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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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Hasegawa S, Sasaki J, Nakao H, Tomimatsu M, Yamamoto S, Watanabe S, Miyabe S, Miyachi H, Goto M. Impact of the lateral skeletal stability following bilateral sagittal split ramus osteotomy for mandibular asymmetry. JPRAS Open 2023; 38:36-47. [PMID: 37675277 PMCID: PMC10477061 DOI: 10.1016/j.jpra.2023.08.006] [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: 05/16/2023] [Accepted: 08/06/2023] [Indexed: 09/08/2023] Open
Abstract
This study evaluated the stability of bilateral sagittal split ramus osteotomy (BSSRO) associated with positional plagiocephaly and temporal and masseter muscles using posteroanterior cephalogram analysis and three-dimensional computed tomography (3D-CT). This retrospective cohort study included 31 patients who underwent BSSRO for mandibular asymmetry. The cranial vault asymmetry index (CVAI) and the cephalic index were used as indicators of positional plagiocephaly. The distance from the vertical reference line to the menton (Me) was measured on posteroanterior cephalograms immediately and 1 year after surgery, and postoperative stability was assessed. Temporal and masseter muscles were constructed from 3D-CT data and their volumes were measured. Simple regression analysis showed a significant correlation between postoperative changes in the vertical reference line to the Me and the CVAI (R = 0.56, p = 0.001), the amount of surgical movement in the vertical reference line to the Me (R = 0.41, p = 0.023), and the variable temporal muscle volume (R = 0.27, p = 0.028). There was no significant correlation between postoperative changes in the vertical reference line to the Me and the cephalic index (R = 0.093, p = 0.62) and variable masseter muscle volume (R = 0.16, p = 0.38). According to multivariate analysis, CVAI (p = 0.003) and amount of surgical movement in the vertical reference line to the Me (p = 0.014) were significant predictors of postoperative change in the vertical reference line to the Me. Positional plagiocephaly and amount of surgical movement influence lateral skeletal stability following BSSRO for mandibular asymmetry.
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Affiliation(s)
- S. Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - J. Sasaki
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - H. Nakao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - M. Tomimatsu
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Yamamoto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Watanabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - H. Miyachi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - M. Goto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
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Mansour NM, Abdelshaheed ME, El-Sabbagh AH, El-Din AMB, Kim YC, Choi JW. Three-Dimensional Evaluation of Skeletal Stability following Surgery-First Orthognathic Approach: Validation of a Simple and Effective Method. Arch Plast Surg 2023; 50:254-263. [PMID: 37256039 PMCID: PMC10226798 DOI: 10.1055/a-2058-8108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/03/2023] [Indexed: 06/01/2023] Open
Abstract
Background The three-dimensional (3D) evaluation of skeletal stability after orthognathic surgery is a time-consuming and complex procedure. The complexity increases further when evaluating the surgery-first orthognathic approach (SFOA). Herein, we propose and validate a simple time-saving method of 3D analysis using a single software, demonstrating high accuracy and repeatability. Methods This retrospective cohort study included 12 patients with skeletal class 3 malocclusion who underwent bimaxillary surgery without any presurgical orthodontics. Computed tomography (CT)/cone-beam CT images of each patient were obtained at three different time points (preoperation [T0], immediately postoperation [T1], and 1 year after surgery [T2]) and reconstructed into 3D images. After automatic surface-based alignment of the three models based on the anterior cranial base, five easily located anatomical landmarks were defined to each model. A set of angular and linear measurements were automatically calculated and used to define the amount of movement (T1-T0) and the amount of relapse (T2-T1). To evaluate the reproducibility, two independent observers processed all the cases, One of them repeated the steps after 2 weeks to assess intraobserver variability. Intraclass correlation coefficients (ICCs) were calculated at a 95% confidence interval. Time required for evaluating each case was recorded. Results Both the intra- and interobserver variability showed high ICC values (more than 0.95) with low measurement variations (mean linear variations: 0.18 mm; mean angular variations: 0.25 degree). Time needed for the evaluation process ranged from 3 to 5 minutes. Conclusion This approach is time-saving, semiautomatic, and easy to learn and can be used to effectively evaluate stability after SFOA.
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Affiliation(s)
- Nabil M. Mansour
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
| | - Mohamed E. Abdelshaheed
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
| | - Ahmed H. El-Sabbagh
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
| | - Ahmed M. Bahaa El-Din
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
| | - Young Chul Kim
- Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Jong-Woo Choi
- Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
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4
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Bahmanyar S, Namin AW, Weiss RO, Vincent AG, Read-Fuller AM, Reddy LV. Orthognathic Surgery of the Mandible. Facial Plast Surg 2021; 37:716-721. [PMID: 34587642 DOI: 10.1055/s-0041-1735309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.
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Affiliation(s)
- Sara Bahmanyar
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Arya W Namin
- Department of Otolaryngology, University of Missouri School of Medicine, University of Missouri, Columbia, Missouri
| | - Robert O Weiss
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Andrew M Read-Fuller
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
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5
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Lin CL, Chen YA, Yao CF, Chang CS, Liao YF, Chen YR. Comparative stability and outcomes of two surgical approaches for correction of class III asymmetry with lip or occlusal cant. Clin Oral Investig 2021; 25:5449-5462. [PMID: 33641063 DOI: 10.1007/s00784-021-03853-4] [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: 09/07/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess and compare the stability and outcomes of the two surgical approaches for patients with roll asymmetry. MATERIALS AND METHODS A total of 50 adult patients were consecutively recruited for this prospective study. Patients with class III asymmetry and lip or occlusal cant who underwent bimaxillary surgery were grouped according to surgical approach: asymmetric posterior impaction on both sides (API, n = 31) and posterior impaction on one side and posterior extrusion on the other side (PIE, n = 19). Postsurgical stability and outcomes between groups were determined with cone-beam computed tomography for facial midline, lip, and occlusal cant at 1 week (T1), and at least 12-month postsurgery (T2, completion of orthodontic treatment). RESULTS Presurgery, the upper anterior occlusal cant and lip cant were significantly greater for the PIE group (p < 0.05). Postsurgery (T2), the mandible moved upward and rotated upward in both groups. However, the upward rotation was significantly greater in the PIE group compared with the API group. Although the two approaches resulted in significant improvements in facial symmetry, the deviation in the facial midline remained under-corrected for most API patients. CONCLUSIONS Patient outcomes for mandibular stability and facial symmetry differed between the two surgical approaches for correction of class III asymmetry with lip or occlusal cant. CLINICAL RELEVANCE The findings of this study suggest that planned over-correction is a reasonable option for the approach of asymmetric posterior impaction on both sides.
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Affiliation(s)
- Chih-Ling Lin
- New Taipei City Municipal TuCheng Hospital (Chang Gung Memorial Hospital, TuCheng), Taipei, Taiwan.,Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ying-An Chen
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chuan-Fong Yao
- New Taipei City Municipal TuCheng Hospital (Chang Gung Memorial Hospital, TuCheng), Taipei, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Shin Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Fang Liao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road Guishan District, Taoyuan City, 333, Taiwan.
| | - Yu-Ray Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Center, Chang Gung Memorial Hospital, 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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6
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A New Approach to Set the Absolute Midsagittal Plane of the Mandible Using a Similarity Index in Skeletal Class III Patients with Facial Asymmetry. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10238550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study sought to test the feasibility of a newly developed plane called computed modified absolute mandibular midsagittal plane (cmAMP) based on the similarity index (SI) for evaluating the stereoscopical symmetry of the mandible by comparison with other proposed midsagittal planes. This study involved 29 adult patients (15 men, 14 women; average age, 23.1 ± 6.9 years) with skeletal Class III facial asymmetry who underwent bimaxillary orthognathic surgery. Using cone-beam computed tomography images taken before and 1 year after surgery, cmAMP with the highest SI value between the two anterior segments of the hemi-mandible was set by a computer algorithm. Results show that the SI using cmAMP had the highest value (0.83 ± 0.04) before surgery compared to the other midsagittal planes, and was not significantly different from the SI (0.80 ± 0.05) using a facial midsagittal plane (MSP) after surgery. The distance (1.15 ± 0.74 mm) and angle (2.02 ± 0.82°) between MSP and cmAMP after surgery were significantly smaller than those between MSP and other midsagittal planes. In conclusion, the cmAMP plane best matches the two anterior segments of hemi-mandible symmetrically and is the closest to MSP after orthognathic surgery in skeletal Class III patients with facial asymmetry.
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7
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Jung S, Choi Y, Park JH, Jung YS, Baik HS. Positional changes in the mandibular proximal segment after intraoral vertical ramus osteotomy: Surgery-first approach versus conventional approach. Korean J Orthod 2020; 50:324-335. [PMID: 32938825 PMCID: PMC7500571 DOI: 10.4041/kjod.2020.50.5.324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/21/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To compare postoperative positional changes in the mandibular proximal segment between the conventional orthognathic surgery (CS) and the surgery-first approach (SF) using intraoral vertical ramus osteotomy (IVRO) in patients with Class III malocclusion. Methods Thirty-eight patients with skeletal Class III malocclusion who underwent bimaxillary surgery were divided into two groups according to the use of preoperative orthodontic treatment CS group (n = 18) and SF group (n = 20). Skeletal changes in both groups were measured using computed tomography before (T0), 2 days after (T1), and 1 year after (T2) the surgery. Three-dimensional (3D) angular changes in the mandibular proximal segment, condylar position, and maxillomandibular landmarks were assessed. Results The mean amounts of mandibular setback and maxillary posterior impaction were similar in both groups. At T2, the posterior portion of the mandible moved upward in both groups. In the SF group, the anterior portion of the mandible moved upward by a mean distance of 0.9 ± 1.0 mm, which was statistically significant (p < 0.001). There were significant between-group differences in occlusal changes (p < 0.001) as well as in overjet and overbite. However, there were no significant between-group differences in proximal segment variables. Conclusions Despite postoperative occlusal changes, positional changes in the mandibular proximal segment and the position of the condyles were similar between CS and SF, which suggested that SF using IVRO achieved satisfactory postoperative stability. If active physiotherapy is conducted, the proximal segment can be adapted in the physiological position regardless of the occlusal changes.
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Affiliation(s)
- Seoyeon Jung
- Department of Dental Education, Yonsei University College of Dentistry, Seoul, Korea
| | - Yunjin Choi
- Department of Statistics, University of Seoul, Seoul, Korea
| | - Jung-Hyun Park
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Medical Center, Seoul, Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyoung-Seon Baik
- Department of Orthodontics, Yonsei University College of Dentistry, Seoul, Korea
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Rokutanda S, Yamada SI, Yanamoto S, Sakamoto H, Furukawa K, Rokutanda H, Yoshimi T, Nakamura T, Morita Y, Yoshida N, Umeda M. Anterior relapse or posterior drift after intraoral vertical ramus osteotomy. Sci Rep 2020; 10:3858. [PMID: 32123263 PMCID: PMC7052185 DOI: 10.1038/s41598-020-60838-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
This study aimed to evaluate the factors contributing to postoperative anterior relapse or posterior drift of the distal segment after intraoral vertical ramus osteotomy. A retrospective cohort study was conducted which included 31 patients who underwent setback surgery for mandibular prognathism by the intraoral vertical ramus osteotomy technique. Uni- and multivariate analyses were performed to determine the association of potential explanatory variables (sex, age, magnitude of setback, differences in setback magnitude between sides (right/left), duration of splint use, Angle’s classification of malocclusion, mandibular angle, and tightness of occlusion of the molars) with positional changes in the distal segment. The setback magnitude was only significant factor affecting (P = 0.015) for posterior drift, with significant posterior in setback magnitudes of less than 7.25 mm. Posterior drift after intraoral vertical ramus osteotomy is less likely if setback magnitude exceeds 7.25 mm. For setbacks less than 7.25 mm, posterior drift should either be carefully corrected postoperatively, or an alternative surgical technique should be used. The setback magnitude showed a significant association with the risk of posterior drift following intraoral vertical ramus osteotomy, and the determined cut-off value may serve as a predictor for postoperative outcomes.
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Affiliation(s)
- Satoshi Rokutanda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan. .,Department of Oral and Maxillofacial Surgery, Juko Memorial Nagasaki Hospital, 1-73 Akunoura Town, Nagasaki city, Nagasaki, 850-0063, Japan.
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matumoto City, Nagano, 390-8621, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Hiroshi Sakamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Kohei Furukawa
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Hiromi Rokutanda
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Tomoko Yoshimi
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Takuya Nakamura
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Yukiko Morita
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Noriaki Yoshida
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8588, Japan
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Dilaver E, Gulsilay S, Sina U. Stability of the surgery-only orthognathic approach in class III patients with maxillary retrognathia. SANAMED 2020. [DOI: 10.24125/sanamed.v15i1.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: The aim was to compare the stability of the surgery-only approach (SOA, indicating surgery without orthodontics) to the orthodontics-first approach (OFA; orthodontics followed by surgery) in patients with dentofacial deformities. Methods: All ten patients who underwent SOA and 10 OFA were included. Cephalometric radiographs were taken before surgery (T0), and six months after SOA or OFA(T2). The actual maxillary movement was measured intraoperatively (T1). The difference between T2-T0 and T1 is accepted as relapse. Each cephalometric film was analyzed using specialized software and the stability of actual advancement was analyzed. Results: Difference of relapse amount between SOA and OFA groups was statistically significant (p = 0.016). Conclusion: Although the stability of SOA was less than OFA, the amount of advancement was higher in SOA
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10
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Huang X, Cen X, Sun W, Xia K, Yu L, Liu J, Zhao Z. The impact of surgery-first approach on the oral health-related quality of life: a systematic review and meta-analysis. BMC Oral Health 2019; 19:136. [PMID: 31286944 PMCID: PMC6615189 DOI: 10.1186/s12903-019-0842-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/01/2019] [Indexed: 02/05/2023] Open
Abstract
Background The oral health-related quality of life (OHRQoL) is affected by dentofacial deformity. Patients with dentofacial deformity are normally treated with orthognathic surgery, including conventional three-stage method (CTM) and surgery first approach (SFA). The aim of this systematic review and meta-analysis was to compare the impact of SFA with CTM on the OHRQoL of patients with severe dentofacial deformity. Methods Five English databases, three Chinese databases, and six grey literature databases were searched (January 2000 to July 2018). Randomized controlled trials, controlled clinical trials, and cohort studies assessing the OHRQoL of patients who underwent SFA or CTM were included. After selecting studies, extracting data, and assessing risk-of-bias according to the Cochrane Handbook for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale, meta-analysis was performed to elucidate the effects of SFA on the changes of OHRQoL of patients with dentofacial deformity at each stage and made a comparison with CTM. Results There were 4 studies with 122 participants were selected for the final analysis. Three among these studies were included in meta-analysis, 2 of which were included in each forest plot. All the included studies were graded as moderate value of evidence according to GRADE quality analysis. Over the period of 2-year follow-up after bonding, the OHRQoL of the patients in SFA group showed an improving trend and was better than those in CTM group generally. After debonding, the summary scores of the 14-item Oral Health Impact Profile (OHIP-14) (− 2.92, P = 0.12) and Orthognathic Quality of Life Questionnaire (OQLQ) (− 5.59, P = 0.01) were smaller in SFA group than CTM group. Conclusions Clinical evidence indicates that SFA can contribute to the better OHRQoL in patients with dentofacial deformity immediately and persistently.
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Affiliation(s)
- Xinqi Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiao Cen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Department of Temporomandibular joint, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wentian Sun
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Kai Xia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Liyuan Yu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jun Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China. .,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China. .,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China.
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11
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Gandedkar NH, Dávila MMC, Chng CK, Liou EJW, Darendeliler A. Surgery-first orthognathic approach: A “scoping review” for mapping outcomes and plausible recommendations to develop core outcome sets. APOS TRENDS IN ORTHODONTICS 2019. [DOI: 10.25259/apos-77-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims and Objectives
The aim of this scoping review was to identify the type of outcomes measured in surgery- first orthognathic approach (SFOA). The objectives were to classify the outcomes into predetermined domains and explore the degree of representation of each domain. Furthermore, to identify which domains are over- or under-represented and determine whether the findings of this scoping review could be employed to provide a template for core outcome sets (COS). Five outcomes were identified, and all the research pertinent to SFOA were assigned to these outcomes.
Materials and Methods
Electronic databases and additional records were searched from January 2009 to March 2019 to source the data, and 525 records were identified.
Results
The initial database and additional search resulted in 525 records, of which 54 potentially relevant articles were retrieved in full. 35 studies met the selection criteria following screening and were included in the scoping review with the results of the search depicted in the preferred reporting items for systematic reviews and meta-analyses. Domains such as morphological features or changes in maxillofacial skeleton and occlusion (n = 25, 71.42%) and psychosocial well-being including quality of life outcome (n = 8, 22.85%) were well represented while functional status (n = 1, 2.85%), health resource utilization (n = 0), and adverse effects (n = 1, 2.85 %) were under-represented.
Conclusions
Limited research on SFOA precludes development of COS. However, future SFOA clinical trials should consider underrepresented outcome domains to address the SFOA treatment modality comprehensively.
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Affiliation(s)
- Narayan H. Gandedkar
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Medicine and Health, School of Dentistry, The University of Sydney, New South Wales 2006, Sydney, Australia,
| | - María Mélita Chacón Dávila
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Medicine and Health, School of Dentistry, The University of Sydney, New South Wales 2006, Sydney, Australia,
| | - Chai Kiat Chng
- Cleft and Craniofacial Centre and Dental Service, KK Women’s and Children’s Hospital, Singapore,
| | - Eric J. W. Liou
- Department of Craniofacial Orthodontics, Craniofacial Research Center, Chang Gung Memorial Hospital and Graduate Institute of Craniofacial Medicine, Chang Gung University, Taipei, Taiwan
| | - Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Medicine and Health, School of Dentistry, The University of Sydney, New South Wales 2006, Sydney, Australia,
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12
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Lo SH, Chen YA, Yao CF, Liao YF, Chen YR. Is skeletal stability after bimaxillary surgery for skeletal class III deformity related to surgical occlusal contact? Int J Oral Maxillofac Surg 2019; 48:1329-1336. [PMID: 30954332 DOI: 10.1016/j.ijom.2019.03.895] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
A stable occlusion at the time of surgery is considered important for post-surgical stability after orthognathic surgery. The aim of this study was to determine whether skeletal stability after bimaxillary surgery using a surgery-first approach for skeletal class III deformity is related to the surgical occlusal contact or surgical change. Forty-two adult patients with a skeletal class III deformity corrected by Le Fort I osteotomy and bilateral sagittal split osteotomy with a surgery-first approach were studied. Dental models were set and used to measure the surgical occlusal contact, including contact distribution, contact number, and contact area. Cone beam computed tomography was used to measure the surgical change (amount and rotation) and post-surgical skeletal stability. The relationship between skeletal stability and surgical occlusal contact or surgical change was evaluated. No relationship was found between maxillary or mandibular stability and surgical occlusal contact. However, a significant relationship was found between maxillary and mandibular stability and the amount and rotation of surgical change. The results suggest that in the surgical-orthodontic correction of skeletal class III deformity with a surgery-first approach, the post-surgical skeletal stability is not related to the surgical occlusal contact but is related to the surgical change.
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Affiliation(s)
- S H Lo
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-A Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - C-F Yao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Y-F Liao
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Y-R Chen
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
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13
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Choi TH, Kim SH, Yun PY, Kim YK, Lee NK. Factors Related to Relapse After Mandibular Setback Surgery With Minimal Presurgical Orthodontics. J Oral Maxillofac Surg 2019; 77:1072.e1-1072.e9. [PMID: 30707985 DOI: 10.1016/j.joms.2018.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/08/2018] [Accepted: 12/25/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The aims of this study were to compare the presurgical conditions, surgical changes, and postsurgical changes in patients with skeletal Class III malocclusion with different degrees of horizontal relapse after mandibular setback surgery (MS) with minimal presurgical orthodontics (MPO) and to identify the factors contributing to this relapse. MATERIALS AND METHODS For this retrospective study, 33 consecutive patients who underwent MS-MPO were selected. Lateral cephalograms were taken preoperatively (T0), 1 month after surgery (T1), and at orthodontic debonding (T2). Patients were divided into low relapse (LR; n = 18; relapse, <1 mm) and high relapse (HR; n = 15; relapse, >2 mm) groups based on the cephalometric distance of mandibular horizontal relapse. Paired t test, independent t test, and Pearson correlation analysis were used to evaluate surgical (T0 to T1) and postsurgical (T1 to T2) changes in the skeletodental variables and to explore the relation between surgical changes and horizontal relapse. RESULTS Compared with the LR group, the HR group exhibited more upward movement with counterclockwise rotation of the mandible from T1 to T2. The HR group presented at T0 with a more prognathic mandible, greater vertical facial height, and a positive overbite. In addition, the HR group presented more posterior movement with clockwise rotation of the mandible, increased overjet, and decreased overbite from T0 to T1. Horizontal relapse of the mandible was positively correlated with the amount of setback and clockwise rotation of the mandible and the change in overjet and was negatively correlated with the change in overbite. CONCLUSIONS Mandibular instability was related to the extent of setback and clockwise rotation of the mandible, decreased overbite, and increased overjet during MS-MPO.
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Affiliation(s)
- Tae-Hyun Choi
- Clinical Assistant Professor, Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So-Hyun Kim
- Resident, Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pil-Young Yun
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Kim
- Professor, Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nam-Ki Lee
- Professor, Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Korea.
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14
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Han JJ, Jung S, Park HJ, Oh HK, Kook MS. Evaluation of Postoperative Mandibular Positional Changes After Mandibular Setback Surgery in a Surgery-First Approach: Isolated Mandibular Surgery Versus Bimaxillary Surgery. J Oral Maxillofac Surg 2018; 77:181.e1-181.e12. [PMID: 30326227 DOI: 10.1016/j.joms.2018.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/20/2018] [Accepted: 09/05/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to compare postoperative positional changes in the mandible after isolated mandibular surgery (IMS) or bimaxillary surgery (BMS) in a surgery-first approach (SFA). MATERIALS AND METHODS The authors designed and implemented a retrospective cohort study composed of patients who underwent mandibular setback surgery using the SFA. Surgical and postoperative changes were evaluated using lateral cephalograms taken 1 month before surgery (T0), 1 week after surgery (T1), and immediately after debonding of orthodontic appliances (T2; 16.6 ± 8.7 months after surgery). To predict postoperative mandibular positional changes from the increase in vertical dimension (VD) in surgical occlusion, the mandible was rotated counterclockwise to the preoperative VD on the lateral cephalogram at T1, and resultant mandibular positional changes were measured. To evaluate actual postoperative mandibular positional changes between each time point and compare them between the 2 groups, independent t test, paired t test, and repeated-measures analysis of variance were performed. RESULTS Thirty patients were evaluated (16 in IMS group and 14 in BMS group). The 2 groups showed significant time-course mandibular positional changes from T0 to T1 and from T1 to T2 within each group (point B, P < .001), although no statistically significant differences were observed between groups. There was no statistically relevant difference between groups in the predicted and actual postoperative rotational movements. In addition to the mandibular forward movement that resulted from postoperative mandibular counterclockwise rotation, additional horizontal relapse occurred. CONCLUSION The present findings suggest that the mandible exhibits notable postoperative forward movement during postoperative orthodontic treatment, regardless of the extent of the orthognathic surgery in the SFA, and it is necessary to consider mandibular forward movement from the VD increase in surgical occlusion and additional relapse during the treatment planning stage.
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Affiliation(s)
- Jeong Joon Han
- Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Buk-Gu, Gwangju, Republic of Korea
| | - Seunggon Jung
- Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Buk-Gu, Gwangju, Republic of Korea
| | - Hong-Ju Park
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Buk-Gu, Gwangju, Republic of Korea
| | - Hee-Kyun Oh
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Buk-Gu, Gwangju, Republic of Korea
| | - Min-Suk Kook
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Buk-Gu, Gwangju, Republic of Korea.
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15
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Jeong JH, Choi SH, Kim KD, Hwang CJ, Lee SH, Yu HS. Long-Term Stability of Pre-Orthodontic Orthognathic Bimaxillary Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Surgery. J Oral Maxillofac Surg 2018; 76:1753-1762. [DOI: 10.1016/j.joms.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
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Wei H, Liu Z, Zang J, Wang X. Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:107-116. [PMID: 29631986 DOI: 10.1016/j.oooo.2018.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/09/2018] [Accepted: 02/25/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE There are conflicting views on the postoperative stability of surgery-first and surgery-early approaches in orthognathic surgery. We systematically reviewed the literature to compare the difference in postoperative stability between a surgery-first/early orthognathic approach (SFEA) and a conventional orthodontics-first approach (COA). STUDY DESIGN PubMed, Embase, and Cochrane Library were searched for studies related to the postoperative stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted mean differences with 95% confidence intervals were pooled using a random-effects model. RESULTS We analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifested less postoperative stability than COA group (weighted mean difference, 1.50; P < .00001), with moderate heterogeneity (I2 = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis conducted by omitting one study at a time further validated the robustness of the result. CONCLUSIONS Based on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postoperative stability than in the COA group. Patient screening and treatment plans should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.
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Affiliation(s)
- Hongpu Wei
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Zhixu Liu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiajie Zang
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
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17
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Wei H, Wang X. Re: Dr Yang's Meta-Analysis. J Oral Maxillofac Surg 2017; 75:2483. [PMID: 28935229 DOI: 10.1016/j.joms.2017.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
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18
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Song HS, Choi SH, Cha JY, Lee KJ, Yu HS. Comparison of changes in the transverse dental axis between patients with skeletal Class III malocclusion and facial asymmetry treated by orthognathic surgery with and without presurgical orthodontic treatment. Korean J Orthod 2017; 47:256-267. [PMID: 28670567 PMCID: PMC5466908 DOI: 10.4041/kjod.2017.47.4.256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/31/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate transverse skeletal and dental changes, including those in the buccolingual dental axis, between patients with skeletal Class III malocclusion and facial asymmetry after bilateral intraoral vertical ramus osteotomy with and without presurgical orthodontic treatment. Methods This retrospective study included 29 patients with skeletal Class III malocclusion and facial asymmetry including menton deviation > 4 mm from the midsagittal plane. To evaluate changes in transverse skeletal and dental variables (i.e., buccolingual inclination of the upper and lower canines and first molars), the data for 16 patients who underwent conventional orthognathic surgery (CS) were compared with those for 13 patients who underwent preorthodontic orthognathic surgery (POGS), using three-dimensional computed tomography at initial examination, 1 month before surgery, and at 7 days and 1 year after surgery. Results The 1-year postsurgical examination revealed no significant changes in the postoperative transverse dental axis in the CS group. In the POGS group, the upper first molar inclined lingually on both sides (deviated side, −1.8° ± 2.8°, p = 0.044; nondeviated side, −3.7° ± 3.3°, p = 0.001) and the lower canine inclined lingually on the nondeviated side (4.0° ± 5.4°, p = 0.022) during postsurgical orthodontic treatment. There were no significant differences in the skeletal and dental variables between the two groups at 1 year after surgery. Conclusions POGS may be a clinically acceptable alternative to CS as a treatment to achieve stable transverse axes of the dentition in both arches in patients with skeletal Class III malocclusion and facial asymmetry.
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Affiliation(s)
- Han-Sol Song
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Yul Cha
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Yang L, Xiao YD, Liang YJ, Wang X, Li JY, Liao GQ. Does the Surgery-First Approach Produce Better Outcomes in Orthognathic Surgery? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2017; 75:2422-2429. [PMID: 28672138 DOI: 10.1016/j.joms.2017.06.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/13/2017] [Accepted: 06/03/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE The surgery-first approach (SFA) in orthognathic surgery, performed without presurgical orthodontic treatment, has gained attention, but the results remain controversial. The purpose of this study was to assess the current evidence on stability, efficacy, and surgical results of SFA versus conventional 3-stage method (CTM) orthognathic surgery. MATERIALS AND METHODS A comprehensive search in PubMed and Web of Science was conducted. A systematic review and cumulative meta-analysis of all comparative studies were performed to assess the 2 strategies (SFA and CTM) using a random- or a fixed-effects model. Outcomes included treatment duration, postoperative stability, surgical movement, and postoperative occlusion. RESULTS Ten nonrandomized controlled studies including 513 patients were identified. Compared with CTM, patients in the SFA group benefited from shorter total treatment duration (weighted mean difference [WMD], -5.25; 95% confidence interval [CI], -8.21 to -2.29; P = .0005), similar postoperative stability of the mandible (WMD, 0.35 mm; 95% CI, -0.24 to 0.94; P = .55) and maxilla (WMD, 0.13 mm; 95% CI, -0.35 to 0.60; P = .60), similar surgical movements, and other surgical results. CONCLUSIONS SFA offers an efficient alternative to CTM with shorter total treatment duration, similar postoperative stability, and other surgical results but longer postoperative orthodontic time.
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Affiliation(s)
- Le Yang
- Resident, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yu-Dong Xiao
- Resident, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yu-Jie Liang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xi Wang
- Resident, Department of Orthodontics, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jing-Yuan Li
- Resident, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Gui-Qing Liao
- Professor and Chief, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
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Choi SH, Kang DY, Cha JY, Jung YS, Baik HS, Hwang CJ. Is There a Difference in Stability After Intraoral Vertical Ramus Osteotomy Between Vertically High-Angle and Normal-Angle Patients? J Oral Maxillofac Surg 2016; 74:2252-2260. [PMID: 27403878 DOI: 10.1016/j.joms.2016.06.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/16/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Few studies have evaluated the relapse pattern of intraoral vertical ramus osteotomy (IVRO) for the correction of mandibular prognathism with a high angle. The aim of this study was to measure the association between vertical facial types (high and normal mandibular plane angle) and relapse after IVRO for the management of mandibular prognathism. MATERIALS AND METHODS The retrospective cohort study sample (skeletal Class III patients) was divided into 2 groups according to the angle of the sella-nasion plane relative to the mandibular plane (SN-MP) at the initial examination. Lateral cephalograms were analyzed for the predictor (facial type) and outcome (cephalometric changes over time) variables before surgery, 7 days after surgery, and 12 months after surgery. The 2 groups were matched for sample size (n = 20 in each). Data were analyzed using repeated-measures analysis of variance with Bonferroni correction. RESULTS The normal-angle group (group N, SN-MP from 27° to 37°) and high-angle group (group H, SN-MP >37°) were not significantly different in terms of gender and age at the initial examination. Seven days after surgery, the mandibles in group H moved 2.5 mm more superiorly than those in group N (P = .013); consequently, the amount of overbite correction in group H was approximately 2 mm greater than that in group N (P = .002). Nevertheless, 12 months after surgery, there was no statistically significant difference in relapse of the maxilla and mandible between the 2 groups. In the 2 groups, the mandible moved approximately 0.7 mm superiorly during retention. CONCLUSIONS These findings suggest that IVRO is a clinically acceptable and stable treatment modality for mandibular prognathism with a high angle.
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Affiliation(s)
- Sung-Hwan Choi
- Fellow, Department of Orthodontics, The Institute of Cranial-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Da-Young Kang
- Graduate Student, Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Jung-Yul Cha
- Associate Professor, Department of Orthodontics, The Institute of Cranial-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Young-Soo Jung
- Professor, Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hyoung-Seon Baik
- Professor, Department of Orthodontics, The Institute of Cranial-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Chung-Ju Hwang
- Professor, Department of Orthodontics, The Institute of Cranial-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
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Ann HR, Jung YS, Lee KJ, Baik HS. Evaluation of stability after pre-orthodontic orthognathic surgery using cone-beam computed tomography: A comparison with conventional treatment. Korean J Orthod 2016; 46:301-9. [PMID: 27668193 PMCID: PMC5033769 DOI: 10.4041/kjod.2016.46.5.301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/14/2016] [Accepted: 07/22/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the skeletal and dental changes after intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontics by using cone-beam computed tomography (CBCT). METHODS This retrospective cohort study included 24 patients (mean age, 22.1 years) with skeletal Class III malocclusion who underwent bimaxillary surgery with IVRO. The patients were divided into the preorthodontic orthognathic surgery (POGS) group (n = 12) and conventional surgery (CS) group (n = 12). CBCT images acquired preoperatively, 1 month after surgery, and 1 year after surgery were analyzed to compare the intergroup differences in postoperative three-dimensional movements of the maxillary and mandibular landmarks and the changes in lateral cephalometric variables. RESULTS Baseline demographics (sex and age) were similar between the two groups (6 men and 6 women in each group). During the postsurgical period, the POGS group showed more significant upward movement of the mandible (p < 0.05) than did the CS group. Neither group showed significant transverse movement of any of the skeletal landmarks. Moreover, none of the dental and skeletal variables showed significant intergroup differences 1 year after surgery. CONCLUSIONS Compared with CS, POGS with IVRO resulted in significantly different postsurgical skeletal movement in the mandible. Although both groups showed similar skeletal and dental outcomes at 1 year after surgery, upward movement of the mandible during the postsurgical period should be considered to ensure a more reliable outcome after POGS.
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Affiliation(s)
- Hye-Rim Ann
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea.; The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyoung-Seon Baik
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea.; The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Choi SH, Yoo HJ, Lee JY, Jung YS, Choi JW, Lee KJ. Stability of pre-orthodontic orthognathic surgery depending on mandibular surgical techniques: SSRO vs IVRO. J Craniomaxillofac Surg 2016; 44:1209-15. [DOI: 10.1016/j.jcms.2016.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/15/2016] [Accepted: 07/18/2016] [Indexed: 11/28/2022] Open
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23
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Choi SH, Cha JY, Park HS, Hwang CJ. Intraoral Vertical Ramus Osteotomy Results in Good Long-Term Mandibular Stability in Patients With Mandibular Prognathism and Anterior Open Bite. J Oral Maxillofac Surg 2016; 74:804-10. [DOI: 10.1016/j.joms.2015.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/22/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
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Kwon YW, Bayome M, Park JU. Stability After Bilateral Sagittal Split Osteotomy With Rigid Internal Fixation in Surgery-First Approach. J Oral Maxillofac Surg 2016; 74:828.e1-6. [PMID: 26723177 DOI: 10.1016/j.joms.2015.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the stability of bilateral sagittal split ramus osteotomy (BSSO) setback with rigid internal fixation in a surgery-first approach (SFA) for patients with skeletal Class III malocclusion. PATIENTS AND METHODS Twenty-seven consecutive patients with skeletal Class III malocclusion treated with BSSO with the SFA were included in the study. Lateral cephalograms were taken and traced before surgery and 1 and 6 months after surgery. Cephalometric measurements were compared using repeated-measures analysis of variance. A P value less than or equal to .05 was considered significant. RESULTS The study included 9 men (age, 25.7 ± 2.9 yr) and 18 women (age, 26.6 ± 4.2 yr). Treatment time was 8.4 ± 1.5 months. Horizontally, there were no meaningful anteroposterior changes of the pogonion and B point during the postsurgical period (0.9 and 0.6 mm, respectively). Vertically, the pogonion showed superior movement after surgery (2.4 mm) without major postsurgical change (0.6 mm). The B point showed major superior movement after surgery (2.3 mm) and during the postsurgical period (1.2 mm). The inclination of the lower incisor was increased labially during the postsurgical period (2.4°), although this was not statistically important. CONCLUSIONS In the present study, there was no major horizontal relapse for any variable (<1 mm). Vertically, all variables showed no meaningful changes during the postsurgical period except the B point showed 1.2 mm of superior displacement. BSSO with rigid fixation using the SFA seems to be an effective and predictable procedure in patients with skeletal Class III malocclusion.
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Affiliation(s)
- Young-Wook Kwon
- Former Graduate Student, Department of Oral and Maxillofacial Surgery, Catholic University of Korea, Seoul, Korea
| | - Mohamed Bayome
- Research Assistant Professor, Graduate School, Catholic University of Korea, Seoul, Korea; Visiting Professor, Department of Postgraduate Studies, Universidad Autónoma del Paraguay, Asunción, Paraguay
| | - Je Uk Park
- Professor, Department of Oral and Maxillofacial Surgery, Seoul St Mary's Hospital, Catholic University of Korea, Seoul, Korea.
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