Leward C. Fish

Surgical-orthodontic correction of open-bite deformity

The combined simultaneous anterior and posterior maxillary ostectomy has proved to be a useful method of treating skeletal open-bite. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower-face height, contour-deficient chin, and Class II malocclusion. Primary contraindications are the Class III skeletal open-bite and lip competence. We have used the procedure as routine treatment for many open-bites over the past 5 years since we first described it. Clinically, the results have been most gratifying, with marked improvement in facial appearance and stability of the open-bite correction. A preliminary study of stability following this procedure indicated good stability with regard to the vertical repositioning of the maxillary segments. A recently completed study by us on thirty-two patients treated with this procedure and followed for an average of 1.5 years showed excellent stability. This is by no means the only method by which open-bite may be successfully treated, but it is one more method to add to our armamentarium. The surgical procedure must be carefully planned and executed to attain the best possible results. Furthermore, the orthodontic procedures, particularly those involving vertical forces, must be provided at the proper time so that the surgical results are not compromised. Nevertheless, with proper planning, attention to detail, and meticulous execution, the results are rewarding.

Mandibular deficiency syndrome

Abstract Persons with Class II malocclusion have extremely variable esthetic, skeletal, neuromuscular, occlusal, and growth characteristics. In order to achieve optimum esthetic and functional treatment results, with good stability, this variability must be appreciated. In this article the variability of these traits is outlined and discussed with regard to their clinical significance.

Mandibular deficiency syndrome: II. Surgical considerations for mandibular advancement

Eight factors which contribute to the successful surgical correction of the deficient mandible have been briefly discussed. Consideration of the recommendations made will permit surgeons to avoid pitfalls, regardless of the specific surgical technique used to advance the mandible, and will result in improved treatment results. The type of mandibular deficiency syndrome and its severity will dictate which factors need to be considered in a given case. A modified sagittal osteotomy is described as our preferred surgical technique to achieve these objectives and minimize untoward sequelae.

Surgical-orthodontic correction of vertical maxillary excess

Superior repositioning of the maxilla via maxillary ostectomy has proved to be useful method of treating patients with vertical maxillary excess. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower facial height, contour-deficient chin, and either Class I or Class II malocclusion. We have used this procedure as routine treatment for vertical maxillary excess over the past 5 years. Timing of the surgery is not so important in non-open-bite patients, and the procedure can be done with equal success before any orthodontic intervention, during orthodontic treatment, and following all orthodontic procedures. Timing is primarily dependent upon the orthodontists desires. Since the surgery can produce a much simpler orthodontic problem, thus reducing treatment time and allowing a better over-all result, we recommend that it be done as early in treatment as possible. Clinically, the over-all improvement in facial appearance and the predictability and stability of the results have made this a most versatile and effective procedure when carried out with good planning, proper execution and attention to detail.

The surgical-orthodontic correction of maxillary deficiency

Abstract To date surgeons have primarily emphasized surgical advancement of the retrusive or retodisplaced maxilla. There has been no emphasis on combined surgical-orthodontic treatment sequencing in this deformity. Moreover, the maxilla may be deficient not only anteroposteriorly but also vertically and/or transversely. Frequently, when the maxilla is deficient, two or three of these spatial components of the deformities coexist to various degrees. Thus, the term maxillary deficiency is used here to describe the general nature of the skeletal deformity.

Indications for simultaneous mobilization of the maxilla and mandible for the correction of dentofacial deformities

As improvements in diagnosis, treatment planning, and surgical techniques have evolved it has become increasingly more common to consider simultaneous mobilization of the maxilla and mandible in order to achieve optimal correction of selected dentofacial deformities. In the experiences of the authors, there are patients with specific deformities of the Class III, Class II, Class I, and asymmetry types who can benefit from simultaneous mobilization of both jaws. It is the purpose of this article, the first in a series of three, to detail those specific conditions which warrant consideration for simultaneous mobilization of the maxilla and mandible. In the second article the details of treatment planning for simultaneous mobilization of the maxilla and the mandible will be presented, and in the third article the results of treatment in 100 consecutive cases will be evaluated.

Surgical-orthodontic treatment planning for simultaneous mobilization of the maxilla and mandible in the correction of dentofacial deformities

Simultaneous mobilization of the maxilla and mandible is indicated for the optimal correction of specific dentofacial deformities, as discussed in the preceding publication. Because of the added complexity of this type of surgical-orthodontic treatment, it is important to determine the absolute need for surgery and to construct a detailed blueprint of the specific changes to take place at the time of surgical intervention as well as those to be made by the orthodontist prior to initiation of any treatment. The intent of this article is to describe a technique of treatment planning which includes cephalometric prediction tracings, model surgery, determination of orthodontic-surgical sequencing, splint construction, and specific sequencing of surgery. When followed, these guidelines will enable the surgeon and the orthodontist to accurately determine the need for simultaneous mobilization of both the maxilla and the mandible and provide more predictable and stable results when it is performed.

Surgical superior repositioning of the maxilla: What to do with the mandible?

During superior repositioning of the maxilla (SRM), the mandible autorotates forward and upward at pogonion, with the condyle as the center of rotation. Thus, in each instance when planning surgical superior repositioning of the maxilla one must decide, on the basis of esthetics and cephalometric prediction criteria, the magnitude of autorotation and the contribution of this rotation toward the desired occlusal and esthetic result. In many instances the maxilla can be moved somewhat posteriorly or anteriorly, and thus simultaneous mandibular surgery is not required to achieve the desired result. In some cases, however, simultaneous mandibular advancement or set-back is required to achieve the desired occlusal and esthetic result. This article discusses the specifics of making the decision regarding what to do with the mandible when superiorly repositioning the maxilla.

Orthognathic surgery: The correction of dentofacial deformities

The field of orthognathic surgery offers ever-improving technology to better rehabilitate patients with dentofacial deformities. Hospital stays have been reduced due to improved surgery and anesthesia. Rigid internal fixation has increased comfort for many patients by eliminating the inconvenience of having the jaws wired together. Most important has been the realization that teamwork between the general dentist and the various specialty disciplines is indispensable for good patient care and the attainment of the very best results.

The surgical-orthodontic correction of mandibular deficiency. Part II

As discussed in Part I of this study, persons with mandibular deficiency and Class II malocclusions exhibit a wide spectrum of esthetic, cephalometric, and occlusal characteristics. In many such patients optimal overall results are best obtained via a combined orthodontic-surgical approach. In such patients a critical evaluation is essential to decide (1) the optimal operation and (2) the appropriate orthodontic-surgical sequencing. Our method of making these two basic decisions was presented in Part I. In this article the indications for mandibular advancement with or without genioplasty, total subapical mandibular advancement, superior repositioning of the maxilla, and inferior repositioning of the maxilla are discussed in detail. These alternatives are illustrated with representative cases, and the results are discussed. The intention of these two presentations is to illustrate an orthodontic-surgical approach to the correction of mandibular deficiency and Class II malocclusion that is predicated on a systematic evaluation of the individual patient rather than a standard approach.