Moving the mandible in orthognathic surgery - A multicenter analysis.

Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlössmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.

Dental and skeletal effects of two-piece and three-piece surgically assisted rapid maxillary expansion with complete mobilization: a retrospective cohort study.

PURPOSE: The aim of this study was to examine the dental and skeletal widening effects of 2 surgically assisted rapid maxillary expansion (SARME) techniques after complete mobilization of the maxilla in patients with transverse maxillary hypoplasia and bilateral crossbite. MATERIALS AND METHODS: A retrospective cohort study design was implemented evaluating 2 treatment groups with complete Le Fort I osteotomy and segmentation of the maxilla followed by distraction using a tooth-borne expansion device: patients without crowding of the incisor roots underwent 2-piece SARME and patients with crowding underwent 3-piece SARME. Linear transverse measurements were performed on dental casts (intercanine and inter-second molar distance) and posteroanterior cephalograms (skeletal jugulum distance) before surgery (T1) and at 6 weeks (T2), 6 months (T3), and 12 months (T4) postoperatively. RESULTS: The study included 24 patients (13 women and 11 men; mean age, 27 yr; standard deviation, 18.5 yr). Significant maxillary expansion was achieved by the 2 surgical techniques (P < .05), especially in the posterior portion. From T1 to T2, widening values (+3.8 mm) at the intercanine level in the 2-piece SARME group were significantly higher (P = .004) than those in the 3-piece SARME group. Distraction effects were mainly skeletal, whereas dental relapse tendencies predominated at T3 and T4. CONCLUSION: The 2 SARME methods ensured sufficient widening with satisfactory results after a 12-month period. To decrease surgical risks to the incisor roots and esthetic impairments, 3-piece SARME with complete mobilization is recommended in cases of transverse posterior maxillary hypoplasia and crowding of the incisor roots.

Orthodontic orthognathic surgical treatment of a subject with Williams Beuren syndrome a follow-up from 8 to 25 years of age.

This article presents a survey of characteristic features of Williams-Beuren syndrome (WBS) as reported in the literature and the interdisciplinary treatment of a subject with WBS with special regard to morphological and functional disorders. Typical features of a patient with WBS and his dental development in a follow-up from 8 to 25 years of age are shown. Early orthodontic treatment approaches, later combined orthodontic-orthognathic surgical procedures, and the status 5 years after surgery are presented.