ortho - the international C.E. magazine of orthodontics

ortho1_2013 I C.E. article_ orthognathic surgery 06 I This article qualifies for C.E. credit. To take the C.E. quiz, log on to www.dtstudyclub. com.Subscriberstothemaga- zine may take this quiz for free and will be emailed an access code after the maga- zine’s release. If you do not receive the code, please write to support@dtstudyclub.com. Non-subscribers may take the quiz for $20. You can access the quiz by using the QR code below. _c.e. credit Author_Theodore D. Freeland, DDS, MS Concepts, goals and techniques for successful orthognathic surgery cases _In this article, you will be introduced to the concepts, goals and techniques needed to diagnosis surgicalcases,whensurgicalcasesshouldbestarted and how to gain the knowledge needed to create successful results. We’ll delve into joint status, soft-tissue analysis, surgical treatment objectives, pre-treatment surgi- cal setups and surgical setups. We’ll then follow-up by looking at the concepts of natural head position, the axis-horizontal plane and the true vertical line will be introduced. By the end of this article, you should have: • An overview of the knowledge needed for successful treatment. • An introduction into what, when and how to perform successful cases. • An overview of joint health. • A summary of the soft-tissue analysis. • An outline of the surgical treatment objective. • An overview of diagnostic and surgical setups. Remember that this article is an introduction only; it’s not intended to teach you how to do surgi- calcases.Advancedtrainingwillbeneededtomaster successful orthognathic surgical cases. So with no further ado, let’s get started. _Functional occlusion The goal is to obtain functional occlusion. Before treatment, you have to determine if you have an orthognathic surgery case. You don’t want to begin orthodontic treatment with the idea that if ortho- dontics fails, we will do surgery. You’ll see in Figures 1–3 that this case involves every facet of dentistry. Changes occurred not only inthefacialfeatures,butalsointheteeththemselves. It involved orthodontic and orthognathic surgery, but also lengthening the front teeth by the restora- tive dentist to achieve the natural smile in balance (Figs. 1–3). To this end, we need to look at five areas: • joint status, • soft-tissue analysis, • surgical treatment objective, • pre-surgical setup/surgical setup technique, • surgery. We’ll give you a brief overview of the goals for eachoftheareas,thendoanin-depthlookintoeach of them individually. _Joint status Starting with the first area, you need to know the joint status. Is the joint healthy, is it degenerating, is thereadiscproblem?Thismeansyou’llneedtoapply not only a good clinical exam, but also articulated models that can measure the difference between centric occlusion and centric relation. _Soft-tissue analysis You’llneedtoknowhowtoanalyzethesofttissue. You’llneedthisbecauseyouarelookingateverything from a soft-tissue standpoint, or put another way, you’re recording the basic measurements that come fromsofttissue,nothardtissue.Ifyoudealwithhard tissueonly,thenyouwillcomeupshortinthesofttis- sue.Ignoringthesofttissuewillresultinafacethat’s not improved, just different. _Surgical treatment objective You need to know how to do a surgical treatment objective. You’ll need to know the technique, and you’llneedtoknowhowtoapplyitbecausethesurgi- cal treatment objective allows you to treat the face, the occlusion, in a two-dimensional medium.