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ePaper created 2014-10-07, 09:31:41 | version 1.30.01
I CE article _ orthognatic surgery You don’t want the patient to come out of burger andfindthatthepatienthastroublefindingastable maximal intercuspation with the joint seated. In order to gain even stops, we had to remove some tooth enamel around the upper and lower arches.That’swhatwedointheoperatingroombe- forewebegintheoperation.Wedotheequilibration 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. 18), the facial changes includeashorteningofthelowerfacialthird.Anad- equate overbite has been established so a mutually protectedocclusioncanseen.Theproperdisclusion, wherethebackteethseparatebyatleast2to3mm, has been established. Ifweapplythesecondconcept(“youcan’tbelieve what you see in the mouth”), we need to go to post treatment hinge-axis mounted models. Figure 19 shows the cone-beam data, both pre- and post treatment. Note the double plates on the mandible toestablishastableplatformtopositionthemaxilla. _Surgery One of the most important take-away lessons from this article is that you need to know your surgeon. Establishing a one-on-one relationship with your surgeon can be challenging. If the ortho- dontist 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 knowl- edge of the surgeon, then youneedtoknowwhathap- pens at the hospital because this becomes an important part, especially during re- covery. The people who are handling recovery need an exceptional level of com- passion, 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 ten 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 segments have stabilized _Additional considerations We know that you need to know the joint status. You’llneedtoknowhowtodoasoft-tissueanalysis andhowtoestablishasurgicaltreatmentobjective. You’llneedtoknowhowtodopre-treatmentsetups and surgical setups. You need to apply all of these techniques on all patients (mixed dentition, ado- lescent or adult). If the teeth aren’t in the correct position in the jaw, then there’s no way the surgeon can place the parts correctly, resulting in surgical failure. Most surgical failures happen because of ortho- dontics. One of the things you need to keep in mind in your pre-treatment surgical orthodontics is that you established the correct arch form. Without the correct arch form, it’s difficult to put the parts together. The other thing to keep in mind is the actual 3-D position of the teeth. If you have up-righted Fig. 18_Post-treatment intra-oral and extra-oral photos. 14 I cone beam3_2014 Fig. 18 CBE0314_06-15_Freeland 30.09.14 14:13 Seite 9