Controversies in the Satisfaction of Surgeons and Orthodontists on Facial Aesthetics after Orthognathic Surgery

Aim Acceptable facial aesthetics is a common desire among patients presenting with dentofacial deformities planning to undergo orthognathic surgeries. Thus, professionals must be alert to their patients’ complaints as well as their desires regarding facial morphology, because this is quite subjective and personal. This research aimed at evaluating the different views of orthodontists and oral maxillofacial surgeons regarding the facial analysis of patients who undergo orthognathic surgery. Methods Thirty individuals were selected with a minimum postoperative period of 6 months and photographed in the frontal and profile norm. Facial morphology characteristics were recorded to observe the agreement of the assessments of four professionals (two orthodontists and two surgeons). Results A significant agreement was seen between the orthodontists regarding the nasolabial angle (80%). In the frontal analysis, the agreement percentage (60%) between orthodontists and surgeons was considerable regarding facial asymmetry assessment. Conclusions Professionals must keep alert to facial analysis, especially in terms of tegumental harmony, for the orthognathic surgery to reestablish, satisfactorily, the facial aesthetics in all parameters set.

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Correction of Facial Asymmetry Using Patient-Specific Implants: A Case Report

The American Journal of Cosmetic Surgery ◽

10.1177/0748806819900729 ◽

2020 ◽

Vol 37 (3) ◽

pp. 109-113

Author(s):

Manolis Manolakakis ◽

Ryan Richards

Keyword(s):

Orthognathic Surgery ◽

Treatment Options ◽

Facial Asymmetry ◽

Patient Specific ◽

Facial Aesthetics ◽

Rapid Palatal Expansion ◽

Orthodontic Therapy ◽

Alloplastic Implants ◽

Dentofacial Deformities ◽

Tear Trough Deformity

Dentofacial deformities can have a profound impact on patients’ function and facial aesthetics. Traditionally, dentofacial deformities and malocclusion have been managed with growth modification, orthodontic therapy, and orthognathic surgery, or a combination of these modalities. The aim of this article is to discuss the use of patient-specific alloplastic implants as an adjunct or alternative to orthognathic surgery in patients with dentofacial deformities. A 40-year-old man who previously underwent surgically assisted rapid palatal expansion followed by LeFort I osteotomy advancement, intraoral vertical ramus osteotomy setback (IVRO), rhinoplasty, and fat transfer to the malar region presented with a chief complaint of dissatisfaction due to significant facial asymmetry. Tear trough deformity, concave nasal dorsum with nasal tip deviation to the left, submalar fullness, chin deviation to the right, and a poorly defined mandibular border outline were all noted on physical examination. The patient was treated with lower lid blepharoplasty with fat repositioning, buccal fat pad reduction (bichectomy), and patient-specific malar and mandibular border implants. In a patient who has a moderate-to-severe malocclusion and dentofacial deformity, traditional treatment includes orthodontic correction and orthognathic surgery. Patients undergoing primary orthognathic surgery can benefit from alloplastic implants. For patients who have residual maxillary or mandibular asymmetry after orthognathic surgery, the treatment options are secondary orthognathic procedures or facial implants. These patients can benefit from treatment with alloplastic facial implants as an adjunct or alternative to orthognathic surgery to normalize skeletal contours and improve facial aesthetics. Patient-specific alloplastic implants can be used as a powerful adjunct or alternative to orthognathic surgery. Patients with mild occlusal and skeletal deformities who have traditionally been treated with orthodontic therapy alone can benefit from evaluation of alloplastic implants. Patients with residual asymmetries after orthognathic surgery can benefit from alloplastic implants as an adjunct with secondary osteotomies or as an alternative altogether.

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Management of dentofacial deformities and facial asymmetry with orthognathic surgery concomitant alloplastic temporomandibular joint replacement whit stock prosthesis

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2017.02.1102 ◽

2017 ◽

Vol 46 ◽

pp. 326-327

Author(s):

B. Mejia ◽

A. Bordoy ◽

A. Jimenez

Keyword(s):

Temporomandibular Joint ◽

Joint Replacement ◽

Orthognathic Surgery ◽

Facial Asymmetry ◽

Dentofacial Deformities

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Clinical and radiographic evaluation of maxillary central incisors exposure in patients undergoing maxillary advancement

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.20.6.052-059.oar ◽

2015 ◽

Vol 20 (6) ◽

pp. 52-59

Author(s):

Guilherme dos Santos Trento ◽

Felipe Bueno Rosettti Bernabé ◽

Delson João da Costa ◽

Nelson Luis Barbosa Rebellato ◽

Leandro Eduardo Klüppel ◽

...

Keyword(s):

Orthognathic Surgery ◽

Statistical Tests ◽

Radiographic Evaluation ◽

Upper Lip ◽

Clinical Exposure ◽

Maxillary Central Incisor ◽

Maxillary Advancement ◽

Nasolabial Angle ◽

Dentofacial Deformities ◽

Lateral Cephalograms

Abstract Introduction: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. Objective: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. Methods: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%). Results: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002). Conclusions: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness.

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Impact of orthognathic surgery on quality of life in patients with different dentofacial deformities: longitudinal study of the Oral Health Impact Profile (OHIP-14) with at least 1 year of follow-up

Oral and Maxillofacial Surgery ◽

10.1007/s10006-021-00992-6 ◽

2021 ◽

Author(s):

Jacco G. Tuk ◽

Jerome A. Lindeboom ◽

Misha L. Tan ◽

J. de Lange

Keyword(s):

Quality Of Life ◽

Oral Health ◽

Postoperative Period ◽

Orthognathic Surgery ◽

Health Impact ◽

Oral Health Impact Profile ◽

Dentofacial Deformities ◽

The Mean ◽

The Impact

Abstract Objective The objective of this study was to assess the impact of orthognathic surgery for dental facial deformities on oral health-related quality of life (OHRQoL) in the immediate postoperative period up to at least 1 year after surgery. Study design This prospective study evaluated data from 85 patients. OHRQoL was assessed using the Dutch version of the Oral Health Impact Profile questionnaire (OHIP-14NL) preoperatively (T0), each day for 7 days postoperatively (T1–T7) and 4 weeks (T8), 6 months (T9), and at least 1 year (T10) after surgery. The total OHIP score was calculated for each patient, with higher OHIP scores indicating a worse impact on oral health. Patients also completed an extra questionnaire about self-care, discomfort, and experienced pain (rated on a 10-point scale) in the postoperative period (T1–T10). Results The mean OHIP score increased sharply at T1 compared to T0 but decreased significantly in the first postoperative week. The mean OHIP score at T8 was still higher than before surgery. However, at T9 and T10, the mean OHIP score was significantly lower than at T0 (P < .05). No significant difference in OHIP score was found between gender, age, type of surgery, and indication for surgery. Pain significantly decreased from T6 to T0. The OHIP and pain scores significantly positively correlated at every time point except T9. Conclusion The findings indicate that OHRQoL is reduced from baseline in the immediate postoperative period but improves over time. By 1 year, OHRQoL improves significantly after orthognathic surgery in patients with dentofacial deformities.

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Digital platform for planning facial asymmetry orthodontic-surgical treatment preparation

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.23.3.080-093.sar ◽

2018 ◽

Vol 23 (3) ◽

pp. 80-93 ◽

Cited By ~ 1

Author(s):

Octavio Cintra ◽

Simonas Grybauskas ◽

Carlos Jorge Vogel ◽

Dalia Latkauskiene ◽

Nilo Alves Gama Jr

Keyword(s):

Surgical Treatment ◽

Present Article ◽

Orthognathic Surgery ◽

Surgical Planning ◽

Treatment Protocol ◽

Facial Asymmetry ◽

Individual Case ◽

Virtual Planning ◽

Digital Platform ◽

Dentofacial Deformities

ABSTRACT Dentofacial deformities usually are surgically treated, and 3D virtual planning has been used to favor accurate outcomes. Cases reported in the present article show that orthognathic surgery carried out to correct facial asymmetries does not comprise only one treatment protocol. 3D virtual planning might be used for surgical planning, but it should also be used to diagnose the deformity, thus allowing for an analysis of the best-recommended possibilities for the orthodontic preparation that suits each individual case.

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Orthognathic Surgery—LeFort I Osteotomy

Facial Plastic Surgery ◽

10.1055/s-0041-1735308 ◽

2021 ◽

Author(s):

Robert O. Weiss ◽

Adrian A. Ong ◽

Likith V. Reddy ◽

Sara Bahmanyar ◽

Aurora G. Vincent ◽

...

Keyword(s):

Orthognathic Surgery ◽

Preoperative Assessment ◽

Surgical Team ◽

Complex Type ◽

Close Collaboration ◽

Facial Aesthetics ◽

Facial Analysis ◽

Profound Impact ◽

Surgical Success ◽

Facial Surgery

AbstractOrthognathic surgery is a complex type of facial surgery that can have a profound impact on a patient's occlusal function and facial aesthetics. Close collaboration between the maxillofacial surgeon and an orthodontist is required, and the surgical team must have a strong foundation in facial analysis and firm understanding of the maxillofacial skeleton to achieve surgical success. Herein, we review the maxillary LeFort I osteotomy as it pertains to orthognathic surgery, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.

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Staged Orthodontic, Orthognathic Surgery and Open Septorhinoplasty for Management of Cleidocranial Dysplasia: A Case Report

Surgical Case Reports ◽

10.31487/j.scr.2020.06.01 ◽

2020 ◽

pp. 1-4

Author(s):

Bee Tin Goh ◽

Mei Hui Tan ◽

Tian Ee Seah

Keyword(s):

Orthognathic Surgery ◽

Permanent Teeth ◽

Cleidocranial Dysplasia ◽

Class Iii ◽

Class Iii Malocclusion ◽

Autosomal Dominant Disorder ◽

Facial Aesthetics ◽

Facial Profile ◽

Case Presentation ◽

Dentofacial Deformities

Background: Cleidocranial dysplasia (CCD) is a rare autosomal dominant disorder with a prevalence of 1:1,000,000. These patients often present with dentofacial deformities such as midface hypoplasia, multiple supernumeraries and delayed eruption and non-eruption of permanent teeth. Case Presentation: We report a staged orthodontic, orthognathic surgery and open septorhinoplasty management of a 13-year-old male Chinese Singaporean patient diagnosed with cleidocranial dysplasia. He presented with multiple retained primary teeth, buried supernumerary teeth and unerupted permanent teeth. He had a Class III malocclusion and concave facial profile. The multidisciplinary management, which took place over 12 years, resulted in much improved occlusion and facial aesthetics. Conclusion: Collaboration of different specialties and careful planning is required for the successful treatment of cleidocranial dysplasia

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Conservative treatment of a Class I malocclusion with 12 mm overjet, overbite and severe mandibular crowding

Dental Press Journal of Orthodontics ◽

10.1590/s2176-94512012000500007 ◽

2012 ◽

Vol 17 (5) ◽

pp. 43-52

Author(s):

Marcos Alan Vieira Bittencourt ◽

Arthur Costa Rodrigues Farias ◽

Marcelo de Castellucci e Barbosa

Keyword(s):

Class I ◽

Facial Features ◽

Conservative Approach ◽

Upper Lip ◽

Facial Aesthetics ◽

Lower Lip ◽

Angle Class ◽

Nasolabial Angle ◽

Lower Arch ◽

Lower Incisors

INTRODUCTION: A female patient aged 12 years and 2 months had molars and canines in Class II relationship, severe overjet (12 mm), deep overbite (100%), excessive retroclination and extrusion of the lower incisors, upper incisor proclination, with mild midline diastema. Both dental arches appeared constricted and a lower arch discrepancy of less than -6.5 mm. Facially, she had a significant upper incisors display at rest, interposition and eversion of the lower lip, acute nasolabial angle and convex profile. OBJECTIVE: To report a clinical case consisting of Angle Class I malocclusion with deep overbite and overjet in addition to severe crowding treated with a conservative approach. METHODS: Treatment consisted of slight retraction of the upper incisors and intrusion and protrusion of the lower incisors until all crowding was eliminated. RESULTS: Adequate overbite and overjet were achieved while maintaining the Angle Class I canine and molar relationships and coincident midlines. The facial features were improved, with the emergence of a slightly convex profile and lip competence, achieved through a slight retraction of the upper lip and protrusion of the lower lip, while improving the nasolabial and mentolabial sulcus. CONCLUSIONS: This conservative approach with no extractions proved effective and resulted in a significant improvement of the occlusal relationship as well as in the patient's dental and facial aesthetics.

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