Skeletal Stability after Orthognathic Surgery in Severe Skeletal Class III Malocclusion Patients according to Changes in Anteroposterior Discrepancy and Occlusal Planes

골격성 III급 부정교합 환자에서 하악골의 이동량과 교합평면의 변화에 따른 술 후 안정성

  • Lee, Jung-Han (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Sung-Hee (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Baek, Young-Jae (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Ahn, Kyung-Yong (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Hwang, Dae-Seok (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Yong-Deok (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Uk-Kyu (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University)
  • 이정한 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 김성희 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 백영재 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 안경용 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 황대석 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 김용덕 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 김욱규 (부산대학교 치의학전문대학원 구강악안면외과학교실)
  • Received : 2012.08.27
  • Accepted : 2012.11.22
  • Published : 2012.11.30

Abstract

Purpose: The purpose of this study was to evaluate postsurgical facial hard tissue stability after orthognathic surgery with/without posterior impaction in skeletal class III malocclusion patients, and to evaluate the horizontal relapse tendency, according to changes in anteroposterior discrepancy and occlusal planes. Methods: Ninety patients, who had undergone orthognathic surgery in Pusan National University Dental Hospital, were enrolled in this study. Three main groups were classified as follows: Thirty patients underwent mandibular setback bilateral sagittal split ramus osteotomy (BSSRO) only (BSSRO group, BG); another thirty patients underwent mandibular setback BSSRO and Le Fort I osteotomy with posterior impaction (posterior impaction group, PG); and another thirty patients underwent mandibular setback BSSRO and Le Fort I osteotomy without posterior impaction (non-posterior impaction group, NPG). Preoperative (T0), immediate postoperative (T1) and six-month follow-up period (T2) lateral cephalograms were taken, and various parameters were measured. The analyses were done by linear and angular measurements between T0-T1 and T1-T2, to evaluate postsurgical facial hard tissue stability. Results: Mean horizontal relapse rates were distributed from 11.81% to 19.08%, and there were significant postsurgical changes (0.52 mm~2.44 mm) at the B point in all 3 groups. But, there were no statistical differences on relapse rate among BG, PG and NPG patients. Conclusion: In this study, the postsurgical stabilities of BSSRO and Le Fort I osteotomy with/without posterior impaction in skeletal class III malocclusion patients were acceptable. There were no significant statistical differences in mandibular stability according to changes in anteroposterior discrepancy and occlusal planes.

Keywords

References

  1. Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: a hierarchy of stability. Int J Adult Orthodon Orthognath Surg 1996;11:191-204.
  2. Kobayashi T, Watanabe I, Ueda K, Nakajima T. Stability of the mandible after sagittal ramus osteotomy for correction of prognathism. J Oral Maxillofac Surg 1986;44:693-7. https://doi.org/10.1016/0278-2391(86)90036-4
  3. Franco JE, Van Sickels JE, Thrash WJ. Factors contributing to relapse in rigidly fixed mandibular setbacks. J Oral Maxillofac Surg 1989;47:451-6. https://doi.org/10.1016/0278-2391(89)90276-0
  4. Reyneke JP, Bryant RS, Suuronen R, Becker PJ. Postoperative skeletal stability following clockwise and counter-clockwise rotation of the maxillomandibular complex compared to conventional orthognathic treatment. Br J Oral Maxillofac Surg 2007;45:56-64. https://doi.org/10.1016/j.bjoms.2005.12.015
  5. Nakajima T, Kajikawa Y, Tokiwa N, Hanada K. Stability of the mandible after surgical correction of skeletal class III malocclusion in 50 patients. J Oral Surg 1979;37:21-5.
  6. Laufer D, Glick D, Gutman D, Sharon A. Patient motivation and response to surgical correction of prognathism. Oral Surg Oral Med Oral Pathol 1976;41:309-13. https://doi.org/10.1016/0030-4220(76)90143-2
  7. Juggins KJ, Nixon F, Cunningham SJ. Patient- and clinician- perceived need for orthognathic surgery. Am J Orthod Dentofacial Orthop 2005;128:697-702. https://doi.org/10.1016/j.ajodo.2004.09.022
  8. Kim JH, Kim SG, Oh JS. Complications related to orthognathic surgery. J Korean Assoc Maxillofac Plast Reconstr Surg 2010;32:416-21.
  9. Van Sickels JE. prevention and management of complication in orthognathic surgery. In: Miloro M, Ghali GE, Larsen PE, editors. Peterson's principles of oral and maxillofacial surgery. Hamilton: Decker Inc; 2004. p.1212.
  10. Pepersack WJ, Chausse JM. Long term follow-up of the sagittal splitting technique for correction of mandibular prognathism. J Maxillofac Surg 1978;6:117-40.
  11. MacIntosh RB. Experience with the sagittal osteotomy of the mandibular ramus: a 13-year review. J Maxillofac Surg 1981; 9:151-65.
  12. Bailey LJ, Cevidanes LH, Proffit WR. Stability and predictability of orthognathic surgery. Am J Orthod Dentofacial Orthop 2004;126:273-7. https://doi.org/10.1016/j.ajodo.2004.06.003
  13. Sorokolit CA, Nanda RS. Assessment of the stability of mandibular setback procedures with rigid fixation. J Oral Maxillofac Surg 1990;48:817-22. https://doi.org/10.1016/0278-2391(90)90340-8
  14. Ingervall B, Thuer U, Vuillemin T. Stability and effect on the soft tissue profile of mandibular setback with sagittal split osteotomy and rigid internal fixation. Int J Adult Orthodon Orthognath Surg 1995;10:15-25.
  15. Mobarak KA, Krogstad O, Espeland L, Lyberg T. Long-term stability of mandibular setback surgery: a follow-up of 80 bilateral sagittal split osteotomy patients. Int J Adult Orthodon Orthognath Surg 2000;15:83-95.
  16. Joss CU, Thüer UW. Stability of hard tissue profile after mandibular setback in sagittal split osteotomies: a longitudinal and long-term follow-up study. Eur J Orthod 2008;30:352-8. https://doi.org/10.1093/ejo/cjn008
  17. Ive J, McNeill RW, West RA. Mandibular advancement: skeletal and dental changes during fixation. J Oral Surg 1977;35:881-6.
  18. Lake SL, McNeill RW, Little RM, West RA. Surgical mandibular advancement: a cephalometric analysis of treatment response. Am J Orthod 1981;80:376-94. https://doi.org/10.1016/0002-9416(81)90173-1
  19. Epker BN, Wessberg GA. Mechanisms of early skeletal release following surgical advancement of the mandible. Br J Oral Surg 1982;20:175-82. https://doi.org/10.1016/S0007-117X(82)80035-8
  20. Schendel SA, Epker BN. Results after mandibular advancement surgery: an analysis of 87 cases. J Oral Surg 1980; 38:265-82.
  21. Steinhauser EW. Advancement of the mandible by sagittal ramus split and suprahyoid myotomy. J Oral Surg 1973;31:516-21.
  22. Wessberg GA, Schendel SA, Epker BN. The role of suprahyoid myotomy in surgical advancement of the mandible via sagittal split ramus osteotomies. J Oral Maxillofac Surg 1982;40:273-7. https://doi.org/10.1016/0278-2391(82)90217-8
  23. Welch TB. Stability in the correction of dentofacial deformities: a comprehensive review. J Oral Maxillofac Surg 1989;47:1142-9. https://doi.org/10.1016/0278-2391(89)90003-7
  24. Hoppenreijs TJ, Freihofer HP, Stoelinga PJ, et al. Skeletal and dento-alveolar stability of Le Fort I intrusion osteotomies and bimaxillary osteotomies in anterior open bite deformities. A retrospective three-centre study. Int J Oral Maxillofac Surg 1997;26:161-75.
  25. Yoon HJ, Rebellato J, Keller EE. Stability of the Le Fort I osteotomy with anterior internal fixation alone: a case series. J Oral Maxillofac Surg 2005;63:629-34. https://doi.org/10.1016/j.joms.2004.12.013
  26. Chemello PD, Wolford LM, Buschang PH. Occlusal plane alteration in orthognathic surgery--part II: long-term stability of results. Am J Orthod Dentofacial Orthop 1994;106:434-40. https://doi.org/10.1016/S0889-5406(94)70066-4
  27. Epker BN, Schendel SA. Total maxillary surgery. Int J Oral Surg 1980;9:1-24. https://doi.org/10.1016/S0300-9785(80)80002-0
  28. LaBanc JP, Epker BN. Changes of the hyoid bone and tongue following advancement of the mandible. Oral Surg Oral Med Oral Pathol 1984;57:351-6. https://doi.org/10.1016/0030-4220(84)90148-8
  29. Epker BN, Fish LC. The surgical-orthodontic correction of Class III skeletal open-bite. Am J Orthod 1978;73:601-18. https://doi.org/10.1016/0002-9416(78)90222-1
  30. Kirkpatrick TB, Woods MG, Swift JQ, Markowitz NR. Skeletal stability following mandibular advancement and rigid fixation. J Oral Maxillofac Surg 1987;45:572-6. https://doi.org/10.1016/0278-2391(87)90266-7
  31. Choi HW, Kim KW, Lee EY. Comparative study of stability and relapse according to fixation method after bilateral sagittal split ramus osteotomies in mandibular prognathic patients. J Korean Assoc Maxillofac Plast Reconstr Surg 2005;27:334-45.