Residents’ journal review

Surgery-first approach offers good results

Liao YF, Chiu YT, Huang CS, Ko EW, Chen YR. Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgical-orthodontic correction for skeletal Class III open bite. Plast Reconstr Surg 2010;126:2074-83

Traditionally, surgical treatment requires presurgical orthodontics to decompensate the malocclusion, orthognathic surgery to correct the skeletal discrepancy, and postsurgical orthodontics for finishing. This retrospective study examined the effect of presurgical orthodontics on treatment outcome regarding facial esthetics, occlusion, stability, and efficiency in skeletal Class III open-bite patients. Thirty-three patients were selected and divided into 2 groups: 13 received presurgical orthodontics, and 20 did not receive presurgical orthodontics. There were no significant differences between the groups in terms of the initial peer assessment rating (PAR) scores and cephalometric measurements. The results demonstrated no significant differences in facial convexity, facial height, upper or lower lip to E-plane, nasolabial angle, overbite, or PAR score at orthodontic debonding. The group with no presurgical orthodontics displayed a significantly larger overjets than did the presurgical orthodontics group (3.0 ± 1.2 vs 2.2 ±1.1 mm). Both values were within normal limits, and the difference was not clinically significant. No difference was found between the groups in maxillary stability in the vertical or horizontal plane. There was a statistically significant difference in mandibular stability vertically: in the group with no presurgical orthodontics, the mandible moved superiorly. However, this is a favorable direction in a patient with a Class III open bite, because it deepened the bite and is most likely due to the removal of dental interferences during the postsurgical orthodontics. The presurgical orthodontics group had a significantly longer treatment time (512 ± 103 vs 342 ± 127 days). Although further randomized and prospective trials are indicated, this study illustrates that reduced treatment time in the surgery-first approach might alleviate patient burnout without significant clinical differences in esthetics, occlusion, and stability.

Reviewed by Tanya Saour

Microsurgery for rapid dental repositioning

Bertossi D, Vercellotti T, Podesta A, Nocini PF. Orthodontic microsurgery for rapid dental repositioning in dental malpositions. J Oral Maxillofac Surg 2010; e-pub ahead of print

The number of adult patients seeking orthodontic treatment has increased over the years. Adults usually expect the best results in the shortest time possible and seek less-invasive techniques at lower costs due to the constraints imposed by medical insurance on orthognathic surgery. Therefore, shortening treatment time is a significant consideration in their treatment acceptance. The purposes of this study were to assess orthodontic treatment time and avoid orthognathic surgery in borderline patients by using piezosurgical bone cuts. Ten patients were divided into 2 groups: group A, 5 patients with multiple dental ankylosis in the mandible; group B, 5 patients with maxillary hypoplasia in both the sagittal and transverse planes and crowding. Both groups were treated by using the monocortical tooth dislocation and ligament distraction technique followed by immediate application of orthodontic forces. This was performed with piezoelectric bone surgery to produce vertical inverted-Y corticotomies around each root to eliminate cortical bone resistance. The authors reported a decrease in orthodontic treatment time compared with conventional treatment (70% for group A, 65% for group B). No periodontal pocketing was noticed, and the gingival papilla was preserved. No severe postsurgical complications were reported. The authors believe that, when compared with dentoalveolar distraction osteogenesis with bur and osteotomes, this technique appears to be less invasive and safer, since microvibrations selectively cut only mineralized structures without damaging soft tissues. Further research with a larger sample in a randomized control trial design is necessary to support the use of piezosurgery in dentoalveolar distraction osteogenesis.

Reviewed by Amin Movahhedian

Microsurgery for rapid dental repositioning

Bertossi D, Vercellotti T, Podesta A, Nocini PF. Orthodontic microsurgery for rapid dental repositioning in dental malpositions. J Oral Maxillofac Surg 2010; e-pub ahead of print

The number of adult patients seeking orthodontic treatment has increased over the years. Adults usually expect the best results in the shortest time possible and seek less-invasive techniques at lower costs due to the constraints imposed by medical insurance on orthognathic surgery. Therefore, shortening treatment time is a significant consideration in their treatment acceptance. The purposes of this study were to assess orthodontic treatment time and avoid orthognathic surgery in borderline patients by using piezosurgical bone cuts. Ten patients were divided into 2 groups: group A, 5 patients with multiple dental ankylosis in the mandible; group B, 5 patients with maxillary hypoplasia in both the sagittal and transverse planes and crowding. Both groups were treated by using the monocortical tooth dislocation and ligament distraction technique followed by immediate application of orthodontic forces. This was performed with piezoelectric bone surgery to produce vertical inverted-Y corticotomies around each root to eliminate cortical bone resistance. The authors reported a decrease in orthodontic treatment time compared with conventional treatment (70% for group A, 65% for group B). No periodontal pocketing was noticed, and the gingival papilla was preserved. No severe postsurgical complications were reported. The authors believe that, when compared with dentoalveolar distraction osteogenesis with bur and osteotomes, this technique appears to be less invasive and safer, since microvibrations selectively cut only mineralized structures without damaging soft tissues. Further research with a larger sample in a randomized control trial design is necessary to support the use of piezosurgery in dentoalveolar distraction osteogenesis.

Reviewed by Amin Movahhedian

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Apr 13, 2017 | Posted by in Orthodontics | Comments Off on Residents’ journal review
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