Authors’ response

We would like to thank Dr Connell for his comments. We generally agree with him, with the exception that not all articles in the orthodontic literature need to concern the occlusion. Nonetheless, we were remiss in not clarifying that our comprehensive workup included evaluations of the dentition, the occlusion, and the temporomandibular joints.

It is true that surgeons performing maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) have frequently not dealt with the occlusion; ie, they have left the preexisting occlusal relationship unchanged. That has not been our policy, and the patients we treated in this study underwent presurgical and postsurgical orthodontic treatment in coordination with the surgery.

Sleep specialists have gone directly to surgery under the caveat that there is significant morbidity and mortality with prolonged untreated OSA. The truth is that surgery with orthodontic treatment occurs for several reasons. One is the long length of presurgical orthodontic treatment that many orthodontists require before moving on to surgery. Patients with severe OSA who cannot tolerate CPAP or don’t wear it routinely do not have 2 or 3 years to wait. This, however, does not mean that we cannot perform orthodontic treatment and obtain a normal Class I occlusion postsurgically. Because of this very fact, we have used a rapid presurgical orthodontic treatment that enables the patient to go expeditiously to surgery without compromising the final occlusion. Only the tooth movements necessary for the jaws to be correctly positioned at surgery are done preoperatively. The patient is left in a light wire, and the arches are not fully leveled. The occlusion is finalized postsurgically by continuing the orthodontic treatment. This is actually easier because the skeletal base is then Class I, and the bone metabolism is greatly increased postoperatively. For this reason, we start the tooth movements within a week of surgery instead of waiting several months, as many do. This means less orthodontic work preoperatively and more postoperatively, resulting in a functional Class I occlusion. We have looked at skeletal relapse with MMA, as have others, and it is minimal: less than 1 mm. This issue has not been a major concern since the evolution of rigid internal fixation.

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on Authors’ response

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