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ortho - the international C.E. magazine of orthodontics

ortho1_201314 I I C.E. article_ orthognathic surgery and find that the patient has trouble finding a stable maximal intercustation with the joint seated. In order to gain even stops, we had to remove some tooth enamel around the upper and lower arches. That’s what we do in the operating room be- fore we begin the operation. We do the equilibration when the patient is asleep and before the operation begins. As you can see in the post treatment intra-oral and extra-oral photos (Fig. 19), the facial changes include a shortening of the lower facial third. An adequateoverbitehasbeenestablishedsoamutually protected occlusion can seen. The proper disclusion, where the back teeth separate by at least 2 to 3 mm, has been established. If we apply the second concept (“you can’t be- lieve what you see in the mouth”), we need to go to post treatment hinge-axis mounted models. Figure 20 shows the cone-beam data, both pre- and post treatment. Note the double plates on the mandible to establish a stable platform to position the maxilla. _Surgery One of the most important take-away lessons from this article is that you need to know your sur- geon. Establishing a one-on-one relationship with your surgeon can be challenging. If the orthodontist does not know what the surgeon goes through, then in the planning stage pre-treatment, the teeth may be placed in a position that the surgeon will have trouble establishing in the correct skeletal position. This is a relationship that simply takes time. Once you have knowledge of the surgeon, then you need to know what happens at the hospital because this becomes an important part, especially during recovery. The people who are handling recovery need an exceptional level of compassion, and they need to be able to handle emergencies. Oftentimes the patient will get sick, and his or her teeth are held together with elastic and wires. The healing period normally lasts 10 weeks. It may be longer depending on how the segments are healing. The point is that we don’t get into post-surgical orthodontics before the seg- ments have stabilized _Additional considerations We know that you need to know the joint status. You’ll need to know how to do a soft-tissue analysis and how to establish a surgical treatment objective. Fig. 20 Fig. 20_ Cone-beam data, both pre- and posttreatment.