• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.97-101
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• 2015

Maxillary transverse deficiency is one of the most common deformities among occlusal discrepancies. Typical surgical methods are segmental Le Fort I osteotomy and surgically-assisted rapid maxillary expansion (SARME). This patient underwent a parasagittal split with a Le Fort I osteotomy to correct transverse maxillary deficiency. During follow-up, early transverse relapse occurred and rapid maxillary expansion (RME) application with removal of the fixative plate on the constricted side was able to regain the dimension again. RME application may be appropriate salvage therapy for such a case.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.28.1-28.6
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• 2016

Backgrounds: Insufficient intermaxillary space is caused by non-restoration following tooth extraction in the past, and this involves eruption of the opposing teeth and changes of the arch structure. Such cases are difficult just by a simple prosthetic approach, and diversified treatment plans should be established. Among these, posterior maxillary segmental osteotomy (PMSO) is an efficient treatment option than extraction of opposing teeth as it surgically repositions multiple erupted teeth and alveolar bone. PMSO can preserve the natural teeth; therefore, it is being regarded as a treatment method which can improve insufficient intermaxillary space significantly. Case presentation: In this case report, the first patient received PMSO in order to place an implant in the mandibular edentulous space after decreased vertical dimension is restored, and the second patient received PMSO along with orthodontic treatment to obtain the intermaxillary space and balance the interarch molar width. Conclusion: PMSO is the treatment of choice when occlusion is compromised in the presence of decreased vertical dimension or arch length discrepancy.

• Journal of Korean Dental Science
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• v.13 no.2
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• pp.67-72
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• 2020

Purpose: This clinical study presented the effectiveness of 2-stage posterior maxillary segmental osteotomy (PMSO) under local anesthesia in gaining interarch space to restore the posterior mandibular segment with dental implants. Materials and Methods: Nine patients who received two-stage PMSO for mandibular implant placement from 2003 to 2011 were included in the study. Of the 9 patients, 7 were female and 2 were male. Ages ranged form 28 to 72 (mean 46.6). Potential complications were investigated such as sinus infection, survival of bone segment, inflammatory root resorption of adjacent teeth, relapse of bone segment and timing of implant placement, delivery of implant prosthesis and stability of bone segment. Result: None of the patients showed relapse or complication. Bone segments were stabilized by opposed implant prosthesis. Conclusion: Office-based 2-stage PMSO under local anesthesia can be considered a stable and predictable procedure. Also pedicle damage can be avoided by allowing favor of blood supply to the bone segments. From these advantages, it can be concluded that this surgical procedure can decrease post-operative complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.5
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• pp.329-334
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• 2009

Objective: To evaluate the ratio between bone-contact length and inter-segmental length of the rigid fixation screw used in bilateral sagittal split ramus osteotomy (BSSRO) for mandibular setback. Material and Methods: Records of 40 patients with Class III malocclusion were selected. 20 of them had BSSRO, while the other 20 had BSSRO with maxillary LeFort I osteotomy. All of the patients had three noncompressive bicortical screws inserted at the gonial angle through transcutaneous approach. Two screws were inserted antero-posteriorly above inferior alveolar nerve and one screw was inserted below. The lengths of bone-contact and that of inter-segmental part were measured using cone-beam computed tomography. Ratio between these two measured lengths was calculated. Results: Both bone-contact and inter-segmental lengths were longer in BSSRO group than in BSSRO with maxillary LeFort I osteotomy group. Ratio of bone-contact to inter-segmental length was lower in BSSRO group than in BSSRO with Lefort I group. Both bone-contact and inter-segmental lengths were longer at the antero-superior position than at the inferior position. However, their ratio showed little difference. Conclusion: This study suggest that stability of screws in BSSRO group was greater than in BSSRO with Lefort I group. Stability of screws at the antero-superior position was greater than at the inferior position. Ratio of bone-contact to inter-segmental lengths was 0.2 in average.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.4
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• pp.338-347
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• 2001

Purpose: This is to review the cases of posterior maxillary segmental osteotomies to regain the interarch spaces for dental implants in the posterior mandible. Materials & Methods: Seven patients who presented with alveolar extrusion of upper posterior molars underwent segmental osteotomies by single-stage Kufner's buccal approach under the intravenous sedation and local anesthesia. The posterior maxillary cento-alveolar segments were repositioned upward using pre-fabricated palato-occlusal resin splints and immobilized with osteosynthesis microplates and screws. Dental implants were installated simultaneously. The regained spaces, tooth vitality, periodontal healing, relapse, tenderness on function, and complications including maxillary sinus involvements were evaluated periodically for over one year after the surgeries. Results: The single-tage procedures were completed within 80 minutes without any surgical complications. The posterior maxillary segments were repositioned upward to regain the interarch spaces ranging from 2.5 to 5.5mm. All teeth involved in the procedures keep their vitalities. The repositioned segments were maintained showing neither evidence of periodontal break-down nor tenderness to function. One patient whose segments had not been immobilized by osteosynthesis plate resulted in 2mm down-ward relapse in post-operative 8 months. A case of postoperative nasal bleeding from the posterior-lateral wall resulted in oroantral fistula and chronic maxillary sinusitis later. Conclusion: The extruded dento-alveolar segments of the posterior maxilla were repositioned properly by Kufner's one-stage segmental osteotomies. One microplate can be of help to keep the position until the osseous healing enough to support the masticatory force.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.3
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• pp.74-80
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• 1990

This is to report a case of surgical and orthodontic of posterior scissor bite, deep bite and gummy smile by the segmental osteotomies. The surgical thechnics procedures used are Peterson's mandibular posterior segmental osteotomy, modified $K{\ddot{o}}le$ technic for mandibular anterior segment and Wunderer's maxillary anterior segmental osteotomy. The results are as follows : 1) Peterson's mandibular posterior segmental osteotomy could be achieved by the buccal approach with some difficulties in accessbility. 2) Upper and lower anterior segmental osteotomies were followed separately to correct the deep curve of Spee, deep bite and gummy smile in shortened period. 3) All alveolar segments were immobilized in preplanned position by the prefabricated palatal and lingual resin splint, therefore intermaxillary fixation was not necessary.

• The korean journal of orthodontics
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• v.28 no.6 s.71
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• pp.975-979
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• 1998

Our Goal of modified segmental osteotomy on maxilla accompanied by mandibular anterior subapical osteotomy was to get the best results from patients of bi-alveolar or bi-maxillary protrusion. In this study, cephalometric and photo (en face, profile) analysis have been compared to define the soft tissue change after surgery. Lip protrusion was efficiently reduced and nasolabial angle was much obtused. Although nose was a little widened, it was quite acceptable. Blood circulation on osteotomized segment was well maintained. This relatively simple methods could be successfully applied to many patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.2
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• pp.124-129
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• 2013

Multiple segment osteotomy orthognathic surgery serves to combine the total or segmental maxillary and mandibular correction of the dentofacial deformities with concurrent procedures to provide immediate repositioning to the dento-osseous elements. In addition, splitting the palate may often be necessary to correct a functionally poor relationship of the maxilla to the mandible or the facial skeleton by realigning the maxillary arch. In this case, the discrepancy in a bimaxillary horizontal relationship and the space between the 2nd premolar and 2nd molar was retained after lengthy preoperative orthodontic treatment. However, we could correct these dento-osseous discrepancies immediately by performing midpalatal expansion, anterior segmental osteotomy and symphyseal osteotomy with bimaxillary osteotomies. If the blood supply to each segment segments was maintained and primary closure of the operation site was feasible, multiple segment osteotomy was considered as a very effective technique for treating dentofacial deformities in vertical, transverse, and sagittal dimensions with differential repositioning of all segments.

• The Journal of the Korean dental association
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• v.51 no.6
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• pp.322-329
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• 2013

Among the occlusal discrepancies, maxillary transverse deficiency is quite common in several reasons. The reasons are comprised of maxillary hypoplasia, thumb sucking habits, non-syndromic palatal synostosis and syndromal patients including cleft patients. Orthodontic treatment is used routinely to correct a deficiency in young patients while it has limitations for a skeletally mature patient. Surgical treatments help provide effective maxillary expansion to correct a deficiency in adults. Surgical methods can be categorized to segmental Le Fort I osteotomy and surgically assisted rapid maxillary expansion(SARME). Both methods seem successful but each method would have its own indication. We give a review on transverse maxillary deficiency and two surgical methods.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.6
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• pp.332-336
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• 2012

Objectives: This study sought to evaluate fixation methods and determine the best method for the postoperative stabilization of maxillary osteotomy. For our analysis we performed a three-dimensional finite element analysis of stress distribution on the plate, screw, and surrounding bone, as well as displacement onto the plate. Materials and Methods: We generated a model using synthetic skull scan data; an initital surface model was changed to a solid model using software. Modified anterior segmental osteotomy (using Park's method) was made using the program, and four different types of fixation methods were used. An anterior load of 100 N was applied on the palatal surface of two central incisors. Results: The Type 1 (L-shaped) fixation method gave stresses of 187.8 MPa at the plate, 45.8 MPa at the screw, and 15.4 MPa at the bone around the plate. The Type 2 (I-shaped) fixation method gave stresses of 186.6 MPa at the plate, 75.7 MPa at the screw, and 13.8 MPa at the bone around the plate. The Type 3 (inverted L-shaped) fixation method gave stresses of 28.6 MPa at the plate, 29.9 MPa at the screw, and 15.3 MPa at the bone around the plate. The Type 4 (I-shaped) fixation method gave stresses of 34.8 MPa at the plate, 36.9 MPa at the screw, and 14.9 MPa at the bone around the plate. The deflection of the plates for the four fixation methods was 0.014 mm, 0.022 mm, 0.017 mm, and 0.018 mm, respectively. Conclusion: The Type 3 (inverted L-shaped) fixation method offers more stability than the other fixation methods. We therefore recommend this method for the postoperative stabilization of maxillary osteotomy.