J Dent Rehabil Appl Sci.  2016 Mar;32(1):70-79. 10.14368/jdras.2016.32.1.70.

Orthognathic surgery on Skeletal Class III patiens with collapsed vertical dimension: case report

• Choi YK
• Kim YD
• Park SB
• Kim YI
• Kim SS
• Son WS

• KMID: 2162381
• DOI: http://doi.org/10.14368/jdras.2016.32.1.70

Abstract

Patients who lost posterior teeth due to periodontitis or dental caries have collapsed vertical dimension, unstable occlusion and change of the mandibular position. In particular, patients in orthognathic surgery, clinician should re-establish the pre-operative stable position of mandibular condyle in articular fossa and favorable vertical dimension for high post-operative stability of mandible. Therefore, interdisciplinary approach and co-operation, including prosthetics, orthodontics, oral and maxillofacial surgeon, from diagnosis and treatment plan is important to get a good outcome. This case report was patients who had collapsed occlusal plane due to severe dental caries on maxillary molars with skeletal Class III malocclusion. Before orthognathic surgery, resetting of maxillary occlusal plane with temporary removable denture was performed. Then successful multidisciplinary approach was done and lead to acceptable clinical outcome.

Keyword

posterior teeth missing; bite collapse; vertical dimension; condyle position; orthognathic surgery; interdisciplinary approach

MeSH Terms

Dental Caries
Dental Occlusion
Dentures
Diagnosis
Humans
Malocclusion
Mandible
Mandibular Condyle
Molar
Orthodontics
Orthognathic Surgery*
Periodontitis
Tooth
Vertical Dimension*

Figure

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  Fig. 1 (A) Pre-treatment panoramic radiograph, (B) Postendodontic treatment(before orthognathic surgery) panoramic radiograph. #14, 25, 26, 36, 37, 46 were extracted.

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  Fig. 2 Pretreatment (before orthognathic surgery) extra (A) and intra (B) oral photos.

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  Fig. 3 Pretreatment (before orthognathic surgery) lateral cephalometric radiograph and analysis. *, **, *** Indicates that the value is beyond one, two or three times of the standard deviation. SNA, the angle of sella-nasion-A point; SNB, the angle of sella-nasion-B point; ANB, the angle of A point-nasion-B point; 1-SN, the angle of the long axis of maxillary central incisors between sella-nasion plane; 1-Mx.OP., the angle of the long axis of maxillary central incisors between maxillary occlusal plane; IMPA, the angle of the lowermost tangent to the mandible and the long axis of mandibular incisors; FMA, Frankfort mandibular plane angle; FH-Occ., the angle of Frankfort Horizontal plane and bisecting occlusal plane; Wits, Wits appraisal.

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  Fig. 4 A diagram for multidisciplinary treatment plan.

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  Fig. 5 Comparison of lateral cephalometric radiograph between pretreatment (A) and after maxillary temporary denture delivery (B).

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  Fig. 6 Comparison cast model between pretreatment (A, B) and after maxillary temporary denture delivery (C, D).

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  Fig. 7 Post-Orthognathic surgery (1 month) extra (A) & intra (B) oral photos. Mini-screws were inserted on both maxillary and mandibular dentoalveolar area.

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  Fig. 8 Post-Orthognathic surgery (1 month) Panoramic, lateral, postero-anterior cephalometric radiograph (A) and lateral cephalometric analysis (B). SNA, the angle of sella-nasion-A point; SNB, the angle of sella-nasion-B point; ANB, the angle of A point-nasion-B point; 1-SN, the angle of the long axis of maxillary central incisors between sella-nasion plane; 1-Mx.OP., the angle of the long axis of maxillary central incisors between maxillary occlusal plane; IMPA, the angle of the lowermost tangent to the mandible and the long axis of mandibular incisors; FMA, Frankfort mandibular plane angle; FH-Occ., the angle of Frankfort Horizontal plane and bisecting occlusal plane; Wits, Wits appraisal.

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  Fig. 9 Set-up model for final prosthetics.

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  Fig. 10 Post-orthodontic treatment. Maintain vertical position on mandibular teeth. #46 was protracted.

Reference

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