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cosmetic dentistry - beauty & science

30 I I case report _ orthodontic _Operation risk Any surgical procedure can lead to unex- pected complications, which must always be considered according to the risk–benefit prin- ciple. Today, the need for osteotomy remains controversial because a jaw deformity is not a serious illness like a tumour, abscess or bone fracture, which is necessarily treated by surgery. Since deformities are often aesthetic correc- tions and can be classified as elective procedures, operation safety is a chief concern. Isolated osteotomies of the mandible, which present a significantlylowersurgeryrisk,shouldbethefirst choice for orthodontic–surgical interventions. The most significant risk of osteotomy of the mandible is a probability of about 5 % of damag- ing the sensory nerve, called the inferior alveo- lar nerve. This can cause sensibility problems of the lower lip and chin area (Figs. 9a–c). Additional serious risks are not expected using Obwegeser–Dal Pont surgery and post-opera- tive bleeding can be controlled very safely. _Interdisciplinary collaboration The literature review of work done in the 1970s makes clear that today’s conscientious collaboration between surgeons and orthodon- tists is not a matter of course. Over the years, orthognathic surgery was considered to be the last option for treating orthodontic cases that could not be resolved using standard treatment techniques. Therefore, operations were carried out based on tolerance of dentoalveolar com- pensation and likely made further corrective surgery more probable. Today, in almost all cases of malocclusion, orthodontic treatment is preceded by surgical treatment. Nowadays, the planning of the oper- ation based on simulated cast surgery and the creation of a splint is a very safe method by which to achieve predictable and stable long- term results (Figs. 10a & b). Individual den- toalveolar discrepancies in occlusion can be corrected preoperatively or post-operatively by orthodontic treatment. Therefore, interdiscipli- nary collaboration is always a benefit for the patient and treatment team._ Figs. 9a & b_Post-op X-ray diagnostics (orthopantomograph, cephalometric radiograph). Intensive shift of the mandible can cause temporary sensitivity disturbances in the area of the lower lip and chin, which improves rapidly in most cases. Figs. 10a & b_Pre-op view (a) and post-op view (b). Significant improvement in lateral occlusion and the elimination of latero-gnathia is clearly visible. cosmeticdentistry 2_2012 Dr Martin Jaroch Aesthetic and Function Dr Bunz—Dr Jaroch & Partner Professional Practice of Orthodontics Teggingerstr.5 78315 Radolfzell,Germany Dr Friedrich Bunz Aesthetic and Function Dr Bunz—Dr Jaroch & Partner Professional Practice of Orthodontics Teggingerstr.5 78315 Radolfzell,Germany _contact cosmeticdentistry Fig. 10a Fig. 10b Fig. 9a Fig. 9b