3. Patient evaluation and diagnosis
a. Patient concerns
b. Clinical evaluation
1. Facial form-frontal and profile
long, short, convex, concave, flat
2. Relation ship of facial thirds
3. Soft tissue –dentition relations
smile line, Occlusal cant, dental
midlines
4.
5. Orthognathic planning
To get an optimal balance between
1.Aesthetics
2.Function
3.Stability
4.Clinical measurements
a. Vertical dimensions
b. Antero posterior dimensions
c. Transverse dimensions
d. Intra arch dimensions
6. Cont’d
5.Radiographic analysis
a. Cephalometric
b. Orthopantomogram
6.Dental study models
7.Speech
8.Audiometry
9.Medical and psychological
7.
8.
9.
10. Sequence of treatment planning
Dental and periodontal
Extractions
Presurgical orthodontics
Orthognathic surgery
Post surgical orthodontics
Maintenance
Others
11. Presurgical orthodontics
Position the teeth over their
respective basal bone
Align and level the teeth
Adjust for tooth size discrepancies
Correct rotated teeth
Co-ordinate upper and lower arch
widths
12. Types
Segmental maxillary surgery
1. Single tooth osteotomy
2. Corticotomy
3. Anterior segmental osteotomy
a.wassmund-1935
b.wunderer-1963
c. Cupar’s down fracture
14. Total maxillary surgery
Le fort I osteotomy
a. Classic down fracture
b. Buttress release (surgically assisted
maxillary expansion)
c. Quadrangular
Le fort II osteotomy
a. Anterior
b. Pyramidal
c. quadrangular
15. Cont’d
Le fort III osteotomy
Gillies
Tessier
4.Other midface osteotomies
a. Zygomatic osteotomies
b. Malar –maxillary osteotomy
16.
17.
18.
19. Segmental maxillary osteotomies
Surgical repositioning is possible for
small dento alveolar segments
provided maximum mucoperiosteal
attachment is maintained
Incisions planned such that maximum
soft tissue pedicle is maintained
Apicoectomy of teeth should be
avoided during the procedure to
prevent pulpal atrophy
20. Single tooth osteotomies
for upper anterior teeth which are
dilacerated or traumatically impacted
Incision-high vestibular cut or two vertical
incisions on either side of tooth
Osteotomy- 3 mm apical to root apex and
at least 2-3 mm from alveolar crest
Separation done using fine osteotomes
Fixing done to adjacent teeth using inter
dental wires
21. Corticotomy
To permit surgically assisted
retraction of upper anterior teeth in
class II div I mal occlusions
Vestibular incision from premolar to
premolar is used
Cortical bone removed labially and
palatally
Bone also removed from 5mm above
the teeth
22. Posterior segmental maxillary
osteotomy
Correction of anterior or posterior
open bite
Correction of posterior cross bites
Closure of edentulous spaces as in
cleft cases
23. Horse shoe osteotomy
Palate remains in original position
Dento alveolar complex alone is
repositioned
Aim is to minimize the size of the
reduction of the nasal cavity
Technically difficult since multiple
areas of bony contacts are there
24. Anterior segmental maxillary
osteotomy
Used when alteration of premaxilla in
the vertical plane is required as in
anterior open bite or deep over bite
Three techniques are usually
described
Down fracture technique preferred
when vertical movement is required
28. Wassmund technique
Incisions
vertical incisions in premolar region
and along frenum
Midline sagittal section along hard
palate
29.
30. osteotomies
bone cuts made through tunneling
approach under mucosa
Buccal- right angled osteotomy with
extraction of first premolars
Sub labial-separation of nasal septum and
lateral nasal wall
Palatal-transverse cut from first premolar to
first premolar
10-15 mm of bone between nasal floor and
tooth apices
31. Wunderer technique
Similar to wassmund
Palate is exposed by a transverse
palatal incision with margins away
from osteotomy site
32.
33.
34.
35. Le fort I osteotomy
Classic le fort I down fracture (bell)
1.Allows full mobilization of maxilla
2.Permits bone surgery under direct
vision
3.Reduced risk of relapse
37. Surgical technique
Vestibular incision from first molar to
first molar
Osteotomy at least 5 mm above
apices of the teeth
Anterior cut-4-5 mm above canine
vertical cut-zygomatic buttress region
Posterior cuts-4-5 mm above molar
apices
38. Cont’d
Osteotomy of lateral nasal wall and
septum
Separation of pterygomaxillary
junction
Curved osteotomes used for
pterygoid disjunction
Down fracture of maxilla using rowes
disimpaction forceps
39. Cont’d
Complete mobilization and trimming
of maxilla is done
Maxilla should be able to sit in a
passive position
Stability and healing is facilitated by
interpositional bone grafts
43. Le fort II osteotomy
For correction of nasomaxillary
hypoplasia
It is a pyramidal naso-orbital maxillary
osteotomy
44.
45.
46. Le fort III osteotomy
Total midface osteotomy
For correction of various craniofacial
syndromes like aperts crouzon etc
47.
48. Post surgical orthodontics
Final tooth alignment and parallelism
Maximum inter digitations
Ideal overbite and over jet
Centric occlusion =centric relation
