Guilherme Genehr Fritscher

Bone Substitutes in Le Fort I Osteotomy to Promote Bone Union and Skeletal Stability

Maxillary advancement by Le Fort I osteotomy has become the standard procedure to restore function and facial esthetics, correct skeletal and occlusal discrepancies, and treat obstructive sleep apnea in patients with facial deformities. Incomplete ossification between the bone segments at the jaw osteotomy site has proven to be a major problem in these patients. There are several studies in the literature that address orthognathic surgery, but only a limited number that discuss the use of graft materials in maxillary osteotomy. Bone grafts were introduced in recent decades in order to promote and improve bone union and prevent the formation of gaps. This study will discuss the results obtained using bone substitutes in orthognathic surgery for maxillary advancement and maxillary repositioning with Le Fort I osteotomy, in a clinical report and a literature review, covering the main indications and specifying the type of material used and the stability of the surgical procedure postoperatively.

Assessment of the Postoperative Stability of Mandibular Orthognathic Surgery for Correction of Class III Skeletal Malocclusion.

Abstract To assess the stability of mandible position after orthognathic surgery for correction of class III skeletal malocclusion. Twenty adult males, aged 18 to 40 years, with Angle class III skeletal malocclusion underwent preoperative orthodontic treatment for elimination of dental compensations followed by combined maxillomandibular surgery with rigid internal fixation. Lateral cephalograms from each patient, obtained in the natural head position before surgery, immediately after surgery, and at 6-month follow-up, were retrieved from the files of the Pontifical Catholic University of Rio Grande do Sul outpatient Oral and Maxillofacial Surgery clinic and compared. Comparison of craniometric landmark measurements showed that the precision of mandibular setback was compromised in the horizontal plane, with a mean mandibular relapse of 37.75% at point B and 45.85% at point Pg. Improved intercuspation and adaptation of the musculature to the new position of the jaws after orthognathic surgery lead to counterclockwise rotation of the mandible, ultimately displacing the mandible more anteriorly than desired.