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ePaper created 2014-10-07, 09:31:41 | version 1.30.01
CE article _ orthognatic surgery I _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 Startingwiththefirstarea,youneedtoknowthe joint status. Is the joint healthy, is it degenerating, is there a disc problem? This means you’ll need to apply not only a good clinical exam, but also ar- ticulated models that can measure the difference between centric occlusion and centric relation. _Soft-tissue analysis You’ll need to know how to analyze the soft tis- sue. You’ll need this because you are looking at everything from a soft-tissue standpoint, or put another way, you’re recording the basic measure- ments that come from soft tissue, not hard tissue. Ifyoudealwithhardtissueonly,thenyouwillcome up short in the soft tissue. Ignoring the soft tissue will result in a face that’s not improved, just dif- ferent. _Surgical treatment objective You need to know how to do a surgical treat- ment objective. You’ll need to know the technique, and you’ll need to know how to apply it because the surgical treatment objective allows you to treat the face, the occlusion, in a two-dimensional medium. _Pre-surgical setup/surgical setup technique Once you have established what you’ll need to do from the surgical treatment objective, you will needtodowhatwecallapre-surgicalsetup.Other- wise you’ll need to apply the knowledge you’ve gained from the patient, soft-tissue analysis and the surgical treatment objective, and perform a three-dimensional workup to make sure what you have planned will work with the joints, muscles and nervous system. _Surgery Finally, you need to know surgery. I recommend that the orthodontist be in the operating room so you know what the surgeon is doing, and how the surgery goes. It’s very important to know that the surgeon gets the joints seated in a passive manner. If the joint is stressed, then there’s a good chance that we’ll have some surgical relapse. _Joint status Jointanalysiswillincludethreeportions:history, a clinical examination and imaging. Building a history will be similar to traditional patient assessment. We need to know if there are any family members who exhibit TMJ problems. If yes, then there’s a good chance the patient will develop significant joint issues that will affect the outcome of treatment. After an oral investigation, a thorough clinical examination of the joints will need to occur. We’ll be on the lookout for any type of injuries to the mandible. If the patient has had any injury that in- volves the chin, there’s a good chance that the joint may have been damaged. Finally, we need to look into any past treatment. Has the patient had orthodontics before? Has the patient had a lot of restorative dentistry? This is important because all of the above have a tendency to affect joint status. Fig. 1c_Patient oral casting. Fig. 2_Joint degeneration. I 07cone beam3_2014 Fig. 2Fig. 1c CBE0314_06-15_Freeland 01.10.14 11:31 Seite 2