Treatment Considertion In Orthognathic Surgery (Resisdent)

Question 1

What to consider for treatment?

Answer 1

Age of pt
Type of skeletal problem
Severity of skeletal problem

Question 2

Options for tx

Answer 2

Growth modification
Camouflage
Orthognathic surgery (pre surgical ortho, then surgery, then post surgical ortho)

Question 3

What factors influence dental and facial esthetics?

Answer 3

Smile line
Amount of gum tissue that shows when pt smiles
Width of the smile
Midlines
Facial proportions
Facial symmetry
Age

Question 4

What is the indication for surgery

Answer 4

Tx objectives and goals that are outside the range of ortho possibility, which changes with age

Question 5

Sagittal split, Lefort I year

Answer 5

1960s

Question 6

Two jaw procedures, improved ortho interaction year

Answer 6

1970s

Question 7

Rigid internal fixation year

Answer 7

1980s

Question 8

Procedural refinements, early distraction osteogenesis year

Answer 8

1990s

Question 9

Mandible forward limitations

Answer 9

Less stability after about 8mm of advancement
Rotational pattern makes a difference

Question 10

Most successful mandibular advancement

Answer 10

Short face with rotation of the chin down

Question 11

Maxilla forward limitation

Answer 11

The longer the move, the less stable

Question 12

What is the best way to treat class III problems

Answer 12

Maxillary surgery

Question 13

What is often desired from maxilla forward

Answer 13

Forward plus down

Question 14

Mandible back limitation

Answer 14

Difficult to control the ramus inclination at surgery

Question 15

Maxilla down and maxilla wider limited by

Answer 15

The muscle force, soft tissue stretch

Question 16

Ortho preparation for surgery must include removal of dental compensation for the skeletal deformity

Answer 16

Decompensation

Question 17

Why is it important to tell pts things will get worse before they get better

Answer 17

Ortho prep for surgery often is reverse of conventional ortho treatment

Question 18

Class II extraction pattern

Answer 18

Mandibular premolars
Decompensates flaring
Increases mandibular surgical movement
Finish with class III molars

Question 19

What may be necessary for class II patients

Answer 19

To extract lower premolars or use class III elastics

Question 20

Class III extraction patterns

Answer 20

Maxillary premolars
Deompensates flaring
Increases maxillary surgical Movement
Finish with class II molars

Question 21

What may be necessary in class III patients

Answer 21

To extract upper premolars or use Class II elastics

Question 22

Surgical ortho tx to increase facial height

Answer 22

Mandibular osteotomy
Rotate chin down

Question 23

Surgical ortho tx to decrease facial height

Answer 23

Maxillary Lefort osteotomy (impaction)
Rotate chin up

Question 24

Surgical ortho tx deep bite pts

Answer 24

Post surgical leveling
Ext- some space is left open prior to surgery
After surgery - pts significant posterior open bite is closed using vertical elastics
Increases the lower facial height of the deep bite pt

Question 25

Surgical ortho tx open bite

Answer 25

Pre surgical leveling or surgical assisted leveling Make the open bite significantly worse prior to surgery Allows surgeon to establish proper vertical dimension on the pt during surgery

Question 26

Pre surgical ortho - incisor position

Answer 26

Anterior posterior - exactly where they should be at completion or slightly over treated

Question 27

Incisor position pre surgery class II

Answer 27

Uppers slightly protrusive, lowers slightly retracted

Question 28

Incisor position pre surgery class III

Answer 28

Uppers slightly retrusive, lowers slightly protracted

Question 29

Pre surgical ortho - obtain arch compatibility

Answer 29

Transverse Watch arch form Canine width may need adjustment Several study models

Question 30

What does the surgeon do if the 2nd molars or canines are in the way at the time of surgery

Answer 30

Surgeon will correct by grinding on enamel in operating room

Question 31

General rule

Answer 31

Should not take more than a year to get a pt ready for orthognathic surgery

Question 32

What can wait until after surgery

Answer 32

Extrusion (leveling) Root paralleling

Question 33

What do you have to do before surgery

Answer 33

Intrusion AP incisor positioning Everything necessary to set it up for finishing in 6 months post surgery

Question 34

When is the pt ready for surgery

Answer 34

When the ortho thinks the pt is ready

Question 35

Final surgical planning

Answer 35

Stabilizing arch wires- stainless steel, fully engaged Soldered or welded lugs on arch wires Records Final surgical prediction - cephalometric Model surgery - surgeon does

Question 36

Why is it important for the ortho to see the results of the model surgery

Answer 36

Details of occlusion that make no difference to the surgeon can greatly affect time in finishing/post-surgical orthodontics

Question 37

Surgical splints advantages

Answer 37

Less reliance on surgeons judgement as to placement in operating room Less pre surgical ortho needed

Question 38

Surgical splint guideline

Answer 38

Thin splint preferred

Question 39

Stabilizing arch wires goal

Answer 39

Prevent tooth movement

Question 40

Stabilizing arch wires- 18 slot brackets

Answer 40

17x25 stainless steel wire

Question 41

Stabilizing arch wires - 22 slot brackets

Answer 41

21x25 TMA or stainless steel wires

Question 42

Post operative expectations

Answer 42

Lots of swelling Short term parenthesis of infraorbital nerve (maxilla) and IAN (mandible) Significant pain is uncommon due to parenthesis Usually, 1 overnight hospital stay per jaw

Question 43

Potential complications

Answer 43

Long term sensory impairment, more common in BSSO 20% of young patients with increase incidence with age

Question 44

Mandibular techniques

Answer 44

Intraoral vertical ramus osteotomy (IVRO) Bilateral sagittal split osteotomy (BSSO) Genioplasty

Question 45

IVRO advantages

Answer 45

Lower incidence of nerve injury

Question 46

IVRO disadvantages

Answer 46

Requires maxillomandibular fixation Setback only

Question 47

BSSO Advantages

Answer 47

Versatility Maxillomandibular fixation usually not necessary

Question 48

BSSO disadvantages

Answer 48

Nerve injury

Question 49

Genioplasty

Answer 49

Osteotomy versus implant Osteotomy is highly versatile allowing for movement of the chin in all directions Implants can only augment chin Reports of bone resorption under implants

Question 50

Lower body osteotomy to reposition - up

Answer 50

Wedge reduction

Question 51

Lower body osteotomy to reposition- forward

Answer 51

Lower border osteotomy or implant

Question 52

Lower body osteotomy to reposition- transversely

Answer 52

Back

Question 53

Maxillary techniques

Answer 53

Lefort osteotomy

Question 54

Lefort osteotomy

Answer 54

High degree of versatility Movements limited by anatomic structures, soft tissues Large movements= grafting Dental injury rare if osteotomy is kept 5 mm above apices May be segmented into 2-3 pieces

Question 55

Choices to surgically widen maxilla

Answer 55

Surgically assisted rapid palatal expansion (SARPE) followed by LeFort osteotomy Segmental LeFort osteotomy

Question 56

SARPE

Answer 56

Better stability

Question 57

Segmental Lefort osteotomy

Answer 57

One surgery, amount of expansion limited by soft tissue

Question 58

Two jar surgery indications

Answer 58

Deformities in both maxilla and mandible Deformity in one jaw requiring a large, unstable movement

Question 59

Adjunctive procedrures

Answer 59

Blepharoplasty Ostoplasty Rhinoplasty Rhytidectomy Laser resurfacing

Question 60

Blepharoplasty

Answer 60

Excess skin —> upper eyelids, bagginess —> lower eyelids

Question 61

Otoplasty

Answer 61

Reduce prominence of the ears

Question 62

rhinoplasty

Answer 62

Cosmetic nose surgery

Question 63

Rhytidectomy

Answer 63

Complete facelift, for deep wrinkles

Question 64

Laser resurfacing

Answer 64

Fine wrinkles