Presentation12 /certified fixed orthodontic courses by Indian dental academy

WHY ORTHOGNATHIC
SURGERY?
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INDIAN DENTAL ACADEMY
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WHY
ORTHOGNATHIC
SURGERY?

ORTHOGNATHIC SURGERY
 Orthognathic surgery is a process in
which dentofacial deformities and
malocclusions are corrected with
orthodontic treatment and surgical
operation of facial skeleton ,sometimes
combined with various soft tissue
procedures.

 ORTHOGNATHIC
ORIGINATES FROM
GREEK WORD
ORTHOS(STRAIGHT)AND GNATHOS
JAWS.

 Orthognathic surgery mainly used for
correction of dentofacial deformities and
various malocclusions.

 Dentofacial deformities:Dentofacial
deformities refers to deviation from
normal facial proportion and dental
relationship that are severe enough to
be handicapping.

 The affected individual are handicapped
in two ways:
1)compromised jaw function.
2)discrimination in social interaction
because of dental and facial
appearance.

 Dentofacial deformities are:Various de
A)facial syndrome and congenital
anomalies:a)Fetal alcohol syndrome.
b)Hemifacial microsomnia.
c)Facial clefting syndrome.
d)Achodroplasia.
e)Maxillary and mandibular trauma.

 Various malocclusions are:
Anteroposterior direction:
Anteroposterior discrepancy-
A))classl
B) classll-
a)div1
b)div2
C) classlll

2)vertical discrepancy:
a)open bite
b)deep bite
3)Transverse discrepancy:
a)narrowing of jaws
b)widening of jaws

 Various dentofacial deformities and
malocclusions are associated with
underlying skeletal discrepancy.

 Question arises:
who is a candidate for surgery in
addition to orthodontics?

 Is that surgery will be needed if there is
severe skeletal or very severe
dentoalveolar problem ,too severe to
correct with orthodontics alone?.

 The answer to second question is:what
makes a problem too severe for
orthodontics alone??

 If the jaw relationship is correct
,crowded and malaligned teeth nearly
always can be corrected by orthodontic
tooth movement.however there are
limits to how far a tooth can be moved.

 For this reason ,surgery to reposition
the jaw often is required for successful
treatment,and soft tissue surgical
procedure may also be needed.
Orthodontic treatment
even if successful in
bringing the teeth into
proper relationship,may not
correct the underlying
skeletal problem well
enough to overcome
psychological handicap.

 If a discrepancy In the size and position
of the jaw contribute to the malocclusion
and it is reflected in improper facial
proportion there are only 3 possible
treatment:

2)Orthodontic camouflage.
3)surgical repositioning of the jaws.
1)modification of growth

 GROWTH MODIFICATION
DENTOFACIAL ORTHOPEDICS

 Dental compensation prevents
correction of skeletal discrepancy
introduce an element of
camouflage

 Mature patient correction of
malocclusion
orthodontic
camouflage

 Dental camouflage mild
discrepancy exist and no potential for
future growth.
 Repositioning of the teeth to
compensate for skeletal discrepancy.

 Example:classll malocclusion with
underdeveloped lower jaw and proclined
upper incisor.
 Camouflage should be abandoned when it
has the potential to correct malocclusion at
the expense of facial esthetics.

 Essence of camouflage
Improve facial improve
relationship dental
relationship

 After the growth has ceased
surgery is the only alternative

 Reverse orthodontics:Making the
malocclusion worse for the orthognathic
surgery.

 When is a problem too severe for
orthodontic treatment only?

 Tremendous advance in the area of
orthognathic surgery since 1970.
 Major role of orthgnathic surgery in
treating patient successfully who has
aesthetically unacceptable and unstable
results after orthodontic camouflage.

 Need for orthognathic surgery-
1)impaired mastication.
2)tempromandibular pain and dysfunction.
3)susceptibility to caries and periodontal
disease.
4)psychological effect resulting from the
unaesthetic appearance from the
dentofacial deformities .

 Soft tissue limitation –1)pressure
exerted by soft tissue lips,cheeks and
tongue which are the primary
determinant of stability.
 2)the periodontal attachment apparatus
 3)tempromandibular and soft tissue
components.

 4)soft tissue integument of the entire
face which determines esthetics.

 Aesthetic guidelines given by Ackerman
and proffit:
 1)protraction of incisors would be more
favorable in a patient with large nose or
chin providing there would not be
excessive deepening of mentolabial
fold.

 2)orthodontics alone can rarely correct
severe midface deficiency or
mandibular prognathism because these
2 conditions are always accompanied
by unaesthetic lip position and neck
form.

 3)moderate amount of mandibular
deficiency are often acceptable to
patients although the orthodontist might
more prominence of the lower face.
 4)maxillary incisor should never
retracted to the point that the inclination
of the upper lip becomes negative to a
true vertical line.

 5)short lower facial height or protrusion
of the teeth may create an ill defined
labiomental sulcus as a result of the
necessity to strain the lips in an efforts
to gain a lip seal.

 6)overretraction of the maxillary incisor
often tilts the occlusal plane down
anteriorly creating an excessive display
of gingiva which is considered
unesthetic .patient do not mind if only
moderate amount of gingiva shows on
smile.

 7)when the lower lip is trapped under
the maxillary incisor or when the
mandibular incisor have been
excessively proclined the resulting lip
position is unacceptable.

 8)Lack of a vermilion border is not
desirable tooth movement that proclined
the incisors would create an
aesthetically fuller lip.
 9)Extreme bilabial protrusion is
generally perceived as unacceptable
regardless of the racial or ethnic group.

 Proffit and colleagues(1992) –guidelines
For predicting successful outcome when
the choise between surgery and
orthodontic correction
Sample size-40 patients

 Conclusion-surgery is likely to be
needed for adolescents beyond the
growth spurts with a classll
malocclusion when
 1)overjet greater then 10 mm
 2)pogonion to nasion perpendicular is
greater then 18mm

 3)mandibular body length less then 70
mm
 4)face height is greater than 125mm.

 Envelop of discrepancy:introduced by
Proffit and Ackerman

 Orthognathic surgery is required for
Psychological Better esthetic improved
satisfaction and function jaw
discrepancy

 Evaluation before orthognathic surgery:
1)psychological 2) soft tissue 3) jaw
evaluation evaluation discrepancy
evaluation

 Psychological evaluation:
Dentofacial deformities and malocclusion
Handicapping malocclusion
Social discrimination Functional abnormalities

 Not so long ago the patient thoughts
and patient perception were considered
soft data ,less important than what
could be physically measured during a
clinical examination or analysis of
diagnostic images.

 From 1990 changed occur and
treatment plan inclined more towards
patients facial esthetics.
 Evaluation of patients feeling and
perception has become necessary.

 Involvement of patient and parents is
necessary in treatment plan.
 Ackerman and Proffit –Clinician
influenced by objective findings
 Patients influenced by subjective
findings

 psychological impact of
dentofacial deformities
Reaction to Effects of
Facial appearance dentofacial
deformities

 Orthognathic surgery-challenge the
patients capacity to adapt.
 Studies also reported 2 main reasons
for which patients are seeking for
treatment:1)esthetic improvement
2)functional improvement

 Edgerton and Knorr(1971):
1)external motivation
2)internal motivation
Helm(1985)-Adult with deep bite,severe
crowding,extreme overjet causes
unfavorable self perception.

 Gerzenic (2002)-studied the
psychological profile of 100 classll and
classlll patients preoperatively and
postoperatively.
 Results-preoperatively classlll patient
felt less attractive then classll patient.

 Attractiveness and self-confidence has
increased more in classlll patients after
surgery.
 Esthetic improvement was the driven
force behind classlll patients to seek
treatment.

 Ceib Phillip-people with dentofacial
disharmony may encounter psychological
distress directly from teasing or indirectly from
sociocultural
percepts.
-Individual with dentofacial disharmonies who
are seeking treatment are experiencing a
level of psychological distress that warrants
intervention.

 Soft tissue evaluation:shift towards soft
tissue paradigm.

 Nose
Lip Facial profile
Chin

 Evaluation of facial proportion and
symmetry:

Evaluation of nose
Evaluation of lip:Lip thickness
Lip fullness
Evaluation of chin:

 Growth modification
 Orthodontic camouflage
 Surgical repositioning of the jaws

 Envelop of discrepency

 Psychological aspect of Dentofacial
deformities

Thank you
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Presentation12 /certified fixed orthodontic courses by Indian dental academy

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