Alteration of Occlusal Plane in Orthognathic Surgery: Clinical Features to Help Treatment Planning on Class III Patients

Abstract

Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up.

Orthognathic correction and corticobasal implant-supported prostheses as a treatment modality for partial edentulism with mandibular prognathism: A case report and review of literature

“…The exact prevalence of DFDs has not been established [4] , [5] ; it ranges from 39 to 93% in children and adolescents [2] , [6] . Approximately 5% of the population of the UK and USA exhibits features of DFDs that require orthognathic surgery as a part of dental treatment [4] .…”

“…Class III malocclusion (mandibular prognathism) is reportedly the most prevalent of all DFDs [4] . Several studies conducted in Hong Kong [4] , [7] , Brazil [8] , the UK [9] , Norway, and the USA have supported this observation [4] , [10] .…”

Combined Orthodontic and Surgical Management for Treatment of Severe Class III Malocclusion with Anterior and Posterior Crossbites

“…Camouflage orthodontic therapy can be considered to correct mild skeletal class III patients with acceptable profiles. However, management of this problem in adult patients will usually require considering the option of orthognathic surgery, especially if the problem was severe [ 4 , 5 ].…”

“…Le Fort I osteotomy and/or bilateral sagittal split osteotomy (BSSO) are the most commonly used surgical procedures to treat severe class III malocclusion. In cases requiring orthognathic surgery, a proper treatment plan is required to achieve a good outcome for the treatment together with accurate identification of the patient's expectations [ 4 , 7 ].…”

Comparação de diferentes planejamentos em cirurgia ortognática para tratamento de assimetrias faciais: relato de casos

“…A cirurgia ortognática é a conduta de escolha para correção de assimetria facial por demonstrar estabilidade em longo prazo e melhora da estética e função mastigatória do paciente (sINGH et al, 2017). A previsibilidade dos resultados cirúrgicos está associada a alguns recursos, tais como de exames clínicos adequados, imagens bidimensionais (2D) e/ou tridimensionais (3D) e ferramentas específicas de planejamento (MARLIÈRE et al, 2018).…”