* Mestre e Doutora pela FOB-USP e ortodontista privada-Bauru / SP. ** Professor Livre Docente em Cirurgia e Traumatologia-FOB-USP e cirurgião privado. *** Pós-Graduando em Patologia Bucal pela FOB-USP e ortodontista privado-Botucatu / SP.
Introduction: Orthognathic surgery (OS) consists of the surgical procedure that aims to correct deformities of the bones of the maxilla and mandible. The records of the first surgeries for the correction of dentofacial deformities date from the mid-nineteenth century and were initially limited to mandibular surgeries. The malocclusion has as one of the primary etiological factors the facial growth pattern. Angle's statement already said that the only possibility of correcting true dentofacial deformities was the combination of orthodontics with surgery, and the importance of the combined effort of these two distinct areas in the approach to dentofacial disharmony in patients with problems was recognized skeletal. Objective: This study aimed to review the literature on OS involving mandible, maxilla, mento and associations. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: A total of 107 articles were found involving “orthognathic surgery". A total of 47 articles were evaluated in full, and 33 were included and discussed in this study. Individuals with class III dentofacial deformities are those that normally present greater aesthetic and functional impact, and for this reason, are the ones that more frequently seek treatment. However, some studies have shown a tendency for complications to occur in older patients submitted to orthognathic surgeries. Mandibular surgical procedures with maxillary segmentation and combining three types of osteotomies should be carefully planned and trained to reduce the occurrence of complications. The surgeon, orthodontist, and all staff involved should be focused on avoiding complications during all phases of treatment. Conclusion: It was concluded that there was an increase in the cases of OS in the last years, and with homogeneous samples between the masculine and feminine genres, and the advances in maxillary surgery corresponded to the greater number of surgical treatments.
Introduction: Orthognathic surgery (OS) is used to improve the patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusions, disease, or trauma. In this context, genioplasty is a procedure to correct an aesthetic and functional deformity of the chin region, improving the contour. Moreover, anterior open bite (AOB) is the lack of vertical contact or negative overbite between the anterior teeth of the superior and inferior arches when the posterior teeth are in occlusion. Objective: The present study aimed to perform a brief systematic review with risk of bias analysis by funnel plot to highlight the main clinical approaches of orthognathic surgery in class II patients with open bites and also concerning genioplasty. Methods: The research was carried out from February 2022 to May 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 115 articles were found. In total, 57 articles were fully evaluated and 34 were included and evaluated in this study. And of the total of 34 articles, only 11 articles were developed as the main clinical results. A total of 32 articles were excluded because they did not meet the GRADE classification, and 16 were excluded because they were at risk of bias. The symmetric funnel plot does not suggest a risk of bias between the small sample size studies. A retrospective observational study compared 57 patient charts on treatment outcomes for anterior occlusion and vertical skeletal stability after maxillary or mandibular surgery to correct Class II malocclusion with a mild to moderate open bite. After surgery, 87% of Le Fort I patients and 63% of patients with bilateral sagittal split osteotomy had a positive overbite, and at the 6-month follow-up, the percentages were 90% and 74%, respectively. Another study showed Class II patients had significantly greater amounts of lateral and lower translation than class III patients. Also, genioplasty represents one of the most common auxiliary procedures and may be associated with corrective surgery for dentofacial dysmorphisms. However, care must be taken with mental nerve injuries, asymmetries, and intraoperative bleeding are the main immediate complications.
Introduction: Anterior open bite is the lack of vertical contact or negative overbite between the anterior teeth of the upper and lower arches when the posterior teeth are in occlusion. Its etiology is multifactorial, including heredity, oral habits, unfavorable growth patterns, and increased lymphatic tissue along with mouth breathing and functional oral matrices. The characteristics of individuals with anterior open bite include excessive gonial, mandibular, and occlusal plane angles, mandibular small body, and ramus increased lower anterior facial height, decreased upper anterior facial height, retrusive jaw, Class II tendency, divergent cephalometric planes, lingual position, and inadequate lip seal. Objective: To carry out a concise systematic review of multi-segmented maxillary ortho-surgical treatment in class II patients with maxillary protrusion and open bite. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. A total of 289 articles were initially found and, after selection, 17 articles were used to compose this study. Results and conclusion: Significant improvement in anterior occlusion can be expected in most patients when maxillary or mandibular surgery is used for Class II open bite correction. However, there will be individual patients in whom there will be considerable post-treatment changes in the anteroposterior and vertical dimensions. Although individual morphology needs to be taken into account, it appears that both short-term and long-term stability are likely to be greater after Le Fort I surgery compared to bilateral sagittal split osteotomy.
Introduction: Class III malocclusion presents with several skeletal and dental factors, highlighting the large or protruding jaw, retrusive maxilla, protrusive mandibular dentition, retrusive maxillary dentition, or combinations. The importance of evaluating class III malocclusions, as well as their treatments, through three-dimensional (3D) images are highlighted. Objective: To present a concise systematic review of the approach of 3D imaging exams to conduct class III malocclusion treatments, as well as to follow up after orthognathic surgery. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 105 articles was found involving class III malocclusion and ortho-surgical treatments guided by three-dimensional (3D) images. A total of 44 articles were fully evaluated and 16 were included and discussed in this study. Positional, structural, and volumetric condylar changes after orthognathic surgery in skeletal Class III patients have been well elucidated using cone-beam computed tomography. In addition, the virtual surgical planning and the surgical splint manufactured in CAD/CAM facilitate treatment planning and offer an accurate surgical result in orthognathic surgery. The application of pre-engineered bone guidance splints allows the treatment of craniofacial deformities with precision. Therefore, the three-dimensional (3D) tool allows for the accuracy of treatments and planning of orthognathic surgery, as well as the best postoperative follow-up.
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