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Saghafi H, Benington P, Ju X, Ayoub A. The surgery-first approach for orthognathic correction of maxillary deficiency-is it stable? Three-dimensional assessment of CBCT scans and digital dental models. Int J Oral Maxillofac Surg 2024; 53:763-770. [PMID: 38448352 DOI: 10.1016/j.ijom.2024.02.006] [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: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
The aim of this study was to determine the skeletal stability of Le Fort I maxillary advancement following the surgery-first approach, by three-dimensional (3D) assessment of cone beam computed tomography (CBCT) scans and digital dental models. CBCT scans of 25 class III patients obtained 1 week preoperatively (T0) and 1 week (T1) and 6 months (T2) postoperatively were superimposed to measure surgical movements (T0-T1) and skeletal relapse (T1-T2). The distorted dentition of the CBCT scans at T1 was replaced with 3D images of the dental models to assess the postoperative occlusion. Surgical movements of the maxilla (mean ± standard deviation values) were 6.79 ± 2.30 mm advancement, 1.28 ± 1.09 mm vertically, and 0.71 ± 0.79 mm mediolaterally. Horizontal rotation (yaw) was 1.56° ± 1.21°, vertical rotation (pitch) 1.86° ± 1.88°, and tilting (roll) 1.63° ± 1.54°. At T2, the posterior relapse was 0.72 ± 0.43 mm (P = 0.001) and relapse in pitch was 1.56° ± 1.42° (P = 0.007). There was no correlation between the size of the surgical movements and the amount of relapse. A weak correlation was noted between the number of teeth in occlusal contact immediately following surgery and relapse of maxillary roll (r = - 0.434, P = 0.030). The stability of maxillary advancement with the surgery-first approach was satisfactory and was not correlated with the quality of the immediate postoperative occlusion.
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Affiliation(s)
- H Saghafi
- Glasgow University Dental Hospital and School, Glasgow, UK
| | - P Benington
- Glasgow University Dental Hospital and School, Glasgow, UK
| | - X Ju
- Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Hospital, Glasgow, UK
| | - A Ayoub
- Glasgow University Dental Hospital and School, Glasgow, UK.
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Grillo R, Borba AM, da Silva YS, Brozoski MA, Miloro M, Naclério-Homem MDG. Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:101-112. [PMID: 38155010 DOI: 10.1016/j.oooo.2023.07.018] [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: 05/02/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Alexandre Meireles Borba
- Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá-MT, Brazil
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
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Merta M, Kiukkonen A, Leikola J, Stoor P, Suojanen J. Skeletal stability after mandible bilateral sagittal split osteotomy - comparison of patient-specific implant and mini-plate fixation: A retrospective study. J Craniomaxillofac Surg 2024; 52:93-100. [PMID: 38129183 DOI: 10.1016/j.jcms.2023.11.010] [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: 11/24/2022] [Revised: 09/24/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of the study was to compare the stability of the virtual surgical planning (VSP) and computer-aided design accompanied by patient-specific implants (PSIs) and conventional mini-plates in mandible advancement with bilateral sagittal split osteotomy (BSSO). This retrospective study evaluates the clinical and cephalometric records of 53 patients (12 male, 41 female) treated with BSSO in Helsinki University Hospital. Subjects were divided into two groups: VSP-PSI (21 patients: 4 male and 17 female; mean age 38 years, range 25-53 years); and conventional wafer-based repositioning with mini-plate fixation (32 patients: 8 male and 24 female; mean age 39 years, range 21-56 years). The effect of the amount and direction of the advancement on the stability was also analysed individually. The standardized lateral cephalometric radiographs in three time points were analysed to compare the groups. After surgery (T2), there were no differences between groups in cephalometric variables. During follow-up (T2-T3), the cephalometric variables in both Groups A and B were stable, so there was no difference in stability between the VSP-PSI and the conventional mini-plate groups. During follow-up, the mandibles rotated clockwise or counterclockwise, relapsed towards their original direction, and the changes were statistically significant (jaw relationship; p = 0.018, soft tissue profile; p = 0.025); when the advancement of mandible was >6 mm, the increase in gonial angle compared to mandibles advanced ≤6 mm was statistically significant (p = 0.03). VSP-PSI and conventional mini-plate fixation can be considered equally stable. Large advancements with counterclockwise rotation regardless of fixation method are more susceptible to relapse. VSP-PSI alone cannot solve the relapse-related concerns in mandible osteotomy.
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Affiliation(s)
- Minna Merta
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti, Finland.
| | - Anu Kiukkonen
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patricia Stoor
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Juho Suojanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti, Finland; Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Thet PH, Kaboosaya B. Reproducibility of Computerized Cephalometric Analysis Software Compared with Conventional Manual Tracing for Analyzing Skeletal Stability After Orthognathic Surgery. J Maxillofac Oral Surg 2023; 22:833-840. [PMID: 38105843 PMCID: PMC10719199 DOI: 10.1007/s12663-023-02071-7] [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: 05/01/2023] [Accepted: 10/29/2023] [Indexed: 12/19/2023] Open
Abstract
Objective This study aimed to compare the difference between analyzing skeletal stability after orthognathic surgery by lateral cephalogram measurement created from Dolphin software (version 11.95) compared with the manual technique. Methods Twenty-eight patients who underwent mandibular setback surgery (BSSRO) were randomly selected between 2015 and 2021. Serial lateral cephalograms were analyzed at four different time sets postoperatively, and a total of 112 cephalometric radiographs were obtained. Horizontal measurement (BX), vertical measurement (BY), and 3 angular measurements (SNB, ANB, and Gonial angle) were analyzed by manual tracing and Dolphin software by 2 examiners. The intraclass correlation coefficient determined the intra-rater reliability. Parameter differences between timelines were observed for skeletal stability, and mean values between methods were compared using the Student's t-test. Results Both examiners were generally consistent in the repeated measurements (ICCs of the manual method ranged from 0.926 to 0.994, and the digital method ranged from 0.719 to 0.956). All variables represented skeletal stability at T0-T1, T0-T2, and T0-T3 showed no statistically significant differences between methods except ANB (T0-T1; p value = 0.009). Conclusions Computerized cephalometric analysis software is relatively reproducible for assessing skeletal changes after orthognathic surgery and can be used routinely in follow-up.
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Affiliation(s)
- Phu Hnin Thet
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330 Thailand
| | - Boosana Kaboosaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330 Thailand
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Li M, Shen S, Zhao Z, Wang B, Yu H. The application of a fully digital approach in the treatment of skeletal class III malocclusion: a preliminary study. BMC Oral Health 2023; 23:237. [PMID: 37095513 PMCID: PMC10124042 DOI: 10.1186/s12903-023-02918-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Skeletal malocclusion patients have facial malformations and occlusal dysfunctions that require orthodontic-orthognathic joint treatment, while the combination treatment takes time and requires close communication between surgeons and orthodontists. Thus, improving the efficiency and effectiveness of the combination treatment is necessary, and it is still a challenge. Now, digital technology provides us with an excellent alternative. Despite the widespread use of digital technology in orthognathic surgery simulation and clear aligner orthodontic therapy, it has not been fully integrated into the combined orthognathic and orthodontic treatment process, and the components remain independent. METHODS A fully digital approach to seamlessly integrating various parts of the combined treatment through digital technology was investigated in this study in order to achieve an efficient transition. Five patients with skeletal Class III malocclusion were enrolled, and all made fully digital treatment plans at the beginning of actual implementation, which included the design of pre-surgical orthodontic, orthognathic surgery, and post-surgical orthodontic. Then, every aspect of the clinical operation was carried out in accordance with the fully digital routine. After the entire treatment process was completed, the skeleton and dentition discrepancy between virtual planning and the actual result was evaluated. RESULTS All participants completed the fully digital treatment process, and no complication was observed. The linear deviation of the skeletal anatomy was less than 1 mm, and the angular deviation was less than 1 degree. Except in one case in the lower dentition, the deviation of the virtual dental design from the real alignment was less than 2 mm. Furthermore, with one exception of maxillary anterior-posterior dimension, the linear deviations of the skeleton were not statistically significant. Therefore, the simulation accuracy of the fully digital approach was clinically acceptable. CONCLUSIONS The digital treatment approach is clinically feasible and has achieved satisfactory results. The discrepancy between virtual design of the entire digital process and actual post-treatment situation was acceptable in clinic. A fully digital approach was proved effective in the treatment of skeletal Class III malocclusion, with which the efficient transition of treatment procedures was realized.
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Affiliation(s)
- Meng Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhiyang Zhao
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Bo Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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D’Antò V, Valletta R, De Simone V, Pisano M, Martina S. Clear Aligners Treatment of Class III Subdivision with an Extraction of a Lower Bicuspid. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3550. [PMID: 36834244 PMCID: PMC9967822 DOI: 10.3390/ijerph20043550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 05/27/2023]
Abstract
The aim of this study was to show a case of a Class III subdivision adult patient treated with clear aligners (CA) and the extraction of a lower bicuspid. A 19-year-old male with a class III canine and molar relationship on the right side and a deviation of lower dental midline to the left asked for an aesthetic treatment. He refused orthognathic surgical procedures, so he was offered a camouflage orthodontic treatment with the extraction of lower right first premolar to achieve a canine Class I relationship and to center the lower midline. The treatment was performed with clear aligners and the use of Class III elastics to maintain distal anchorage on the right side during the canine distalization. At the end of the treatment, the occlusal objectives were achieved.
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Affiliation(s)
- Vincenzo D’Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Rosa Valletta
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Vittoria De Simone
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Massimo Pisano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Allende, 84081 Baronissi, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Allende, 84081 Baronissi, Italy
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Shathi FF, Ryu J, Jung S, Kook MS, Park HJ, Oh HK. Evaluation of mandibular positional changes after orthognathic surgery in skeletal class II and class III surgery-first approach patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:677-684. [PMID: 35472486 DOI: 10.1016/j.jormas.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to predict and compare postoperative changes of mandibular position between mandibular setback and advancement surgery in a surgery-first approach (SFA). MATERIALS AND METHODS The study population included patients who underwent mandibular setback or advancement surgery using bilateral sagittal split ramus osteotomy, those were divided into two groups: mandibular setback and advancement surgery. Surgical and postoperative mandibular positional changes were evaluated by lateral cephalograms and CTs taken within 2 months before surgery (T0), 1 week after surgery (T1), and after the debonding procedure (T2). The postoperative mandibular positional changes were predicted from the increase in vertical dimension (VD) in surgical occlusion and the counterclockwise rotation to the preoperative VD on the lateral cephalograms and CT at T1. Furthermore, resultant measurement on postoperative mandibular positional changes was performed. Finally, we compared the prediction with actual positional changes of the mandible after the debonding procedure. RESULTS Nine SFA patients with mandibular setback surgery and six with advancement surgery were evaluated and significant mandibular changes from T0 to T1 and from T1 to T2 were observed. Negative correlation between horizontal surgical changes and postoperative horizontal changes was present in both groups. The difference between the predicted and actual amount of postoperative mandibular movement was significant in the mandibular advancement surgery group. CONCLUSION Postoperative mandibular relapse appeared much larger in the mandibular advancement surgery group than in the setback group. Therefore, it is more important to consider the postoperative mandibular position change in mandibular advancement surgery in SFA.
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Affiliation(s)
- Fatema Farhana Shathi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Jaeyoung Ryu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea; Chonnam National University Dental Hospital, Gwangju, Republic of Korea.
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea; Chonnam National University Dental Hospital, Gwangju, Republic of Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea; Chonnam National University Dental Hospital, Gwangju, Republic of Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea; Chonnam National University Dental Hospital, Gwangju, Republic of Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea; Chonnam National University Dental Hospital, Gwangju, Republic of Korea
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Hassing GJ, The V, Shaheen E, Politis C, de Llano-Pérula MC. Long-term three-dimensional effects of orthognathic surgery on the pharyngeal airways: a prospective study in 128 healthy patients. Clin Oral Investig 2021; 26:3131-3139. [PMID: 34826028 DOI: 10.1007/s00784-021-04295-8] [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: 08/13/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate volumetric and circumferential pharyngeal airway space (PAS) changes and stability over time as evaluated with cone beam computed tomography (CBCT) before and after orthognathic surgery 2 years postoperatively. MATERIALS AND METHODS One hundred twenty-eight patients underwent bimaxillary orthognathic surgery at the Department of Maxillofacial Surgery of University Hospitals, Leuven, Belgium, were recruited prospectively. Patients were divided into 4 groups based on the amount of mandibular advancement in 5 mm increments (< 0 mm, 0-5 mm, 5-10 mm, or > 10 mm). CBCT data was acquired preoperatively and 1-6 weeks, 6 months, 1 year, and 2 years postoperatively. Patients with a history of maxillofacial trauma or surgery, obstructive sleep apnoea syndrome, or craniofacial anomalies were excluded. Nasopharyngeal, oropharyngeal, and hypopharyngeal PAS volumes and constriction surface areas (mCSA) were measured and compared between each time point with a paired t-test. RESULTS The largest significant increase in oropharyngeal volume and mCSA were observed in the 5-10 mm (+ 13.3-21.7%, + 51.3-83.0%)) and > 10 mm (+ 23.3-44.6%, + 92.3-130.0%) mandibular advancement groups. This increase only remained stable 2 years postoperatively in the > 10 mm group. In other mandibular advancement groups, short-term oropharyngeal volume and mCSA increases were noticed, which returned to baseline levels 6 months to 1 year postoperatively. CONCLUSION Bimaxillary advancement osteotomy significantly increases oropharyngeal volume and mCSA, which remains stable between 6 months to 1 year postoperatively. CLINICAL RELEVANCE Long-term stable volumetric and mCSA enlargements were found with > 10 mm mandibular advancements over a period of 2 years. Return towards baseline levels was observed in the other mandibular advancement groups.
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Affiliation(s)
- Gert-Jan Hassing
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Vincent The
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
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Wang M, Zhang B, Li L, Zhai M, Wang Z, Wei F. Vertical stability of different orthognathic treatments for correcting skeletal anterior open bite: a systematic review and meta-analysis. Eur J Orthod 2021; 44:1-10. [PMID: 33822036 DOI: 10.1093/ejo/cjab011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several orthognathic procedures have been applied to correct skeletal anterior open bites (SAOB). Which method is most stable has been debated and no consensus has been reached and there is no conclusive evidence for clinicians to use. OBJECTIVE To analyse whether maxillary, mandibular, or bimaxillary surgery provides a better stability. MATERIALS AND METHODS A systematic search was conducted up to December 2020 using PubMed, EMBASE, Medline, Scopus, Web of Science, Cochrane CENTRAL, and Google Scholar. We made direct comparisons among the controlled trials and also made indirect comparisons via subgroup analysis on the aspects of occlusional, skeletal, and dento-alveolar stability to assess the overall stability of each method. RESULTS Finally 16 cohort studies were identified. At the occlusional level, pooled change in overbite was 0.21 mm in maxillary surgery, 0.37 mm in bimaxillary surgery, and -0.32 mm in mandibular surgery. At the skeletal level, pooled sella-nasion-Point A angle (SNA) was -0.12 degrees in bimaxillary surgery, -0.37 degrees in maxillary surgery and -0.20 degrees in mandibular surgery. The sella-nasion to palatal plane angle (SNPP) relapsed to a statistically significant degree in all samples received single maxillary surgery. Relapse of the sella-nasion-Point B angle (SNB) was 0.47 degrees in mandibular setback, -1.8 degrees in mandibular advancement, and -0.48 degrees in maxillary surgery. The Sella-Nasion to mandibular plane angle (SNMP) relapsed more in procedures involving bilateral sagittal split osteotomy than in other procedures. As for dento-alveolar changes, intrusion of molars and extrusion of incisors took place in most patients. CONCLUSIONS Bimaxillary surgery produced the most beneficial post-operative increase in overbite, maxillary surgery led to a lesser but still positive overbite change, and mandibular surgery correlated with some extent of relapse. Skeletally, bimaxillary surgery was more stable than maxillary surgery at both SNA and SNPP; SNB was more stable in mandibular setback than advancement; and SNMP was unstable in both mandibular and bimaxillary surgeries versus maxillary surgery with comparable surgical changes. Dento-alveolar compensation helped maintain a positive overbite. REGISTRATION NUMBER CRD42020198088.
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Affiliation(s)
- Mengqiao Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Bowen Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Lan Li
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Mingrui Zhai
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Zhengyan Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Fulan Wei
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
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