Optimization of facial aesthetics through orthognathic treatment: a systematic review

Abstract

Introduction: In the aesthetics scenario, facial optimization is considered an essential outcome of orthognathic treatment (OT) due to its potential advantages in reducing the duration and cost of treatment, providing early aesthetic improvement, and increasing patient satisfaction. Objective: It presents a systematic review study listing the main optimizations of facial aesthetics through orthognathic surgery, to highlight the importance of this treatment for improving patients' comfort and quality of life. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. 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 179 articles were found, 45 articles were evaluated in full and 39 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=69.5%>50%. It was concluded space maintenance is one of the most important activities in the prevention of malocclusion. The maintenance of the lost space is of paramount importance to ensure normal eruption and development of the dentition. Aesthetic/functional rehabilitation is necessary until the eruption of permanent successor teeth occurs. A practical option to obtain this rehabilitation is through the installation of aesthetic or functional space maintainers. There are several requirements, such as maintaining the desired interproximal space, not interfering with the occlusion of the opposing teeth nor with the eruption of the permanent tooth, allowing sufficient mesiodistal space for the permanent tooth alignment to erupt, not inferring in phonetics and chewing and present a simple framework and be easily sanitized. Thus, the neuromuscular stability of the stomatognathic system may be impaired by the presence of deleterious habits.