Condition-specific Quality of Life Assessment at Each Stage of Class III Surgical Orthodontic Treatment —A Prospective Study—

Abstract

Surgical orthodontic treatment has been reported to improve oral health-related quality of life (OHRQL). Such treatment comprises three stages: pre-surgical orthodontic treatment; orthognathic surgery; and post-surgical orthodontic treatment. Most studies have focused on change in OHRQL between before and after surgery. However, it is also necessary to evaluate OHRQL at the pre-surgical orthodontic treatment stage, as it may be negatively affected by dental decompensation compared with at pre-treatment. The purpose of this prospective study was to investigate the influence of surgical orthodontic treatment on QOL by assessing change in condition-specific QOL at each stage of treatment in skeletal class III cases. Twenty skeletal class III patients requiring surgical orthodontic treatment were enrolled in the study. Each patient completed the Orthognathic Quality of Life Questionnaire (OQLQ), which was developed for patients with dentofacial deformity. Its items are grouped into 4 domains: "social aspects of dentofacial deformity"; "facial esthetics"; "oral function"; and "awareness of dentofacial esthetics". The questionnaire was completed at the pre-treatment, pre-surgical orthodontic treatment, and post-surgical orthodontic treatment stages. The results revealed a significant worsening in scores between at pre-treatment and pre-surgical orthodontic treatment in the domains of facial esthetics and oral function (p<0.01), and between at pre-surgical orthodontic and post-surgical orthodontic treatment in all domains except awareness of dentofacial esthetics (p<0.05, p<0.01). A significant correlation was observed between a negative change in overjet and worsening OQLQ scores at the pre-surgical orthodontic treatment stage. Significant correlations were also observed between improvement in upper and lower lip difference, soft tissue pogonion protrusion, and ANB angle and improvement in OQLQ scores at the post-surgical orthodontic treatment stage. These results indicate that morphologic change influences OHRQL in patients undergoing surgical orthodontic treatment not only after surgery, but also during pre-surgical orthodontic treatment.

Impact of surgical orthodontic treatment on quality of life in Chinese young adults with class III malocclusion: a longitudinal study

“…In terms of OQLQ questionnaire, the scores of all domains increased at T 1 , this difference was statistically significant for facial aesthetics ( P < 0.01) and oral function ( P < 0.05), but decreased significantly across all domains after post-surgical orthodontic treatment. Previous studies have also reported this unexpected observation [22, 34, 35], suggesting that quality of life in patients with Class III malocclusion may be worsened during the treatment. The cause of this phenomenon may be due to the psychosocial disadvantages [36] and the worsening of malocclusion [37–39] during pre-surgical orthodontic treatment.…”

“…However, Lee et al reported the improvements of all domains except for awareness of dentofacial aesthetics at postoperative 6 months [26]. Choi et al [10] and Tachiki et al [35] also observed the same findings at the same stage. Cultural and social differences are one of the possible reasons for these results.…”

“…It is reported by most patients that the dental decompensation has an adverse effect on facial aesthetics and this is one of the most stressful periods during the overall treatment [39]. Tachiki and colleagues [35] suggested from their results that there is a transient worsening of quality of life at the post-orthodontic stage, and underlined that dental professionals need to be aware of this and should be used to inform patients about what to expect and provide support to help patients overcome this temporary negative effect of treatment.…”

Effect of surgery-first orthognathic approach on oral health-related quality of life:

“…[13][14][15]17,18 The preoperative deterioration of patients' OHRQoL treated with COST was realized in different studies and could be attributed to the worsening of malocclusion and psychological disadvantages. 20 Dental decompensation in the presurgical phase had a negative impact on facial esthetics, and most patients considered it as the most stressful period during treatment. 21 Therefore, dental professionals should be aware of the harmful changes during presurgical orthodontic treatment and inform their patients what to expect and, if necessary, help them to overcome the negative effects.…”

The impact of surgery-first approach on the oral health-related quality of life: a systematic review and meta-analysis

“…At the same time-point, the patients in CTM group were just at the beginning of presurgical orthodontics and had worse facial deformity as a result of dental decompensation by CTM. Anterior crossbite was reported to influence esthetics and mastication function negatively, which contributed to a worse OHRQoL during the presurgical orthodontic stage [48, 49]. It was also reported that 73.6% patients with dentofacial deformities were uncomfortable by their appearance and almost half of them felt functional limitations before surgery, and esthetic and functional domains of QoL were improved after surgery [50].…”