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Ortho > Treatment Considertion In Orthognathic Surgery (Resisdent) > Flashcards

Treatment Considertion In Orthognathic Surgery (Resisdent) Flashcards

1
Q

What to consider for treatment?

A

Age of pt
Type of skeletal problem
Severity of skeletal problem

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2
Q

Options for tx

A

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

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3
Q

What factors influence dental and facial esthetics?

A

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

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4
Q

What is the indication for surgery

A

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

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5
Q

Sagittal split, Lefort I year

A

1960s

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6
Q

Two jaw procedures, improved ortho interaction year

A

1970s

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7
Q

Rigid internal fixation year

A

1980s

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8
Q

Procedural refinements, early distraction osteogenesis year

A

1990s

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9
Q

Mandible forward limitations

A

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

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10
Q

Most successful mandibular advancement

A

Short face with rotation of the chin down

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11
Q

Maxilla forward limitation

A

The longer the move, the less stable

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12
Q

What is the best way to treat class III problems

A

Maxillary surgery

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13
Q

What is often desired from maxilla forward

A

Forward plus down

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14
Q

Mandible back limitation

A

Difficult to control the ramus inclination at surgery

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15
Q

Maxilla down and maxilla wider limited by

A

The muscle force, soft tissue stretch

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16
Q

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

A

Decompensation

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17
Q

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

A

Ortho prep for surgery often is reverse of conventional ortho treatment

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18
Q

Class II extraction pattern

A

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

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19
Q

What may be necessary for class II patients

A

To extract lower premolars or use class III elastics

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20
Q

Class III extraction patterns

A

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

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21
Q

What may be necessary in class III patients

A

To extract upper premolars or use Class II elastics

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22
Q

Surgical ortho tx to increase facial height

A

Mandibular osteotomy
Rotate chin down

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23
Q

Surgical ortho tx to decrease facial height

A

Maxillary Lefort osteotomy (impaction)
Rotate chin up

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24
Q

Surgical ortho tx deep bite pts

A

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

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25
Q

Surgical ortho tx open bite

A

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

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26
Q

Pre surgical ortho - incisor position

A

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

27
Q

Incisor position pre surgery class II

A

Uppers slightly protrusive, lowers slightly retracted

28
Q

Incisor position pre surgery class III

A

Uppers slightly retrusive, lowers slightly protracted

29
Q

Pre surgical ortho - obtain arch compatibility

A

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

30
Q

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

A

Surgeon will correct by grinding on enamel in operating room

31
Q

General rule

A

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

32
Q

What can wait until after surgery

A

Extrusion (leveling)
Root paralleling

33
Q

What do you have to do before surgery

A

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

34
Q

When is the pt ready for surgery

A

When the ortho thinks the pt is ready

35
Q

Final surgical planning

A

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

36
Q

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

A

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

37
Q

Surgical splints advantages

A

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

38
Q

Surgical splint guideline

A

Thin splint preferred

39
Q

Stabilizing arch wires goal

A

Prevent tooth movement

40
Q

Stabilizing arch wires- 18 slot brackets

A

17x25 stainless steel wire

41
Q

Stabilizing arch wires - 22 slot brackets

A

21x25 TMA or stainless steel wires

42
Q

Post operative expectations

A

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

43
Q

Potential complications

A

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

44
Q

Mandibular techniques

A

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

45
Q

IVRO advantages

A

Lower incidence of nerve injury

46
Q

IVRO disadvantages

A

Requires maxillomandibular fixation
Setback only

47
Q

BSSO Advantages

A

Versatility
Maxillomandibular fixation usually not necessary

48
Q

BSSO disadvantages

A

Nerve injury

49
Q

Genioplasty

A

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

50
Q

Lower body osteotomy to reposition - up

A

Wedge reduction

51
Q

Lower body osteotomy to reposition- forward

A

Lower border osteotomy or implant

52
Q

Lower body osteotomy to reposition- transversely

A

Back

53
Q

Maxillary techniques

A

Lefort osteotomy

54
Q

Lefort osteotomy

A

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

55
Q

Choices to surgically widen maxilla

A

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

56
Q

SARPE

A

Better stability

57
Q

Segmental Lefort osteotomy

A

One surgery, amount of expansion limited by soft tissue

58
Q

Two jar surgery indications

A

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

59
Q

Adjunctive procedrures

A

Blepharoplasty
Ostoplasty
Rhinoplasty
Rhytidectomy
Laser resurfacing

60
Q

Blepharoplasty

A

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

61
Q

Otoplasty

A

Reduce prominence of the ears

62
Q

rhinoplasty

A

Cosmetic nose surgery

63
Q

Rhytidectomy

A

Complete facelift, for deep wrinkles

64
Q

Laser resurfacing

A

Fine wrinkles

Ortho (19 decks)

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