated inward, tilted forward, and tilted inward. In the BSSO with Le Fort I osteotomy group, the rotation and tilt angle changes of the condylar long axis on both sides were stable 6 months after surgery. CONCLUSIONS The addition of Le Fort I osteotomy did not significantly change the rotation and tilt direction of the condylar long axis and could accelerate the stability of the condylar long axis after BSSO surgery.
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Virtual Surgical Planning Combined With Intraoperative Navigation in Mandibular Bilateral Sagittal Split Osteotomy for Accurate Placement of Patient Specific Implants. J Craniofac Surg 2021; 32:2666-2670. [PMID: 34260465 DOI: 10.1097/scs.0000000000007937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The aim of the study is to evaluate clinical methods to obtain a significantly improved fitting of patient specific implants (PSI) in bilateral sagittal split osteotomies and to evaluate the use of electromagnetic navigation as a potential guide for condyle positioning. A prospective study using (1) a solid bite registration index during preoperative computed tomography, (2) critical planning with regard to the condylar rotation, (3) a piezoelectric saw throughout the mandibular osteotomy, and (4) intraoperative navigation to determine the position of the PSIs and the mandibular segments intraoperatively was performed. Ten patients were treated. Five underwent bilateral sagittal split osteotomies and 5 bimaxillary osteotomy. All of the PSIs fitted precisely onto the mandible and the screws into the predrilled screw holes. The predetermined occlusion was obtained. A precise fitting of the PSIs in the lower jaw seems to be possible to achieve with above-mentioned methods. The intraoperative navigation system gives a possibility to verify the surgical outcome during surgery but is not accurate enough to be used as a virtual drill guide alone.
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Neeraj, Reddy SG, Dixit A, Agarwal P, Chowdhry R, Chug A. Relapse and temporomandibular joint dysfunction (TMD) as postoperative complication in skeletal class III patients undergoing bimaxillary orthognathic surgery: A systematic review. J Oral Biol Craniofac Res 2021; 11:467-475. [PMID: 34345581 DOI: 10.1016/j.jobcr.2021.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/17/2021] [Accepted: 06/27/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives The aim of this study was to determine Relapse and TMD as postoperative complication in skeletal class III patients undergoing bimaxillary orthognathic surgery. Materials and methods Data was obtained by database searching using The Cochrane Central Register of Controlled Trials (central), PUBMED, SCOPUS, EMBASE, Google scholar, National Medical library, New Delhi. The titles and abstracts of the electronic search results were screened and evaluated by two observers for eligibility according to the inclusion and exclusion criteria. Results 5261 articles were retrieved for the review. Among these, 3474 duplicate articles were removed. 418 studies were selected based on the eligibility criteria. For the present review, 30 articles were included after elimination according to the inclusion criteria. The Prisma diagram flowchart demonstrates our selection scheme. Quality assessment criteria to evaluate the studies were decided by two review authors in accordance with CONSORT guidelines. Each study was assessed using the evaluation method described in the Cochrane Handbook for Systematic Reviews. Among the 30 studies included in the review, marked degree of relapse in the mandible was noted from 3 months - 1 year postoperatively in 8 studies, 5 studies reported both TMD prevalence and relapse, whereas only 4 studies reported TMD disorder alone. Conclusion Complications of relapse and TMD are associated with bimaxillary orthognathic surgery procedures. More RCTs and CCTs are needed in this regard to get better quality evidence. This review was registered with PROSPERO: CRD42020211342.
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Affiliation(s)
- Neeraj
- Department of Dentistry and Craniomaxillofacial Surgery, AIIMS, Rishikesh, India
| | - Srinivas Gosla Reddy
- Department of Dentistry and Craniomaxillofacial Surgery, AIIMS, Rishikesh, India
| | - Ashutosh Dixit
- Department of Dentistry and Craniomaxillofacial Surgery, AIIMS, Rishikesh, India
| | - Padmanidhi Agarwal
- Department of Dentistry and Craniomaxillofacial Surgery, AIIMS, Rishikesh, India
| | - Rebecca Chowdhry
- Department of Dentistry and Craniomaxillofacial Surgery, AIIMS, Rishikesh, India
| | - Ashi Chug
- Department of Dentistry and Craniomaxillofacial Surgery, AIIMS, Rishikesh, India
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Analysis of Sagittal Position Changes of the Condyle After Mandibular Setback Surgery Across the Four Different Types of Plating Systems. J Craniofac Surg 2021; 32:2441-2445. [PMID: 33710053 PMCID: PMC8478309 DOI: 10.1097/scs.0000000000007578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The authors analyzed the three-dimensional postoperative condylar position change across the plating systems. This retrospective study was conducted with the patients who underwent bilateral sagittal split ramus osteotomy with setback surgery. The condylar change was analyzed from preoperative cone-beam computed tomography to postoperative 1 month (T1) and postoperative 6 months (T2) using superimposition software, automatically merging based on the anterior cranial base. The condylar changes during T1 and T2 were analyzed across the four types of plates (4-hole sliding, heart-shaped, 3-hole sliding, and 4-hole conventional) Mean intraclass correlation coefficient values were consistently high for each measurement (>0.850). During T1, the conventional plate had a decreased condylar anterior distance when compared with the 3-hole sliding plate (P = 0.032). During T2, the conventional plate had an increased condylar posterior distance when compared with the 3-hole sliding plate (P = 0.031). Superimposition software based on the anterior cranial base could be available for measurement of condylar position with highly reproducible results. After bilateral sagittal split ramus osteotomy, the 3-hole sliding plate could effectively compensate for the anterior displacement of the condyle compared to other plates.
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Lee JY, Lee SM, Kim SH, Kim YI. Long-term follow-up of intersegmental displacement after orthognathic surgery using cone-beam computed tomographic superimposition. Angle Orthod 2021; 90:548-555. [PMID: 33378504 DOI: 10.2319/061119-398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate intersegmental displacement during long-term follow-up after bilateral sagittal split osteotomy (BSSO) by mandibular body area superimposition. MATERIALS AND METHODS Cone-beam computed tomography (CBCT) images of 23 patients ages 18-37 years with class III malocclusion before orthognathic surgery were obtained. A three-dimensional (3D) CBCT examination was performed at four stages: surgery (T0), 6 months after surgery (T1), 1 year after surgery (T2), and long-term follow-up (6.1 ± 2.1 years, T3). The CBCT datasets were superimposed on the symphyseal area and the lower part of the distal segment of the mandible between T0 and the other time points (T1, T2, and T3). The reference points (both condyle, coronoid, and sigmoid) were estimated by the CBCT analyzed program. RESULTS The coronoid, condylion, and sigmoid showed changes within 6 months after surgery, but there was no significant change in the intersegmental displacement between 6 months and 6 years after surgery. The distances between the left and right coronoid, condylion, and sigmoid from T0 to T3 were noted. CONCLUSIONS The change in intersegmental displacement between T0 and T3 affecting relapse after orthognathic surgery was not significantly different. This suggests that the mandible itself may have a stable morphology during the follow-up period.
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Oh HJ, Moon JH, Ha H, Son IS, Lee YC, Lee SJ, Sohn HB, Seo BM. Virtually-Planned Orthognathic Surgery Achieves an Accurate Condylar Position. J Oral Maxillofac Surg 2021; 79:1146.e1-1146.e25. [PMID: 33539812 DOI: 10.1016/j.joms.2020.12.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Accuracy in orthognathic surgery with virtual planning has been reported, but detailed analysis of accuracy according to anatomic location, including the mandibular condyle, is insufficient. The purpose of this study was to compare the virtual plan and surgical outcomes and analyze the degree and distribution of errors according to each anatomic location. PATIENTS AND METHODS This retrospective cohort study evaluated skeletal class III patients, treated with bimaxillary surgery. The primary predictor was anatomic locations that consisted of right and left condyles, maxilla, and the distal segment of the mandible. Other variables were age and gender. The primary outcome was surgical accuracy, defined as mean 3-dimensional distance error, mean absolute error, and mean error along the horizontal, vertical, and anteroposterior axes between the virtual plan and surgical outcomes. Landmarks were compared using a computational method based on affine transformation with a 1-time landmark setting. The mean errors were visualized with multidimensional scattergrams. Bivariate and regression statistics were computed. RESULTS This study included 52 patients, 26 men and 26 women, with a mean age of 21 years and 3 months. The mean 3D distance errors for condylar landmarks, maxillary landmarks, and landmarks on the distal segment of the mandible were 1.03, 1.25, and 2.24 mm, respectively. Condylar landmarks, maxillary landmarks, and the landmarks on the distal segment of the mandible were positioned at 0.49 mm inferior, 0.28 mm anterior, and 1.25 mm inferior, respectively. The landmark errors for the distal segment of the mandible exhibited a wider distribution than those for condylar and maxillary landmarks. CONCLUSIONS Agreement between the planned and actual outcome aided by virtual surgical planning was highest for the condyles, followed by the maxilla, and the distal segment of the mandible. It is important to consider the tendency for surgical errors in each anatomic location during operations.
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Affiliation(s)
- Hyun Jun Oh
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Seoul, Korea
| | - Jun-Ho Moon
- Graduate Student, Department of Orthodontics, Graduate School, Seoul National University, Seoul, Korea
| | - Hyunbin Ha
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University, Seoul, Korea
| | - In Seon Son
- Researcher, BOS Research Institute, Seoul, Korea
| | - Yong-Chan Lee
- Private Practitioner, Department of Oral and Maxillofacial Surgery, Bestian Seoul Hospital, Seoul, Korea
| | - Shin-Jae Lee
- Professor, Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Hong-Bum Sohn
- Private Practitioner, Department of Orthodontics, Eton Dental Hospital, Seoul, Korea
| | - Byoung-Moo Seo
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.
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The quantitative correlation between condylar resorption and skeletal relapse following mandibular advancement in skeletal class II malocclusion patients. J Craniomaxillofac Surg 2020; 48:839-844. [DOI: 10.1016/j.jcms.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/12/2020] [Accepted: 07/05/2020] [Indexed: 11/22/2022] Open
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Hu X, Huang X, Gu Y. Assessment of buccal and lingual alveolar bone thickness and buccolingual inclination of maxillary posterior teeth in patients with severe skeletal Class III malocclusion with mandibular asymmetry. Am J Orthod Dentofacial Orthop 2020; 157:503-515. [PMID: 32241357 DOI: 10.1016/j.ajodo.2019.04.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the buccal and lingual alveolar bone thickness and buccolingual inclination of maxillary posterior teeth in patients with severe skeletal Class III malocclusion with and without mandibular asymmetry and compare with those in patients with skeletal Class I malocclusion. METHODS Cone-beam computed tomography images of 69 patients with severe skeletal Class III malocclusion and 30 patients with skeletal Class I malocclusion were collected and reconstructed with Dolphin 3D software. Based on the distance from menton to the sagittal plane (d), the patients with skeletal Class III malocclusion were divided into a symmetry group (d ≤ 2 mm) and an asymmetry group (d ≥ 4 mm). Buccal and lingual alveolar bone thickness and buccolingual inclination of maxillary posterior teeth were measured and compared. Correlations among dental measurements, severity of sagittal discrepancy, and mandibular deviation were analyzed. RESULTS Maxillary posterior teeth on the deviated side in Class III asymmetry group and symmetry group were buccally inclined compared with the Class I group (P < 0.001). A significant negative correlation was noted between buccolingual inclination of maxillary posterior teeth and ANB value with Spearman correlation coefficient of maxillary first molar, second premolar, and first premolar of -0.687, -0.485 and -0.506, respectively (P < 0.001). Maxillary first molar showed thinner buccal alveolar bone on deviated side in asymmetry group and symmetry group of Class III, compared with the Class I group, with average values of 1.21 mm, 1.19 mm, and 1.83 mm, respectively (P < 0.05). The maxillary first premolar also showed thinner buccal alveolar bone on deviated side in Class III asymmetry group compared with the Class I group, with average values of 0.87 mm and 1.28 mm, respectively (P < 0.05). CONCLUSIONS Decompensation of buccally inclined posterior teeth in patients with skeletal Class III malocclusion should be more cautious owing to thinner buccal alveolar bone to avoid a high risk of fenestration and dehiscence.
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Affiliation(s)
- Xinnong Hu
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoyi Huang
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Gu
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
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Ma H, Li W, Xu L, Hou J, Wang X, Ding S, Lv H, Li X. Morphometric evaluation of the alveolar bone around central incisors during surgical orthodontic treatment of high-angle skeletal class III malocclusion. Orthod Craniofac Res 2020; 24:87-95. [PMID: 32615016 DOI: 10.1111/ocr.12408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate morphometric characteristics of alveolar bone around the incisors of high-angle skeletal class III patients receiving surgical orthodontic treatment. SETTING AND SAMPLE POPULATION Thirty high-angle skeletal class III patients (mean age, 20.94 ± 3.25 years) underwent cone-beam computed tomography before treatment (T0), after pre-surgical orthodontic treatment (T1) and after treatment (T2). MATERIALS AND METHODS The vertical bone level (VBL), alveolar bone thickness (ABT), alveolar bone area (ABA) and position of upper and lower central incisors (UCIs and LCIs) were evaluated. The ABT included five levels (4, 6, 8 mm from the cemento-enamel junction, midroot and root apex level). One-way repeated measures ANOVA with Bonferroni's multiple-comparison test and matched t test was performed to compare variables. RESULTS Before treatment, the average labial ABT was approximately 1 mm in UCIs and 0.38 ~ 0.79 mm in LCIs, and the VBL of the LCIs was over 2 mm. After treatment, the VBL increased by 2.19 ± 1.96 mm (P < .001) on the lingual side of UCIs and 2.78 ± 2.29 mm and 3.09 ± 2.52 mm on the labial and lingual sides of LCIs, respectively (all P < .001). ABT at every level decreased significantly, decreasing by 1.66 ± 1.93 mm at the 8 mm level of UCIs and 1.06 ± 1.01 mm at the apex of LCIs (P < .001). The lingual ABA of UCIs and LCIs decreased by over 50% (P < .001). CONCLUSIONS In high-angle skeletal class III patients, the condition of alveolar bone around UCIs and LCIs was extremely poor before treatment. Further alveolar bone resorption occurred during surgical orthodontic treatment. More attention should be paid to the movement of anterior teeth in cases of severe alveolar bone loss.
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Affiliation(s)
- Huimin Ma
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Weiran Li
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Li Xu
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Jianxia Hou
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Xiaoxia Wang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuai Ding
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hangmiao Lv
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaotong Li
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
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Takasu H, Hirota M, Yamashita Y, Iwai T, Fujita K, Mitsudo K. Straight Locking Miniplate Technique Achieves Submillimeter Accuracy of Condylar Positional Change During Bimaxillary Orthognathic Surgery for Patients With Skeletal Class III Malocclusion. J Oral Maxillofac Surg 2020; 78:1834.e1-1834.e9. [PMID: 32428461 DOI: 10.1016/j.joms.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The straight locking miniplate (SLM) technique is a straightforward method to accurately reposition the maxilla during bimaxillary orthognathic surgery. The present study evaluated the accuracy of the SLM technique in maintaining the condylar position during surgery without the use of a cutting guide. PATIENTS AND METHODS The present prospective, single-center study was conducted at Yokohama City University between 2016 and 2017 and included patients with skeletal Class III malocclusion. The patients were divided into 2 groups according to the fixation method used for the mandibular segments. The mandibular segments were fixed with miniplates either manually (manual group) or using the SLM technique (SLM group). Computed tomography was performed before and 3 days after surgery to compare the condylar position. The bodily and rotational movements of the condyle were analyzed. RESULTS The subjects were 18 Japanese patients (36 condyles) who had undergone bilateral set back surgery with Le Fort I osteotomy. The amount of bodily movements in the manual and SLM groups were 1.44 and 0.62 mm, respectively. The degree of rotational movement in the sagittal plane in the manual and SLM groups was 3.33° and 0.23°, respectively. The bodily and rotational movements in the SLM group were significantly smaller than those in the manual group (P < .05 and P < .01, respectively). CONCLUSIONS These results suggest that use of the SLM technique reduces the risk of condylar positional changes to less than 1 mm during orthognathic surgery without the use of any complex devices or a cutting guide.
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Affiliation(s)
- Hikaru Takasu
- Assistant Professor, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Hirota
- Director, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan.
| | - Yosuke Yamashita
- Assistant Professor, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshinori Iwai
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koichi Fujita
- Assistant Professor, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenji Mitsudo
- Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Does the amount of mandibular setback during bimaxillary surgery correlate with the degree of surgical relapse? Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:447-452. [DOI: 10.1016/j.oooo.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/02/2019] [Accepted: 10/30/2019] [Indexed: 11/20/2022]
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Ming Y, Hu Y, Wang T, Zhang J, Li Y, Xu W, Tan H, Ye H, Zheng L. Three-dimensional evaluation of skeletal and dental changes in patients with skeletal class III malocclusion and facial asymmetry after surgical-orthodontic treatment. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:783-798. [PMID: 32417830 DOI: 10.3233/xst-190628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate skeletal and dental changes in patients with skeletal Class III malocclusion and facial asymmetry after surgical-orthodontic treatment using cone-beam computerized tomography (CBCT). METHODS This study included forty adult patients diagnosed with skeletal Class III malocclusion and asymmetry who underwent either isolated mandibular surgery or bimaxillary surgery. CBCT scans were taken before treatment (T0), at the completion of presurgical orthodontic treatment (T1) and after treatment (T2). Mimics 17.0 and 3-Matics 7.0 were used to measure skeletal and dental parameters. Skeletal and dental changes within each group from pretreatment to posttreatment were assessed, and Pearson correlation analysis was used to analyze the correlations among skeletal changes. RESULTS The three-dimensional changes in condylar position were insignificant after surgical-orthodontic treatment in either group (P > 0.05). However, in the one-jaw surgery group, there were significant backward rotations of the condyle and ramus on the nondeviated side (P < 0.05), and the condyle on the deviated side rotated inward and forward significantly in the two-jaw surgery group (P < 0.05) at T2. There were no significant differences in the changes in the total alveolar bone thickness of bilateral first molars during dental decompensation (P > 0.05). The ratio between the buccal and the total bone thickness around the maxillary first molar on the deviated side decreased significantly at T1, as did those around the mandibular first molar on the nondeviated side (P < 0.05). CONCLUSIONS Condylar angulations were less stable after treatment (7 to 9 months after surgery) in both the one-jaw and the two-jaw surgery groups, while condylar displacements were insignificant. In addition, orthodontists should keep a watchful eye to the relative position of the root in the alveolar bone during tooth decompensation.
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Affiliation(s)
- Ye Ming
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- The Affiliated Stomatology Hospital, Zunyi Medical University, Zunyi, China
| | - Yun Hu
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Tao Wang
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jiangtao Zhang
- The Affiliated Stomatology Hospital, Zunyi Medical University, Zunyi, China
| | - Yuyue Li
- Shenzhen Children's Hospital, Shenzhen, China
| | - Wenjie Xu
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Hao Tan
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Huayu Ye
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Leilei Zheng
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Yin Q, Bi R, Abotaleb B, Jiang N, Li Y, Zhu S. Changes in the position of the condyle after bilateral sagittal split ramus osteotomy in patients with mandibular retrusion and protrusion: a new condyle: fossa matching concept. Br J Oral Maxillofac Surg 2019; 57:1086-1091. [PMID: 31623933 DOI: 10.1016/j.bjoms.2019.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/28/2019] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to compare the condylar positional changes after bilateral sagittal split ramus osteotomy (BSSRO) in patients with mandibular retrusion and those with mandibular prognathism. We also studied the correlation between the degree of matching of the condyle and fossa, and condylar displacement. Thirty patients with mandibular retrusion (n=11) or mandibular prognathism (n=19) who underwent BSSRO were included. The condylar position was assessed from spiral computed tomographic (CT) scans taken preoperatively, during the first postoperative week, and at least 6 months postoperatively. All data were measured by MIMICS 17.0 and analyzed by Student's t test and Pearson's correlation analysis. The size of the condyles of patients with mandibular retrusion was significantly less than those of patients with mandibular prognathism (491.5 (172.8) compared with 823.2 (212.0) mm3). The size of the glenoid fossa in those with mandibular retrusion (599.6 (110.4) mm3) and those with prognathism (597.6 (151.6) mm3) did not seem to differ. Postoperatively the condyles moved outwards, backwards, and downwards in both groups of patients. Correlation analysis between the condyle:fossa volume ratio and the condylar positional changes showed that a large condyle:fossa volume ratio correlated with the smaller positional changes in the condyle. The condylar position changed immediately after mandibular advancement and setback, and persisted in the long term. Larger condyles tended to have fewer positional changes.
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Affiliation(s)
- Q Yin
- State Key Laboratory of Oral Diseases &National Clinical Research Center for Oral Diseases & Other Research Platform & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University
| | - R Bi
- State Key Laboratory of Oral Diseases &National Clinical Research Center for Oral Diseases & Other Research Platform & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University
| | - B Abotaleb
- State Key Laboratory of Oral Diseases &National Clinical Research Center for Oral Diseases & Other Research Platform & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - N Jiang
- State Key Laboratory of Oral Diseases &National Clinical Research Center for Oral Diseases & Other Research Platform & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University
| | - Y Li
- State Key Laboratory of Oral Diseases &National Clinical Research Center for Oral Diseases & Other Research Platform & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University.
| | - S Zhu
- State Key Laboratory of Oral Diseases &National Clinical Research Center for Oral Diseases & Other Research Platform & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University.
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Surgery-First and Orthodontic-First Approaches Produce Similar Patterns of Condylar Displacement and Remodeling in Patients With Skeletal Class III Malocclusion. J Oral Maxillofac Surg 2019; 77:1446-1456. [DOI: 10.1016/j.joms.2019.01.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/19/2022]
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Ma HD, Shu JH, Deng XZ, Liu Z. Effect of sagittal split ramus osteotomy on morphologic parameters of temporomandibular joint in patients with mandibular prognathism. Medicine (Baltimore) 2019; 98:e15830. [PMID: 31145325 PMCID: PMC6708877 DOI: 10.1097/md.0000000000015830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to evaluate the change in three-dimensional morphology and clinical symptoms of temporomandibular joint (TMJ) in class III dentofacial deformity patients postoperatively for 6 months after sagittal split ramus osteotomy (SSRO).Seventeen patients with skeletal Class III malocclusion and 10 asymptomatic volunteers (classified as Control group) were recruited for the study and underwent cone-beam computed tomography scanning. The geometries of the maxilla and mandible were reconstructed using MIMICS (Materialise, Leuven, Belgium). The morphologic measurements of the patients' TMJs were done before surgery and at 6-month follow-up - named as Pre and Post groups, respectively.The joint spaces (medial joint space, superior joint space, lateral joint space, anterior joint space, and posterior joint space) of the Control group were significantly greater than those of the Pre and Post groups (P < .05), and SSRO did not significantly change the TMJ morphology parameters. Five patients were found to have preoperative temporomandibular disorder (TMD) symptoms, and 3 of them were relieved at 6 months after surgery. Postoperative TMD symptom was observed in 1 patient without preoperative TMD symptom.SSRO did not markedly alter the TMJ morphology of the patients with mandibular prognathism. The effects of SSRO on TMD symptoms should be related to the type of deformity.
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Liebregts J, Baan F, van Lierop P, de Koning M, Bergé S, Maal T, Xi T. One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery. Sci Rep 2019; 9:3000. [PMID: 30816184 PMCID: PMC6395738 DOI: 10.1038/s41598-019-39250-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/17/2019] [Indexed: 11/09/2022] Open
Abstract
Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. However, controversy surrounds whether the maxilla- or mandible-first surgery approach leads to better surgical outcomes. In our previous study, we have shown that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. However, the post-operative stability of each approach has not been investigated. Therefore, this one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. In total, 106 patients who underwent bimaxillary surgery and had an individualized 3D virtual operation plans, received either maxilla-first (n = 53) or mandible-first (n = 53) surgery. 3D printed interocclusal splints were used during surgery to position the jaws. One year postoperatively a cone-beam computed tomography (CBCT) scan was made to assess the effects using the OrthoGnathicAnalyser. The mean sagittal, vertical and transverse relapse was less than 1.8 mm and no significant differences were found in relapse between the maxilla-first or the mandibular-first surgical procedure. Overall, this study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery.
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Affiliation(s)
- Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Frank Baan
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter van Lierop
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Martien de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.,Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
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Holzinger D, Willinger K, Millesi G, Schicho K, Breuss E, Wagner F, Seemann R. Changes of temporomandibular joint position after surgery first orthognathic treatment concept. Sci Rep 2019; 9:2206. [PMID: 30778128 PMCID: PMC6379562 DOI: 10.1038/s41598-019-38786-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022] Open
Abstract
Orthognathic surgery treatment (OGS) after orthodontic treatment of dentofacial deformities is a widely performed procedure, often accompanied by a bilateral sagittal split osteotomy (BSSO). Positioning of the condyle during this procedure is a crucial step for achieving optimal functional and anatomical results. Intraoperatively poorly positioned condyles can have a negative effect on the postoperative result and the patient’s well-being. Changes of the condylar position during OGS Procedures and its effects on the temporomandibular joint in orthognathic surgical interventions (OGS) are subject of scientific discussions. However, up to date, no study has investigated the role of condyle position in the surgery first treatment concept. The aim of this study was to investigate the influence of OGS on the three-dimensional position of the condyle in the joint in a surgery first treatment concept without positioning device and to record the change in position quantitatively and qualitatively. Analysis of our data indicated that OGS in surgery first treatment concept has no significant effect on the position of the condyle and the anatomy of the temporomandibular joint.
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Affiliation(s)
- Daniel Holzinger
- Department of Oral and Maxillofacial surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Katrin Willinger
- Department of Oral and Maxillofacial surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gabriele Millesi
- Department of Oral and Maxillofacial surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kurt Schicho
- Department of Oral and Maxillofacial surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Elisabeth Breuss
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Florian Wagner
- Department of Oral and Maxillofacial surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Rudolf Seemann
- Department of Oral and Maxillofacial surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Zupnik JT, Ioshida M, Yatabe M, Ruellas ACO, Gomes LR, Aronovich S, Benavides E, Edwards SP, Paniagua B, Cevidanes LHS. Three-dimensional analysis of condylar changes in surgical correction for open bite patients with skeletal class II and class III malocclusions. Int J Oral Maxillofac Surg 2019; 48:739-745. [PMID: 30712988 DOI: 10.1016/j.ijom.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/20/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022]
Abstract
The aim of this study was to quantify three-dimensional condylar displacements as a result of two-jaw surgery for open bite correction in patients with skeletal class II and class III malocclusion. Pre-surgical (T1) and post-surgical (T2) cone beam computed tomography scans were taken for 16 patients with skeletal class II (mean age 22.3±9.47years) and 14 patients with skeletal class III (mean age 25.6±6.27years). T2 scans were registered to T1 scans at the cranial base. Translational and rotational condylar changes were calculated by x,y,z coordinates of corresponding landmarks. The directions and amounts of condylar displacement were assessed by intra- and inter-class Mann-Whitney U-test or t-test. Class II patients presented significantly greater amounts of lateral (P=0.002) and inferior (P=0.038) translation than class III patients. The magnitudes of condylar translational displacements were small for both groups. Skeletal class III patients had predominantly medial (P=0.024) and superior (P=0.047) condylar translation. Skeletal class II patients presented greater condylar counterclockwise pitch (P=0.007) than class III patients. Two-jaw surgery for the correction of open bite led to different directions and amounts of condylar rotational displacement in patients with skeletal class II compared to class III malocclusion, with greater rotational than translational displacements.
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Affiliation(s)
- J T Zupnik
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M Ioshida
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M Yatabe
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA.
| | - A C O Ruellas
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L R Gomes
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - S Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - E Benavides
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA
| | - S P Edwards
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - L H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
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Vale F, Francisco I, Scherzberg J, Guimarães A, Caramelo F, Maló L. Condylar response to large mandibular advancement combined with maxillary impaction and counterclockwise rotation: A computed tomographic study. J Clin Exp Dent 2018; 10:e891-e901. [PMID: 30386522 PMCID: PMC6203919 DOI: 10.4317/jced.54933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022] Open
Abstract
Background This study aims to analyze the effectiveness of cone-beam computed tomography (CBCT) in the evaluation of the condylar position, angulation and intercondylar distance and assess the changes in these parameters before and after bimaxillary surgery, preformed with the critical movments of Le Fort I osteotomy (for impaction of the maxilla and conterclockwise rotation of the upper occlusal plane) and Bilateral Sagittal Split Osteotomy (BSSO) for mandibular advancement (> 8mm). Material and Methods Twenty class II patients successfully treated with BSSO of the mandible, in conjunction with Le Fort I osteotomy, were studied to evaluate the condylar changes before and after surgery. The position of the condyle was classified according to the Pullinger & Hollender’s formula in both phases. A MANOVA analysis followed by post-hoc tests were conducted to ascertain if there were statistically significant differences between pre and post surgical variables under study. The agreement of the condylar position’s classification was evaluated resorting to the Kappa statistics. Results There were no statistically significant differences between the values of the position and angulation of the condyles and intercondylar distance before and after surgery. There was an increase of the axial angle of the left condyle and the frontal angle of both condyles, while there was a decrease of the axial angle of the right condyle, the sagittal angle of both condyles and intercondylar distance. Conclusions The CBCT is a useful method for assessing variations of condylar position in detail. It was verified that the critical movements of maxillary impaction associated with the mandibular advancement do not produce significant alterations in the mandibular condyles, however, these tend to perform a posterior and inferior movement. Key words:Cone-Beam computed tomography, orthognathic surgery, mandibular condyle, osteotomy, le fort, temporomandibular joint.
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Affiliation(s)
- Francisco Vale
- DMD, MSc, PhD. Professor and Chairman - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Inês Francisco
- DMD, MSc. Postgraduate student - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Jessica Scherzberg
- DMD, MSc. Postgraduate student - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Adriana Guimarães
- DMD, MSc. Postgraduate student - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Francisco Caramelo
- MSc, PhD. Professor - Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine - University of Coimbra
| | - Luísa Maló
- DMD, MSc, PhD. Professor - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
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Ueki K, Moroi A, Tsutsui T, Hiraide R, Takayama A, Saito Y, Sato M, Baba N, Tsunoda T, Hotta A, Yoshizawa K. Time-course change in temporomandibular joint space after advancement and setback mandibular osteotomy with Le Fort I osteotomy. J Craniomaxillofac Surg 2018; 46:679-687. [DOI: 10.1016/j.jcms.2018.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/28/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022] Open
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Lim SY, Jiang T, Oh MH, Kook MS, Cho JH, Hwang HS. Cone-beam computed tomography evaluation on the changes in condylar long axis according to asymmetric setback in sagittal split ramus osteotomy patients. Angle Orthod 2018; 87:254-259. [PMID: 28253453 DOI: 10.2319/043016-349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine whether the condylar rotation is affected by asymmetric setback in patients undergoing sagittal split ramus osteotomy. MATERIALS AND METHODS Thirty patients who underwent bilateral sagittal split ramus osteotomy setback surgery were divided into the two groups, symmetric setback and asymmetric setback, according to the right/left difference of setback amount (<2.0, ≥2.0 mm). Condylar long axis changes were evaluated using the three-dimensional superimposition of before and immediately after surgery cone-beam computed tomography volume images. Evaluations were performed separately in lesser setback and greater setback side in patients undergoing asymmetric setback, whereas both side condyles were evaluated together in patients undergoing symmetric setback. Condylar axis changes on axial view were correlated with setback amount or right/left setback difference using Pearson correlation analysis. RESULTS In general, the condylar axis change occurred in a pattern of inward rotation. The condyles in patients undergoing symmetric setback showed 3.4° rotation in average. In case of asymmetric setback, the lesser setback side showed larger value (4.3°) than the greater setback side (2.3°) with a statistical significance. In the correlation analysis, setback amount showed no significant correlation with the condylar axis changes in both groups. However, correlation with right/left setback difference showed a positive correlation in lesser setback side of patients undergoing asymmetric setback. CONCLUSION The findings of this study indicate that large amount of setback alone does not contribute to the change in condylar long axis, but asymmetric setback might cause a change in condylar long axis, particularly on the lesser setback side.
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Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up. Am J Orthod Dentofacial Orthop 2017; 152:268-280. [PMID: 28760289 DOI: 10.1016/j.ajodo.2016.06.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
Abstract
Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment.
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Xi T, van Luijn R, Baan F, Schreurs R, de Koning M, Bergé S, Maal T. Three-dimensional analysis of condylar remodeling and skeletal relapse following bimaxillary surgery: A 2-year follow-up study. J Craniomaxillofac Surg 2017; 45:1311-1318. [DOI: 10.1016/j.jcms.2017.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/12/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022] Open
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Te Veldhuis EC, Te Veldhuis AH, Bramer WM, Wolvius EB, Koudstaal MJ. The effect of orthognathic surgery on the temporomandibular joint and oral function: a systematic review. Int J Oral Maxillofac Surg 2017; 46:554-563. [PMID: 28174061 DOI: 10.1016/j.ijom.2017.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/12/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
The objective of this systematic review was to examine the effect of orthognathic surgery (OS) on the temporomandibular joint and oral function. Electronic databases were systematically searched for studies published until October 2015. Articles were assessed against predefined inclusion criteria. The included papers were divided into four groups based on the type of OS performed. The following items were recorded: quality of evidence using the Oxford Centre for Evidence-Based medicine (CEBM) criteria, number of patients, presence/absence of controls, mean age at treatment, follow-up time, clinical examination findings, bite force, use of the Helkimo Index and Research Diagnostic Criteria for Temporomandibular Disorders, imaging findings, and patient questionnaire results. A total of 4669 articles were identified; 76 relevant articles were included in the review. These studies assessed a total 3399 patients and 380 controls, with a mean age of 25.4 years. The great variety of OS techniques, examination techniques, diagnostic criteria, and imaging techniques used in the articles studied, as well as the quality of the study designs, made it difficult to compare studies and to draw conclusions. However, looking at the different aspects studied in general, it can be stated that OS seems to have little or no harmful effect on the TMJ and oral function (level of evidence: levels II, III, and IV).
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Affiliation(s)
- E C Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands.
| | - A H Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
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Tyan S, Kim HH, Park KH, Kim SJ, Kim KA, Ahn HW. Sequential changes of postoperative condylar position in patients with facial asymmetry. Angle Orthod 2016; 87:260-268. [PMID: 27529733 DOI: 10.2319/030916-203.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate sequential images of the condylar position in relation to the glenoid fossa after orthognathic surgery in patients with facial asymmetry using cone beam computed tomography. MATERIALS AND METHODS A total of 20 adult patients (11 men and 9 women; mean age, 22.1 ± 4.02 years) with facial asymmetry who underwent sagittal split ramus osteotomy with rigid fixation were involved. Cone beam computed tomography scans were obtained before treatment (T0), 1 month before the surgery (T1), and 1 day (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after the surgery. The condyle position was evaluated. RESULTS At 1 day after surgery (T2), the condylar position on both sides significantly changed posteriorly, inferiorly, and laterally, but no significant difference was observed between the nonaffected and affected sides. The condyle on the nonaffected side had a tendency to recover its preoperative position at 3 months after surgery (T3) and inclined slightly laterally up to 1 year after the surgery (T5). The condyle on the affected side returned more closely to the glenoid fossa than to its pretreatment position at 3 months after surgery (T3). Thereafter, it showed a more backward and downward position (T5). CONCLUSIONS The overall condylar position after an orthognathic surgery in patients with facial asymmetry was relatively stable at 1 year after surgery. However, the condyle on the affected side during the first 3 months after surgery should be carefully monitored for surgical stability.
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Ohba S, Nakao N, Kawasaki T, Miura KI, Minamizato T, Koga Y, Yoshida N, Asahina I. Skeletal stability after sagittal split ramus osteotomy with physiological positioning in patients with skeletal mandibular prognathism and facial asymmetry. Br J Oral Maxillofac Surg 2016; 54:920-926. [PMID: 27372232 DOI: 10.1016/j.bjoms.2016.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 06/13/2016] [Indexed: 11/29/2022]
Abstract
The correction of deformities of the jaw in patients with facial asymmetry is challenging because of the high rate of relapse, which may partly be caused by skeletal interference and inappropriate seating of the condylar head. We evaluated outcomes in 30 patients who were treated by short lingual osteotomy with physiological positioning. Nine had facial symmetry (absolute displacement of the menton<2mm), 14 had minor asymmetry (displacement of >2 to <4mm), and 7 severe asymmetry (displacement of >4mm). The postoperative position of the menton (Me) was stable in each group, but deviated by 3.56mm in those with severe asymmetry. This deviation remained immediately after operation and after more than one year in this group, which implies that the Me was not on the mandibular midline. The lateral swing of both sides of the proximal segment did not change immediately after operation in any group. Although short lingual osteotomy with physiological positioning can result in skeletal stability, it is important to assess the association between the dental arch and the mandible using computed tomography to ensure a good outcome in patients with a skeletal class III deformity and facial asymmetry.
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Affiliation(s)
- Seigo Ohba
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University.
| | - Noriko Nakao
- Department of Orthodontics and Dentofacial Orthopedics, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Takako Kawasaki
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Kei-Ichiro Miura
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Tokutaro Minamizato
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Yoshiyuki Koga
- Department of Orthodontics and Dentofacial Orthopedics, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Noriaki Yoshida
- Department of Orthodontics and Dentofacial Orthopedics, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University
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Xi T, de Koning M, Bergé S, Hoppenreijs T, Maal T. The role of mandibular proximal segment rotations on skeletal relapse and condylar remodelling following bilateral sagittal split advancement osteotomies. J Craniomaxillofac Surg 2015; 43:1716-22. [DOI: 10.1016/j.jcms.2015.07.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/30/2015] [Accepted: 07/21/2015] [Indexed: 11/16/2022] Open
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48
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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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