Facial asymmetry correction: From conventional orthognathic treatment to surgery-first approach

Abstract

The surgery-first approach (SFA), which proceeds without presurgical orthodontic treatment, is assumed to shorten the treatment course because the direction of post-surgical orthodontic tooth movement conforms to the normal muscular forces. Moreover, the regional acceleratory phenomenon (RAP), evoked by surgery, helps in tooth alignment and compensation in a faster way. Although SFA has definite advantages, especially in class III individuals, there is a lack of data about its indications in patients with facial asymmetry. In this article, we reviewed recently published articles on the treatment of asymmetric patients using the SFA. Different aspects, including the three-dimensional assessment of stability in different planes, approaches for fabrication of a surgical splint, predictability of the results, skills needed for bimaxillary surgery, indications as the treatment of choice for condylar hyperplasia, and combination with distraction osteogenesis in candidates with severe asymmetries were found to be the main topics discussed for patients presenting with facial asymmetry

Orthodontic Treatment and Healthcare Goals: Evaluation of Multibrackets Treatment Results Using PAR Index (Peer Assessment Rating)

“…The present report evaluated an overview of conventional orthodontic cases. Future research perspective would include studies more focused on the different particular aspects of orthodontic treatment, such as digital orthodontics [ 32 ] orthognathic surgery [ 33 ], disinclusion [ 34 ], or transposition [ 35 ] cases. The evaluation of these variables could modify or confirm the present preliminary results.…”

What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study

“…Alyamani and Abuzinada described 18 cases, where 15 were females [4]. On the other hand, other authors also indicate slight female predominance [5][6][7][8][9][10][11][12][13]. Etiological factors remain unknown, but many are taken into consideration, especially endocrinal and trauma followed by other factors such as genetic, hereditary, or perhaps even iatrogenic once in the close proximity of the joint [5][6][7][8].…”

“…On the other hand, other authors also indicate slight female predominance [5][6][7][8][9][10][11][12][13]. Etiological factors remain unknown, but many are taken into consideration, especially endocrinal and trauma followed by other factors such as genetic, hereditary, or perhaps even iatrogenic once in the close proximity of the joint [5][6][7][8]. Perhaps, other factors might be related to geographical regions and other possible individually driven factors.…”

“…The dentoalveolar discrepancies remain mostly individual, but characteristic open bite in the anterior and premolar teeth is quite common. In lots of cases, the volume of bone overgrowth and the variety of asymmetry levels vary, because of patients' age, growth component ratio, that they underwent orthodontic treatment, and the time from first symptoms to first accurate treatment [6][7][8]12,17].…”

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“…Adopting conventional orthognathic surgeries in correcting facial asymmetry and more specifically medio-lateral deformity is unsatisfactory. The exact deficiency is going back to the restriction of lateral movement of the jaws in bi-maxillary surgery and the associated butterfly effect that has on the facial tissues as a whole that makes it to some extent unpredictable in some cases [16]. Facial implants and camouflage surgery provide an easier alternative and more predictable results in some cases, however, designing and choosing the correct implant thickness is the Achilles heel of the procedure as under and overestimation of the implant size are common [17].…”