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Dental and skeletal changes following sagittal split osteotomy for correction of mandibular prognathism.

Skeletal and dental changes were examined in 15 patients presenting with a Class III malocclusion treated by a sagittal split osteotomy. All patients received orthodontic treatment with Straightwire appliances both prior to and following surgery. These appliances were also used for fixation. The lower incisors were proclined by 8.4 degrees before surgery with little change in upper incisor inclination. With surgery, there was a mean reduction of 4.3 degrees in the angle SNB. Following surgery, the relapse in mandibular position was minimal and was not related to the dental changes during this period. Changes in the vertical skeletal parameters were generally small. The individual cases exhibited a wide variation in the changes.

Adult↗

The surgical correction of vertical maxillary excess (long face syndrome).

The surgical correction of vertical maxillary excess is a relatively new technique. Vertical maxillary excess (VME) may exist alone or in combination with a horizontal mandibular deficiency with or without an anterior open bite. The facial contour is characterized by a long, tapering face with anterior and posterior maxillary overgrowth, a narrow alar base, and lip in competence. Cephalometric analysis demonstrates steep mandibular and occlusal planes in relationship to the cranial base, and increase in facial height, and retroposition of the mandible. Evaluation of study models exhibits increased alveolar bone height, a high palatal vault, and a narrow maxillary arch. The dental relationship may be Class I, II, or III, with Class II being the most common. Orthodontic treatment before surgery consists of correct alignment of the teeth and removal of those dental compensations that preclude good dental interdigitation at surgery. Regardless of the surgical procedure, accurate preoperative planning based on careful evaluation of skeletal, dental, and soft tissue features in conjunction with correct orthodontic surgical sequencing is the key to a satisfactory result. The "downfracturing" or Le Fort I maxillary osteotomy for superior repositioning of the maxilla is the surgical procedure of choice for vertical maxillary excess. Two-, three-, or four-segment maxillary osteotomies can be done in conjunction with the Le Fort I osteotomy without jeopardizing healing capacity.

Adult↗