dental-maxillofacial deformities dept. of oral & maxillofacial surgery school of stomatology li...

Dental-maxillofacial DeformitiesDental-maxillofacial Deformities

Dept. of Oral & Maxillofacial SurgeryDept. of Oral & Maxillofacial Surgery

School of StomatologySchool of Stomatology

LI Qing-yunLI Qing-yun

Phase IPhase I Presurgical treatment

• Orthodontics• Surgical plan

Phase IIPhase II Surgical treatment

• Mandible• Maxilla

Phase IIIPhase III Postsurgical treatment

• Orthodontics• restorative/prosthetic treatment• follow-up

Presurgical Treatment PhasePresurgical Treatment Phase

Presurgical orthodontics

Final surgical planning

Objectives —— Presurgical orthodontics

Decompensation

dental compensation for skeletal deformity

angulation of teeth

accentuate the deformity

Objectives —— Presurgical orthodontics Alignment of the arches Compatibility of the arches

Final Surgical Planning Visual Treatment Objective, VTO

Final Surgical Planning

Computerized imaging CASSOS

Final Surgical Planning

Model Surgery

Exact surgical movements

(distance, direction)

Postoperative occlusion

Face-bowFace-bow

articulator

Surgical Treatment Phase

Surgeries for maxillary deformity

Surgeries for mandibular deformity

Surgeries for maxillary deformity

Segmental osteotomy (Anterior / Posterior)

Indications:

- maxillary protrusion

- marked protrusion of

maxillary teeth

- open bite

Surgeries for maxillary deformity

Le Fort I osteotomy

(total or segmental)

Indications:

- maxillary deformities

- mandibular deformities

Surgeries for maxillary deformity

Le Fort I osteotomy

Le Fort II or III osteotomy

Indications:

- midface deficiency

Surgeries for mandibular deformity

Sagittal split ramus osteotomy,

SSRO

Indications:

- mandibular excess

- mandibular deficiency

- mandibular asymmetry

Adback

rotate

Surgeries for mandibular deformity

Vertical ramus osteotomy

Indications:

- mandibular excess

- mandibular asymmetry

(combined with SSRO)

back

Surgeries for mandibular deformity

Subapical osteotomy

Indications:

- bimaxillary protrusion / open bite

- leveling the plane of occlusion

- uprighting anterior teeth

Surgeries for mandibular deformity

Body osteotomy

Indications:

- mandibular excess (body)

combined with ramus procedure or not

- open bite / spee’s curve reduction

Surgeries for mandibular deformity

genioplasty

Indications:

- chin deformities

Perioperative complications

Airway obstructionedema / blee

ding / displacement… …

Bleeding

Infection

Necrosis of teeth / bone

Healing

Injury of nerve

Postsurgical Treatment Phase Completion of orthodontics

Postsurgical restorative/prosthetic treatment

Follow-up

Pretreatment

SNA 88°

SNB 81°

ANB 7°

PostLe Fort I &genioplasty

SNA 84°

SNB 81°

ANB 3°

Pretreatment

SNA 88°

SNB 92°

ANB 4°

Pre operation& after presurgical

orthodontic treatment

SNA 88°

SNB 92°

ANB -4°

Post Sagittal Split Ramus Osteotomy

SNA 88°

SNB 86°

ANB 2°

Posttreatment

SNA 88°

SNB 86°

ANB 2°