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29Dental Tribune Middle East & Africa Edition | May - June 2014 ortho tribune < Page 28 Fig. 8a, 8b: Intraoperative view of osteosynthesis screws inserted during surgery of the 20-year-old patient. Fig. 10a: Pre-op view. Fig. 9a: Post-op X-ray diag- nostics (orthopantomograph, cephalometric radiograph). Fig. 7a, 7b: Illustration of Obwegeser? Dal Pont osteotomy of the 20-year-old patient: split osteotomy of the intra-oral ramus is clearly visible. Fig. 6b, 6c: Intra-op fixation of the splint for correction of latero-gnathia after osteotomy. Post-op view. Significant im- provement in lateral occlusion and the elimination of latero- gnathia is clearly visible. nation of Obwegeser–Dal Pont and Le Fort I osteotomy. The bimaxillary approach seems reasonable, since the maxilla and mandible influence each other during growth. However, it is frequently only possible to obtain a very good and risk-free result by using Obwegeser–Dal Pont surgery. Fixation in split osteotomy of the mandible is usually realised by using mini- mally invasive plate osteosyn- thesis. In modified techniques of Obwegeser–Dal Pont surgery, a displaced ramus is fixed using osteosynthesis screws only (Ho- chban 1997; Figs. 8a & b). This modification avoids the compli- cated surgical removal of osteo- synthesis plates. Operation risk Anysurgicalprocedurecanlead to unexpected complications, which must always be consid- ered according to the risk–ben- efit principle. Today, the need for osteotomy remains contro- versial because a jaw deformity is not a serious illness like a tu- mour, abscess or bone fracture, which is necessarily treated by surgery. Since deformities are often aesthetic corrections and can be classified as elective procedures, operation safety is a chief concern. Isolated oste- otomies of the mandible, which present a significantly lower surgery risk, should be the first choice for orthodontic–surgical interventions. The most significant risk of os- teotomy of the mandible is a probability of about 5% of dam- aging the sensory nerve, called the inferior alveolar nerve. This can cause sensibility problems of the lower lip and chin area Dr Martin Jaroch Dr Friedrich Bunz Aesthetic and Function Dr Bunz—Dr Jaroch & Partner Pro- fessional Practice of Orthodontics Teggingerstr. 5 78315 Radolfzell, Germany About the Author Science in Every Smile • Applythemosthealthyorthodontictreatment • Expand your adult patient practice • Enhance your competitive edge • Elevate the patient experience • Your patients will love it INVISALIGN® CERTIFICATION RIYADH MAY 17, 2014 Dubai Office: +971 4 385 1663 Riyadh Office: +966 56 114 2557 info@invisaligngcc.com TO REGISTER: PLEASE VISIT register.invisaligngcc.com IT IS TIME TO SEE THE FUTURE NOW! Invisalign uses 3D CAD/CAM technology to visualize the treatment and a step-by-step simulated results. (Figs. 9a–c). Additional serious risks are not expected using Ob- wegeser–Dal Pont surgery and post-operative bleeding can be controlled very safely. Interdisciplinary collaboration The literature review of work done in the 1970s makes clear that today’s conscientious col- laboration between surgeons and orthodontists is not a mat- ter of course. Over the years, orthognathic surgery was con- sidered to be the last option for treating orthodontic cases that could not be resolved using standard treatment techniques. Therefore, operations were car- ried out based on tolerance of dentoalveolar compensation and likely made further correc- tive surgery more probable. Today, in almost all cases of malocclusion, orthodontic treatment is preceded by sur- gical treatment. Nowadays, the planning of the operation 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 dentoalveolar discrepancies in occlusion can be corrected preoperatively or post-operatively by orthodontic treatment. Therefore, inter- disciplinary collaboration is always a benefit for the patient and treatment team.