Dental-maxillofacial Deformities
Dept,of Oral & Maxillofacial Surgery
School of Stomatology
LI Qing-yun
Phase I Presurgical treatment
? Orthodontics
? Surgical plan
Phase II Surgical treatment
? Mandible
? Maxilla
Phase III Postsurgical treatment
? Orthodontics
? restorative/prosthetic treatment
? follow-up
Presurgical Treatment Phase
? Presurgical orthodontics
? Final surgical planning
Objectives —— Presurgical orthodontics
? Decompensation
dental compensation for skeletal deformity
angulation of teeth
accentuate the deformity
Objectives —— Presurgical orthodontics
? Alignment of the arches
? Compatibility of the arches
Final Surgical Planning
? Visual Treatment Objective,VTO
Final Surgical Planning
? Computerized imaging CASSOS
Final Surgical Planning
? Model Surgery
Exact surgical movements
(distance,direction)
Postoperative occlusion
articulator
Face-bow
Surgical Treatment Phase
? Surgeries for maxillary deformity
? Surgeries for mandibular deformity
Surgeries for maxillary deformity
? Segmental osteotomy (Anterior / Posterior)
Indications,
- maxillary protrusion
- marked protrusion of
maxillary teeth
- open bite
Surgeries for maxillary deformity
? Le Fort I osteotomy
(total or segmental)
Indications,
- maxillary deformities
- mandibular deformities
Surgeries for maxillary deformity
? Le Fort I osteotomy
? Le Fort II or III osteotomy
Indications,
- midface deficiency
SNA 88°
SNB 92°
ANB 4°
Surgeries for mandibular deformity
? Sagittal split ramus osteotomy,
SSRO
Indications,
- mandibular excess
- mandibular deficiency
- mandibular asymmetry
Ad back
rotate
Surgeries for mandibular deformity
? Vertical ramus osteotomy
Indications,
- mandibular excess
- mandibular asymmetry
(combined with SSRO)
back
Surgeries for mandibular deformity
? Subapical osteotomy
Indications,
- bimaxillary protrusion / open bite
- leveling the plane of occlusion
- uprighting anterior teeth
Surgeries for mandibular deformity
? Body osteotomy
Indications,
- mandibular excess (body)
combined with ramus procedure or not
- open bite / spee’s curve reduction
Surgeries for mandibular deformity
? genioplasty
Indications,
- chin deformities
Perioperative complications
? Airway obstruction
edema / bleeding / displacement… …
? Bleeding
? Infection
? Necrosis of teeth / bone
? Healing
? Injury of nerve
Postsurgical Treatment Phase
? Completion of orthodontics
? Postsurgical restorative/prosthetic treatment
? Follow-up
SNA 88°
SNB 81°
ANB 7°
SNA 84°
SNB 81°
ANB 3°
SNA 88°
SNB 92°
ANB -4°
SNA 88°
SNB 86°
ANB 2°
SNA 88°
SNB 86°
ANB 2°