WHAT IS ORTHOGNATHIC SURGERY?
The orthognathic surgery It is the surgical manipulation of the different elements of the skeleton of the face to, in this way, restore the anatomical and functional relationship in patients with dentofacial alterations allowing facial harmony.
It is a multidisciplinary treatment, since an orthodontist and maxillofacial surgeon intervene to perform this treatment, obtaining a functional balance.
Thus, the main objectives that orthognathic surgery seeks is to obtain a harmony of the face and teeth, a functional occlusion, thus achieve a health of the orofacial structures and that the procedure to be performed has long-term stability.
WHEN IS IT NECESSARY TO PERFORM AN ORTHOGNATHIC SURGERY?
Orthognathic surgery is indicated in the following aspects:
- There is a severe compromise of facial harmony.
- Surgery is not a substitute for orthodontics, but must be coordinated with it and with other general dentistry procedures.
- Serious orthodontic problems that neither growth modification nor camouflage without surgery are a good solution
Before performing this type of treatment that combines orthodontics with surgery, it is important to be able to analyze the mental and social well-being of certain patients altered by deformities, as well as a psychological evaluation of the patient before operating and have real expectations of the changes afterwards. of surgery.
WHAT IS THE SEQUENCE OF ORTHOGNATIC SURGERY?
Orthognathic surgery not only consists of the procedure on the day of surgery, but a series of sequential analyzes must be performed in order to carry it out successfully.
The sequence of orthognathic surgery is as follows:
- Anamnesis, record taking and clinical analysis
- Diagnosis and planning
- Presurgical orthodontics
- Model surgery and / or 3D planning
- Jaw Surgery
- Post-surgical orthodontics
1. ANAMNESIS, RECORD TAKING AND CLINICAL ANALYSIS
The first step is to take a complete medical history, also analyzing the oral health status as well as a clinical analysis. With this, a photographic study is carried out with intraoral photographs, from inside the mouth, and extraoral, from outside the mouth, to be able to adequately examine the case of each patient.
Next, radiographic records are made: orthopantomography (or panoramic radiography), frontal radiography and lateral skull radiography (or teleradiography). The study is also completed with a three-dimensional radiograph (CBCT) to be able to analyze the case in all dimensions.
Finally, the upper and lower models are taken in order to examine the case out of mouth.
2. DIAGNOSIS AND ORTHODONTIC PLANNING-MAXILLOFACIAL SURGEON
Once the case has been analyzed in detail, a clear diagnosis is obtained from which a planning is established of how orthodontics will be before surgery, what the surgery will be like, what structures will have to be modified to obtain the objectives previously studied in order to achieve precise and exact results.
3. PRE-SURGICAL ORTHODONTICS
Presurgical orthodontics aims to eliminate dental compensations, align and level the arches, correct dental rotations and inclinations, as well as the coordination of the arches (upper and lower) independently.
4. MODEL SURGERY AND / OR 3D PLANNING
Before surgery, a simulation of the surgery is carried out in the models or in a three-dimensional way to be able to visualize all the movements to be performed on the day of surgery.
5. SURGERY OF THE JAWS
The surgery is performed by the maxillofacial surgeon, based on prior planning. During this visit, the skeletal structures are modified to obtain the expected results and a functional improvement and achieve facial harmony.
6. POST SURGICAL ORTHODONTICS
After surgery, compensatory orthodontics are performed to align different positions of the teeth and thus achieve a perfect dental occlusion and relationship between the upper and lower teeth.
This can be immediate or late. In the immediate postsurgical orthodontics, some elastics are placed which will move the bone, and not the teeth. It is usually performed in class II malocclusions when the mandible has been advanced or in classes III when the maxilla has been advanced. Immediate postsurgical orthodontic appointments are very frequent. The late postsurgical orthodontics It is performed when the callus of the fracture performed by orthognathic surgery is already fully formed. It is a mechanics just like conventional orthodontics.
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