The most frequent dentofacial disharmonies are the large jaw, the small jaw, the long face, the old face, the facial asymmetry and the open bite. The best way to solve these imbalances is by combining orthognathic surgery with orthodontics. This treatment will be based on different phases, which I explain below.
Initial evaluation of Orthognathic Surgery
The initial evaluation should be done jointly by the orthodontist and the surgeon .
The first visit should discuss what are the main concerns of the patient, the reason for consultation or main complaint, and what are their expectations, both orthodontic treatment and surgery.
There will also be a dental medical history specifically designed for this treatment. It will be necessary, therefore, to order a series of complementary examinations in order to make a good diagnosis. The complementary examinations consist of:
- Face and Bite Photographs
- Special radiographs of the face with soft tissue contrast and at rest
- Models or impressions of your teeth and their occlusion
The second visit establishes the so-called treatment plan. Before completing, all supplementary exams must be ready.
The patient is presented with the different treatment options, as well as their benefits and possible disadvantages. Therefore, it is necessary that the surgeon specialist in orthognathic surgery is a doctor and dentist, since only in this way will be able to correctly treat and understand this anomaly, offering you the different treatment options from the aesthetic, functional and dental point of view.
Phases of Orthognathic Surgery
The surgical treatment of orthognathic surgery consists of three phases:
1. Preoperative Orthodontics:
The orthodontist will try to straighten teeth, correct inclinations, defeat teeth, coordinate bows separately ... trying to position the teeth in the best possible position. In this period, the occlusion could worsen, but without major concerns since it is a perfectly planned treatment, and once the bones have moved, the teeth will fit well. A week before surgery, the following procedures will be performed:
- A few days after surgery, the orthodontic arch will be replaced by a larger caliber, with metal bands in the last molar, welded hooks or an arch with small loops, in order to help the stability of the operation.
- New dental models, along with x-rays and photos.
- If a bimaxillary surgery is to be performed, a blood donation could be ordered, which would be saved for possible autotransfusion.
- A complete medical history, physical examination, and complete preoperative history will be performed.
2. Orthognathic surgery
This surgery should be performed in a hospital, in the operating room and under general anesthesia. The surgical times will depend on the experience of the surgeon and the complexity of the intervention, varying between two and five hours.
It is the surgeon's job to take the following pre-surgical, as well as intra-surgical and post-surgical measures:
- Controlled and continuous arterial hypotension throughout the intervention
- Dental fixation with wire in oral intubations or the cephalic fixation technique with adhesive, in case of nasal intubation.
- Compressive stockings and adequate angulation of the surgical table
- Anti-edema therapy, 24 hours before the intervention
- Model surgery performed by the surgeon
- Surgical, intermediate and final splints
- Simplified segmental osteotomies
- Latest generation fastening material
- Special tools
- Equipment for facial osteotomies
3. Post-surgery orthodontics
Once the postoperative period has passed and the surgical recovery period is over, the surgeon will send the patient back to the orthodontist to continue and finish the treatment.
Postoperative of Orthognathic Surgery
The recovery time of the surgery depends on different factors, but normally the patients return to their daily activity ten or fifteen days after the operation.
However, before, a number of limitations have had to happen:
- Restrictions on diet
- The first days after the operation, the diet will consist of soups, creams, juices or any food that can be liquefied. Between seven and fifteen days, the diet may be soft.
- Limitation on the opening of the mouth.
- The majority of patients leave the operating room without having limited their oral opening, although once the intervention is performed, it is necessary to use intermaxillary elastics whose purpose is to guide the occlusion. This therapy offers some limitation of movement and will continue for six weeks.
Osteotomies or cuts of bone that are normally used in orthognathic surgery may be used for other techniques:
- Assisted bone expansion: in case the teeth are crowded or mounted one on the other, generally by a bone osseous imbalance of space, it must be done before extractions of teeth, with the consequences that involve extracting a healthy tooth. The orthognathic surgeon can be used to evaluate the possibility of increasing the space to avoid extraction.
- Segmental osteotomies: used to make cuts between the teeth and move them to a better position. Among the most commonly used techniques are the following:
- Restoring the occlusion line
- Change of inclination of anterior or inferior teeth
- Surgical closure of edentulous spaces
- Correction of severe malocclusions