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CE article _ orthognatic surgery I the upper anterior teeth, the surgeon will have a difficult time fitting the mandible to this. If you have tipped the lower anterior teeth back too far—such as in a Class III—then you cannot obtain a good maximum intercuspation because of the incorrect torque of the anteriors. The setup part of the procedure will give you this information. _Age If it’s an adolescent patient, you can do the presurgical orthodontic and establish the correct axial position of the teeth in each jaw. However, do not try to fix the occlusion. That means the teeth will be in the proper positions when you approach the surgery. As a rule, I won’t get into a surgical case before a female is in her early 20s, and with males in their mid 20s. I’ve seen cases where they were done earlier and actually grew out of the correction. _Learning these techniques We all need to be taught to do these things, and itneedstobefromsomeonewhohasdonethemfor a number of years so you can be certain that the methodsyouarelearningwillwork.Theyaretaught in the Advanced Education in Orthodontics (AEO) course, and we do practice them. That includes surgical setup, orthodontic setup, soft-tissue cephalometric analysis and surgical treatment objective. They need to be practiced a number of times. It’s not something you can learn onyourown.Youneedamentorwhowillteachyou all the characteristics you’ll need. In the lab phase of the AEO class, we do get into mounting cases on the true hinge axis. You will learn how to establish these on patients. They are not time consuming. Normally, establishing a hinge axis in the axio-path tracing and transfer takes no morethansixorsevenminutes,sotheclinicianisnot using a lot of his or her time to establish a correct hinge-axis mounting. The instructors will demonstrate how it’s done, and then have you perform the procedures. Under theproperguidance,youcanlearnthesetechniques and apply them in an office setting in an economi- cal manner. Without the coaching, these procedures can feel like too much of a chore. Moreover, without coaching, there’s no way to do a surgical workup for the benefit of the patient, which of course, is the main reason you need to know these procedures. It also helps if you work with the surgeon and the restorative dentist because it’s the restorativedentistwho obtains the final out- come, and he or she needstofinishthecase from where you left it. It takes some time andittakessomeeffort to learn these proto- cols. But once you do learn them, and you have the technique, your sur- gical cases will be more stable, and you’ll cut down the instances of surgical relapse that you see. Above all, remember this is all for the benefit of the patient. You need to spend time learning and you need to spend time in the operating room to know the problems the surgeon encounters. Then you need to spend time in the diagnoses and workup. However,thebenefitisforthepatient,whowinds up with a functioning occlusion and improved face, and the gingival tissues are healthy and the jaw functions correctly._ Fig. 19_Cone-beam data, both pre- and post treatment. I 15cone beam3_2014 Dr Theodore D.Freeland, DDS,MS,is a board-certified orthodontist in Gaylord,Mich. After graduating fromAlbion College in 1967,he attended the University of Detroit Mercy, earning a dental degree in 1971 and his master’s of science in orthodontics in 1978.Freeland has completed Dr.GeneWilliamson’s course in occlusion andTMJ and the Roth/Williams course in advanced orthodontics.In addition,Freeland has served as an adjunct professor in orthodontics at the University of Detroit Mercy,and held appointments at the University of Detroit in fixed prosthetics and orthodontics; the Roth/Williams Center as a clinical instructor; and theAdvanced Education in Orthodontics Group as director and instructor.Freeland is an accomplished author who lectures nationally and internationally. cone beam_about the author Fig. 19 CBE0314_06-15_Freeland 30.09.14 14:13 Seite 10