Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Evaluation of Postoperative Accuracy and Relapse Extent in Orthognathic Surgery Patients: A Case Control Study
Ortognatik Cerrahi Hastalarında Postoperatif Doğruluğun ve Nüks Miktarının Değerlendirilmesi: Olgu Kontrol Araştırması
Tolgahan KARAa, Nihat AKBULUTa, Sibel AKBULUTb, Ahmet ALTANa
aDepartment of Oral and Maxillofacial Surgery, Tokat Gaziosmanpaşa University Faculty of Dentistry, Tokat, Türkiye
bDepartment of Orthodontics, Tokat Gaziosmanpaşa University Faculty of Dentistry, Tokat, Türkiye
Turkiye Klinikleri J Dental Sci. 2022;28(3):481-9
doi: 10.5336/dentalsci.2021-86373
Article Language: EN
Full Text
ABSTRACT
 Objective: The success of orthognatic surgery depends on careful physical examination, correct diagnosis and good treatment planning. The aim of this study was to determine the accuracy of presurgical orthognatic planning and postoperative outcomes in single jaw or double jaw orthognathic surgery cases operated on in the Tokat Gaziosmanpaşa University Dentistry Faculty Department of Oral and Maxillofacial Surgery. Material and Methods: A total of 34 Class III patients were grouped in the form of bimaxillary osteotomy (Group 1), single jaw mandibular osteotomy with mandibular set-back (Group 2) and single jaw maxillary osteotomy with maxillary advancement (Group 3). Orthodontic analysis and measurements were performed on preoperative (T0), immediate postoperative (T1), 6 months (T2) and 12 months (T3) lateral cephalometric radiographs. Results: Based on multivariate analyses, there was no statistically significant difference in any of the groups between our T1-T0 values (p>0.05), with the exception of the distance of the ANS point from the vertical reference point (p=0.004). To evaluate the recurrence rates, the values between the T2- T1 and the T3-T1 periods were examined, and were not found to be statistically significant. However in Group 1, T3-T1 differences with regard to VR-ANS (p=0.003) and VR-L1 (p=0.033) showed a statistically significant recurrence. Conclusion: This study showed that the orthognathic surgical plan resulting from the methods we used were transferred to the surgery correctly. In addition, besides the postoperative orthodontic treatment, our techniques for fixation and osteotomy were effective in reducing the potential for relapse.

Keywords: Orthognathic surgery; recurrence; orthodontics
ÖZET
 Amaç: Ortognatik cerrahinin başarısı dikkatli fizik muayene, doğru teşhis ve iyi bir tedavi planlamasına bağlıdır. Bu çalışmanın amacı, Tokat Gaziosmanpaşa Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Anabilim Dalında opere edilen tek çene veya çift çene ortognatik cerrahi olgularında ameliyat öncesi ortognatik planlamanın ve ameliyat sonrası sonuçların doğruluğunu belirlemektir. Gereç ve Yöntemler: Toplam 34 Sınıf III hasta, çift çene osteotomi yapılanlar (Grup 1), tek çene mandibular geriletme yapılanlar (Grup 2) ve tek çene maksiller ilerletme yapılanlar (Grup 3) olarak gruplandırılmıştır. Operasyon öncesinde (T0), operasyonun hemen sonrasında (T1), 6. ay (T2) ve 12. aylarda ortodontik analiz ve ölçümler yapılmıştır. Bulgular: Çoklu değişken analizlerine göre ANS noktasının dikey referans noktasına olan mesafesi (p=0,004) dışında, T1-T0 değerlerimiz arasında (p>0,05) grupların hiçbirinde istatistiksel olarak anlamlı bir fark yoktu. Nüks oranlarını değerlendirmek için T2-T1 ve T3-T1 dönemleri arasındaki değerlere bakılmış ve istatistiksel olarak anlamlı bulunmamıştır. Ancak Grup 1'de VR-ANS (p=0,003) ve VRL1 (p=0,033) açısından T3-T1 farklılıkları istatistiksel olarak anlamlı bir nüks görülmüştür. Sonuç: Bu çalışma, kullandığımız yöntemlerle oluşturulan ortognatik cerrahi planın operasyona başarıyla aktarıldığını göstermektedir. Ayrıca postoperatif ortodontik tedavinin yanı sıra osteotomi ve fiksasyon yöntemlerimizin de nüksü önlemede etkili olduğu görülmektedir.

Anahtar Kelimeler: Ortognatik cerrahi; nüks; ortodonti
REFERENCES:
  1. Lye KW. Effect of orthognathic surgery on the posterior airway space (PAS). Ann Acad Med Singap. 2008;37(8):677-82. [PubMed] 
  2. Adolphs N, Ernst N, Keeve E, Hoffmeister B. Contemporary correction of dentofacial anomalies: A clinical assessment. Dent J (Basel). 2016;4(2):11. [Crossref]  [PubMed]  [PMC] 
  3. Steinhuber T, Brunold S, Gärtner C, Offermanns V, Ulmer H, Ploder O. Is virtual surgical planning in orthognathic surgery faster than conventional planning? A time and workflow analysis of an office-based workflow for single- and double-jaw surgery. J Oral Maxillofac Surg. 2018;76(2):397-407. [Crossref]  [PubMed] 
  4. Mendes de Paula Gomes A, Adas Saliba Garbin C, da Silva Ferraz FW, Adas Saliba T, Isper Garbin AJ. Dentofacial deformities and implications on quality of life: A presurgical multifactorial analysis in patients seeking orthognathic surgical treatment. J Oral Maxillofac Surg. 2019;77(2):409.e1-409.e9. [Crossref]  [PubMed] 
  5. Olkun HK, Borzabadi-Farahani A, Uçkan S. Orthognathic surgery treatment need in a Turkish adult population: A retrospective study. Int J Environ Res Public Health. 2019;16(11): 1881. [Crossref]  [PubMed]  [PMC] 
  6. Ong MA. Spectrum of dentofacial deformities: a retrospective survey. Ann Acad Med Singap. 2004;33(2):239-42. [PubMed] 
  7. Zere E, Chaudhari PK, Sharan J, Dhingra K, Tiwari N. Developing class III malocclusions: challenges and solutions. Clin Cosmet Investig Dent. 2018;10:99-116. [Crossref]  [PubMed]  [PMC] 
  8. Buchanan EP, Hyman CH. LeFort I osteotomy. Semin Plast Surg. 2013;27(3):149-54. [Crossref]  [PubMed]  [PMC] 
  9. Bennett MA, Wolford LM. The maxillary step osteotomy and Steinmann pin stabilization. J Oral Maxillofac Surg. 1985;43(4):307-11. [Crossref]  [PubMed] 
  10. Yoon HJ, Rebellato J, Keller EE. Stability of the Le Fort I osteotomy with anterior internal fixation alone: a case series. J Oral Maxillofac Surg. 2005;63(5):629-34. [Crossref]  [PubMed] 
  11. Ataç MS, Erkmen E, Yücel E, Kurt A. Comparison of biomechanical behaviour of maxilla following Le Fort I osteotomy with 2- versus 4-plate fixation using 3D-FEA. Part 1: advancement surgery. Int J Oral Maxillofac Surg. 2008;37(12):1117-24. [Crossref]  [PubMed] 
  12. Rubens BC, Stoelinga PJ, Blijdorp PA, Schoenaers JH, Politis C. Skeletal stability following sagittal split osteotomy using monocortical miniplate internal fixation. Int J Oral Maxillofac Surg. 1988;17(6):371-6. [Crossref]  [PubMed] 
  13. Shetty V, Freymiller E, McBrearty D, Caputo AA. Experimental analysis of functional stability of sagittal split ramus osteotomies secured by miniplates and position screws. J Oral Maxillofac Surg. 1996;54(11):1317-24; discussion 1324-6. [Crossref]  [PubMed] 
  14. Ulu M, Soylu E, Kelebek S, Dikici S, Oflaz H. Comparative study of biomechanical stability of resorbable and titanium fixation systems after sagittal split ramus osteotomy with a novel designed in-vitro testing unit. J Craniomaxillofac Surg. 2018;46(2):299-304. [Crossref]  [PubMed] 
  15. Ribeiro-Junior PD, Magro-Filho O, Shastri KA, Papageorge MB. In vitro biomechanical evaluation of the use of conventional and locking miniplate/screw systems for sagittal split ramus osteotomy. J Oral Maxillofac Surg. 2010;68(4):724-30. [Crossref]  [PubMed] 
  16. De Oliveira LB, Reis JM, Spin-Neto R, Gabrielli MA, Oguz Y, Pereira-Filho VA. Mechanical evaluation of six techniques for stable fixation of the sagittal split osteotomy after counterclockwise mandibular advancement. Br J Oral Maxillofac Surg. 2016;54(5):573-8. [Crossref]  [PubMed] 
  17. de Lira Ade L, de Moura WL, de Barros Vieira JM, Nojima MG, Nojima LI. Surgical prediction of skeletal and soft tissue changes in Class III treatment. J Oral Maxillofac Surg. 2012;70(4): e290-7. [Crossref]  [PubMed] 
  18. Sharifi A, Jones R, Ayoub A, Moos K, Walker F, Khambay B, et al. How accurate is model planning for orthognathic surgery? Int J Oral Maxillofac Surg. 2008;37(12):1089-93. [Crossref]  [PubMed] 
  19. Altman JI, Oeltjen JC. Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction. J Craniofac Surg. 2007;18(4):734-9. [Crossref]  [PubMed] 
  20. Becelli R, Renzi G, Carboni A, Cerulli G, Perugini M. Evaluation of the esthetic results of a 40-patient group treated surgically for dentoskeletal class III malocclusion. Int J Adult Orthodon Orthognath Surg. 2002;17(3):171-9. [PubMed] 
  21. Bell WH. Le Forte I osteotomy for correction of maxillary deformities. J Oral Surg. 1975; 33(6):412-26. [PubMed] 
  22. Honrado CP, Lee S, Bloomquist DS, Larrabee WF Jr. Quantitative assessment of nasal changes after maxillomandibular surgery using a 3-dimensional digital imaging system. Arch Facial Plast Surg. 2006;8(1):26-35. [Crossref]  [PubMed] 
  23. Misir AF, Manisali M, Egrioglu E, Naini FB. Retrospective analysis of nasal soft tissue profile changes with maxillary surgery. Journal of Oral and Maxillofacial Surgery. 2011;69(6): e190-e194. [Crossref]  [PubMed] 
  24. Park SB, Yoon JK, Kim YI, Hwang DS, Cho BH, Son WS. The evaluation of the nasal morphologic changes after bimaxillary surgery in skeletal class III maloccusion by using the superimposition of cone-beam computed tomography (CBCT) volumes. J Craniomaxil lofac Surg. 2012;40(4):e87-92. [Crossref]  [PubMed] 
  25. Metzler P, Geiger EJ, Chang CC, Sirisoontorn I, Steinbacher DM. Assessment of three-dimensional nasolabial response to Le Fort I advancement. J Plast Reconstr Aesthet Surg. 2014;67(6):756-63. [Crossref]  [PubMed] 
  26. de Haan IF, Ciesielski R, Nitsche T, Koos B. Evaluation of relapse after orthodontic therapy combined with orthognathic surgery in the treatment of skeletal class III. J Orofac Orthop. 2013;74(5):362-9. [Crossref]  [PubMed] 
  27. Jakobsone G, Stenvik A, Sandvik L, Espeland L. Three-year follow-up of bimaxillary surgery to correct skeletal Class III malocclusion: stability and risk factors for relapse. Am J Orthod Dentofacial Orthop. 2011;139(1):80-9. [Crossref]  [PubMed] 
  28. Mucedero M, Coviello A, Baccetti T, Franchi L, Cozza P. Stability factors after double-jaw surgery in Class III malocclusion. A systematic review. Angle Orthod. 2008;78(6):1141-52. [Crossref]  [PubMed] 
  29. Tabrizi R, Nili M, Aliabadi E, Pourdanesh F. Skeletal stability following mandibular advancement: is it influenced by the magnitude of advancement or changes of the mandibular plane angle? J Korean Assoc Oral Maxillofac Surg. 2017;43(3):152-9. [Crossref]  [PubMed]  [PMC] 
  30. de Lir Ade L, de Moura WL, Oliveira Ruellas AC, Gomes Souza MM, Nojima LI. Long-term skeletal and profile stability after surgical-orthodontic treatment of Class II and Class III malocclusion. J Craniomaxillofac Surg. 2013; 41(4):296-302. [Crossref]  [PubMed] 
  31. Han JJ, Yang HJ, Lee SJ, Hwang SJ. Relapse after SSRO for mandibular setback movement in relation to the amount of mandibular setback and intraoperative clockwise rotation of the proximal segment. J Craniomaxillofac Surg. 2014;42(6):811-5. [Crossref]  [PubMed] 

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