The Surgery-First Orthognathic Approach : With Discussion of Occlusal Plane-altering Orthognathic Surgery

This book is a comprehensive guide to the surgery-first orthognathic approach for patients with malocclusion and skeletal disharmony, which has been successfully applied by the authors in their practices over the past 15 years. The approach breaks with the time-tested principles of traditional orthognathic surgery in that corrective bone surgery is performed first, without the removal of dental compensations, followed by orthodontic finishing. All aspects are covered with the aid of numerous illustrations, the aim being to provide surgeons with a systematic educational tool that will enable them to introduce the approach into their own practice. In addition, the book addresses one of the hot issues in orthodontics, occlusal plane-altering orthognathic surgery, in which surgical modification of the occlusal plane is employed to treat various types of dentofacial deformity and improve facial proportions. This promises to become a very powerful tool in modern orthognathic surgery. Preface Abstract Contents About the Author 1: History and Evolution of the Surgery-First Approach 1.1 Definition and Evolution of SFA 1.2 Benefits and Drawbacks of SFA (Fig. 1.5 and Fig. 1.6) 1.3 SFA Controversies References 2: Surgical Treatment Objectives and the Clinical Procedure for the Surgery-First Approach 2.1 Communication Between Surgeons and Orthodontists in the Surgery-First Approach 2.2 Surgery-First Approach Sequence 2.3 Establishment of the Surgical Treatment Objectives 2.4 Surgical Treatment Objective (STO)—Paper Surgery in FOS 2.5 Surgery-First Approach Clinical Procedure References 3: Model Surgery Setup in the Surgery-First Approach 3.1 Model Setup Procedure 3.2 Virtual 3D Model SetUp References 4: Postoperative Care of Patients Undergoing the Surgery-First Approach and Postoperative Orthodontics Involving Temporary Anchorage Devices 4.1 Postoperative Care of Patients Undergoing the Surgery-First Approach 4.2 Postoperative Orthodontics Combined with the Use of Temporary Anchorage Devices 4.3 Application of TADs in the Surgery-First Approach References 5: Treatment Strategy for Class II Orthognathic Surgery: Orthodontic Perspective 5.1 Orthognathic Surgery for Patients with Class II Malocclusions 5.2 Surgical Treatment Objective for Class II Orthognathic Surgery 5.3 Vertical Position of the Maxilla in Mandibular Retrognathism (Type I) 5.4 Vertical Position of the Maxilla in Mandibular Retrognathism (Type II) 5.5 Vertical Position of the Maxilla in Mandibular Retrognathism (Type III) 5.6 Vertical Position of the Maxilla in Mandibular Retrognathism (Type IV) 5.7 Surgery-First Approach in Class II Surgeries References 6: Treatment Strategy for Facial Asymmetry: An Orthodontic Perspective 6.1 Examination and Evaluation of Facial Asymmetry 6.2 Aspects of Mandibular Asymmetry: Vertical Versus Horizontal Asymmetry 6.3 Surgery-First Approach for Facial Asymmetry References 7: Relapses and Soft Tissue Changes following the Surgery-First Approach: Intraoral Vertical Ramus Osteotomy Versus Sagittal Split Ramus Osteotomy 7.1 Relapses Following the Surgery-First Approach for Patients with Class III Malocclusions: Intraoral Vertical Ramus Osteotomy (IVRO) Versus Sagittal Split Ramus Osteotomy (SSRO) 7.2 Transverse Soft Tissue Changes Following the Surgery-First Approach References 8: Update on Orthognathic Surgical Techniques 8.1 Incision and Dissection 8.2 Osteotomy 8.3 Fixation References 9: Virtual Surgical Planning and Three-Dimensional Simulation in Orthognathic Surgery 9.1 Introduction 9.2 Methods [17, 18] 9.2.1 Data Acquisition 9.2.2 Virtual Surgical Planning 9.2.3 Template Design and Manufacture 9.2.4 Surgical Intervention 9.3 Postoperative Analysis 9.3.1 Measurement Protocol (Fig. 9.8) 9.3.2 Statistical Analysis 9.4 Results (Fig. 9.9) 9.5 Discussion 9.6 Conclusion References 10: Three-Dimensional Photogrammetric Analysis in Orthognathic Surgery 10.1 Introduction 10.1.1 Two-Dimensional (2D) Versus Three-Dimensional (3D) Cameras 10.1.2 3D Photogrammetry in Orthognathic Surgery 10.2 Methods 10.2.1 Imaging Methods 10.2.2 Landmark Identification 10.2.3 Measurement of Actual Distances and Surface Areas on the 3D Images 10.3 Results 10.3.1 Cephalometric Changes 10.3.2 Vertical Facial Proportions (Table 10.2) 10.3.3 Transverse Facial Proportions (Table 10.2) 10.3.4 Nose and Cheek Convexity (Table 10.3) 10.3.5 Lip Contour (Table 10.3) 10.3.6 Frontal Mid- and Lower-Third Facial Surface Areas (Table 10.4) 10.3.7 Soft Tissue Landmarks Related to Facial Symmetry (Table 10.5) 10.4 Discussion References 11: Clinical Application of Surgery-First Orthognathic Surgery in Patients with Class III Dentofacial Deformities 11.1 Introduction 11.2 Results (Figs. 11.7, 11.8, 11.9, 11.10) 11.3 Summary References 12: Clinical Application of the Surgery-First Approach in Patients with Class II Dentofacial Deformities 12.1 Counterclockwise Rotational Movement of the MMC in Patients with Class II Malocclusions Accompanied by OSA Without Maxillary Advancement 12.2 Preliminary Investigation 12.3 Results 12.4 Discussion 12.5 Conclusion References 13: Clinical Application of the Surgery-First Approach to Facial Asymmetry 13.1 Facial Asymmetry Classification 13.1.1 Pseudo Facial Asymmetry (Fig. 13.2) 13.1.2 Developmental Facial Asymmetry (Fig. 13.4) 13.1.3 Overdevelopmental Facial Asymmetry (Figs. 13.5, 13.6) 13.1.4 Underdevelopmental Facial Asymmetry (Figs. 13.7, 13.8) 13.1.5 Craniofacial Asymmetry (Fig. 13.9) 13.2 New Classification of Facial Asymmetry and the Surgery-First Approach (SFA) 13.3 Indications of SFA in Patients with Facial Asymmetry 13.4 Relative Contraindications of SFA 13.5 Post-SFA Stability in Patients with Facial Asymmetry (Figs. 13.15, 13.16, 13.17, 13.18, 13.19) 13.6 Summary References 14: Long-term Follow-up Following the Surgery-First Approach 14.1 Results 14.2 Discussion References 15: Total Treatment Time in the Surgery-First Orthognathic Approach 15.1 Results 15.2 Discussion 15.3 Conclusions References 16: Occlusal Plane-Altering Orthognathic Surgery (Jaw Rotational Orthognathic Surgery) 16.1 Concept of Occlusal Plane-Altering Orthognathic Surgery 16.2 Classification Of Occlusal Plane Altering Orthognathic Surgery 16.3 Surgical Techniques 16.4 Discussion References