• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.29 no.3
• /
• pp.217-226
• /
• 2007

Purpose: Distraction osteogenesis is considered to take favorable effect on the TMJ and be beneficial to prevent the relapse after the mandibular advancement of Class II malocclusion patient. This is the report with literature review on the mandibular advancement in the patients showing preoperative condylar resorption and who need larger amount of advancement. Patients and method: Distraction osteogenesis using intraoral device was performed for three mandibular hypoplasia patients (one male and two females). All patients were adult over 18 years old. The patients showed condylar bony resorption preoperatively. The distraction was performed intraorally with modified SSRO. After 7 days of latency period, activation was performed at the rate of 1.0 mm/day with twice turn. The devices were removed after 4-8 month consolidation period. Results: Total advancement of mandible was average 13 mm. One patient showed openbite immediately after removal of distraction device. It took long time to guide the openbite with elastics. The comparison between cephalometries immediately after device removal and postoperative six month revealed average 3.4 mm relapse. This means that mandibular advancement with distraction osteogenesis needs overcorrection and elastic rehabilitation even after enough consolidation periods. Conclusion: Larger amount of mandibular advancement could be achieved with distraction osteogenesis in severe mandibular hypoplasia with condylar resorption. However, some relapse was found during the follow-up period and the over correction is considered to be needed. The effect of distraction osteogenesis seems to be investigated with long-term follow-up.

• The korean journal of orthodontics
• /
• v.28 no.6 s.71
• /
• pp.893-904
• /
• 1998

There are varieties of severe malocclusions, which can be treated orthodontically, but with a great deal of effort. Anterior openbite, in particular, is one malocclusion thought to be more difficult to treat, and therefore, most of them have to be corrected by means of surgical intervention. To solve these problems, numerous studies pertinent to treatment modalities have been introduced with controversies on the effectiveness of treatment. Suggested treatment modalities for anterior openbite are based directly or indirectly on the neuromuscular and morphological features and on the etiologic and/or the environmental factors. Even though the vertical relationship of the face is increased due to the growth variation, the normal occlusal relationship can be achieved by the adequate dentoalveolar compensatory mechanism, but in the case of inadequate or negative dentoalveolar compensation, openbite is likely to be present. If the skeletal dysplasia is too severe to be solved by orthodontic treatment alone, combined treatment with surgery should be done to restore the function and the esthetics of the orofacial complex. In many cases, however, orthodontic alteration of the dentition pertinent to the given skeletal pattern with the proper diagnosis and treatment planning can bring satisfactory results. The treatment changes with the Multiloop Edgewise Archwire(MEAW) therapy occurred mainly in the dentoalveolar region and showed a considerable similarity to the natural dentoalveolar compensatory mechanism. In other words, the MEAW technique allows orthodontists to produce the natural dentoalveolar compensation orthodontically. Even if an openbite is corrected by the orthodontic dentoalveolar compensation suitable for the skeletal pattern, relapse may still occur by the persisting etiologic factors which originally prohibited the natural dentoalveolar compensation. The etiologic factors should be determined at the time of initial diagnosis and should be controlled during treatment and retention.

• The korean journal of orthodontics
• /
• v.34 no.6 s.107
• /
• pp.497-505
• /
• 2004

The purpose of this study was to evaluate the post-retention stability of the lower incisor axis in Class II division 2 malocclusions. The dental casts and lateral cephalograms from before (T1) and after (T2) orthodontic treatment and long-term post-retention (T3) in 62 Class II division 2 malocclusion cases were included in this study. After several linear and angular measurements at each time were taken, the significance in the amount of change of the lower incisor axis for each gender and extraction versus non-extraction was evaluated. The results showed that the lower incisors that inclined labially during treatment were unstable and relapsed to the original lingual position in Class II division 2 malocclusions (p<0.001). There was no significant difference between extraction and non-extraction groups for the amount of lingual relapse of the lower incisors (p>0.05). There was no significant difference between male and female groups for the axial change of the lower incisors (p>0.05). As a result of multiple regression analysis, the cephalometric measurement best predicting the lower incisor position to the A-Pog line post-retention was pre-treatment L1-Apog(mm) and pre-treatment SNGoMe$(^{\circ})$. Because of the instability of labially inclined lower incisors after orthodontic treatment, the treatment goal should be the pre-treatment incisor axial position.

• The korean journal of orthodontics
• /
• v.38 no.2
• /
• pp.83-94
• /
• 2008

Purpose: The first objective of this study was to compare the upper midface morpholgy, focusing on the soft tissues, between skeletal Class III maloccusion patients with midfacial depression and the norm. The second objective was to estimate and analyze the change in the upper midface soft tissues following surgical correction with maxillary advancement by Lefort I osteotomy and mandibular setback by bilateral sagittal split osteotomy (BSSRO). Methods: The samples consisted of 34 adult patients (15 males and 12 females) with an average age of 21 years, who had severe anteroposterior discrepancy with midfacial depression. These patients had received presurgical orthodontic treatment and surgical treatment which consisted of simultaneous Lefort I osteotomy and BSSRO. Results: The correlation coefficient between changes in maxillary advancement and changes in Or' (soft tissue orbitale) was 0.599 (p < 0.05). Change in maxillary plane angle and vertical change of the maxilla were not correlated with the change in Or' (p < 0.05). The ratio of soft tissue change in Or' to maxillary advancement was 43.57 %, and 81.54 % in Sn. Regression equations between maxillary movement and Or' were devised. The $r^2$ value was 0.476. Conclusions: The majority of measurements in the upper midface in skeletal Class III maloccusions when compared to the norm, showed significant differences. In Class III malocclusion with midfacial depression, maxillary advancement produces soft tissue change in the upper midface.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.34 no.1
• /
• pp.99-107
• /
• 2008

Objective : The objective of this review was to provide reliable comparative results regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured mandibular condyle Patients and Methods : Research of studies from MEDLINE and Cochrane since 1990 was done. Controlled vocabulary terms were used. MeSH Terms were "Mandibular condyle" AND "Fractures, bone". Only comparative study were considered in this review using the "limit" function. According to the criteria, two review authors independently assessed the abstracts of studies resulting from the searches. The studies were divided according to some criteria, and following were measured: Ramus height, condyle sagittal displacement, condyle Towns's image displacement, Maximum open length, Protrusion & Lateral excursion, TMJ pain, Malocclusion, and TMJ disorder. Results : Many studies were analyzed to review the post-operative result of the two methods of treatment. Ramus height decreased more in when treated by closed reduction as opposed to open reduction. Sagittal condyle displacement was shown to be greater in closed reduction. Condyle Town's image condyle displacement had greater values in closed reduction. Maximum open length showed lower values in closed reduction. In protrusive and lateral movement, closed reduction was less than ORIF. Closed reduction showed greater occurrence of malocclusion than ORIF. However, post-operative pain and discomfort was greater in ORIF. Conclusion : In almost all categories, ORIF showed better results than CRIF. However, the use of the open reduction method should be considered due to the potential surgical morbidity and increased hospitalization time and cost. To these days, Endoscopic surgical techniques for ORIF (EORIF) are now in their infancy with the specific aims of eliminating concern for damage to the facial nerve and of reducing or eliminating facial scars. Before performing any types of treatment, patients must be understood of both of the treatment methods, and the best treatment method should be taken on permission.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.32 no.4
• /
• pp.620-627
• /
• 2005

The purposes of early orthodontic intervention are to correct obvious problems, to intercept developing problems and prevent them from becoming worse. Myofunctional influence on facial growth and the dentition change in muscle function and initiate morphologic variation in the normal configuration of the teeth and enhance an already existing malocclusion. Myofunctional therapy has been advocated since 1960's as the treatment for tongue thrust and other oral habits. Pre-orthodontic $TRAINER^{(R)}$ is introduced as functional device usable in children of mixed dentition to correct functional problems concerning soft tissue, tooth and skeleton. The most common cases to treat with Pre-orthodontic $TRAINER^{(R)}$ are lower anterior crowding, anterior open bite, Class II malocclusion and deep bite. Also, it can be used as correction of oral habits. Patients in this cases visited Department of Pediatric Dentistry, School of dentistry, Dankook University for orthodontic treatment. Pre-orthodontic treatment with Pre-orthodontic $TRAINER^{(R)}$ was carried out for correction of the oral habits.

• The korean journal of orthodontics
• /
• v.40 no.3
• /
• pp.145-155
• /
• 2010

Objective: Lateral cephalometric radiographs have been the main form of resource for assessing two dimensional anteroposterior airway changes. The purpose of this study was to evaluate the three dimensional volumetric change in the upper airway space in Class III malocclusion patients who underwent mandibular setback surgery. Methods: Three dimensional cone-beam computed tomographs (CBCT) and their three dimensional reconstruction images were analyzed. The samples consisted of 20 adult patients (12 males and 8 females) who were diagnosed as skeletal Class III and underwent mandibular setback surgery. CBCTs were taken at 3 stages - Baseline (1.8 weeks before surgery), T1 (2.3 months after surgery), and T2 (1 year after surgery). Pharyngeal airway was separated according to the reference planes and reconstructed into the nasopharynx, the oropharynx and the hypopharynx. Measurements at Baseline, T1, and T2 were compared between groups. Results: The result showed the volume of the pharyngeal airway decreased significantly 2.3 months after surgery (p < 0.001) and the diminished airway did not recover after 1 year post-surgery. The oropharynx was the most decreased area. Conclusions: These findings suggest that mandibular setback surgery causes both short-term and long-term decrease in the upper airway space.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.40
• /
• pp.13.1-13.8
• /
• 2018

Background: We evaluated change in the mandibular condyle after orthognathic surgery using cone-beam computed tomography (CBCT) in patients with facial asymmetry. Methods: Thirty patients with skeletal class III malocclusion and mandibular prognathism or facial asymmetry were classified into two groups according to the amount of menton deviation (MD) from the facial midline on anteroposterior (AP) cephalogram: group A (asymmetry, MD ≥ 4 mm; n = 15) and group B (symmetry, MD < 4 mm; n = 15). Position and angle of condylar heads on the axial, sagittal, and coronal views were measured within 1 month preoperatively (T0) and postoperatively (T1) and 6 months (T2) postoperatively. Results: On axial view, both groups showed inward rotation of condylar heads at T1, but at T2, the change was gradually removed and the condylar head returned to its original position. At T1, both groups showed no AP condylar head changes on sagittal view, although downward movement of the condylar heads occurred. Then, at T2, the condylar heads tended to return to their original position. The change in distance between the two condylar heads showed that they had moved outward in both groups, causing an increase in the width between the two heads postoperatively. Analysis of all three-dimensional changes of the condylar head positions demonstrated statistically significant changes in the three different CBCT views in group B and no statistically significant changes in group A. Conclusions: There was no significant difference between the two groups in condylar head position. Because sagittal split ramus osteotomy can be performed without significant change in symmetrical and asymmetrical cases, it can be regarded as an effective method to stabilize the condylar head position in patients with skeletal class III malocclusion and mandibular prognathism or facial asymmetry.

• The korean journal of orthodontics
• /
• v.27 no.1
• /
• pp.79-89
• /
• 1997

One of the strenuous problems in orthodontic procedures is postretention stability and retention against relapse. Many investigative trial had been done to disclose the factors associated with relapse and effective prescription to stave off, however, the nature of these jeopardies remained obscure. The objective was to investigate the long-term stability and quantitative changes of dental arches subsequently after Class I nonextraction treatment. Study models,cephalometric headfilms of 26 samples which were taken before, after teatment and postretention were employed to measure the interdental width of corresponding buccal teeth,overbite,overjet and the inclination of incisors and molars. Statistical analysis was carried to compare each measurements across the time period, and followings were brought around. 1. The quantitative amount of relapse in overbite presented positive correlation with the amount of changes through the treatment. 2. Stability of intercanine width was so far secure in the case the expansion had been done through. 3. The amount of changes in intercanine width of the lower regardless of expansion or contraction manifested less than the upper, however, the relapse ratio got high. 4. The upper and lower incisors were likely to be labioversive, and remained stable after retention. 5. The first molars of the upper and lower were conceivably tipped back immediately after treatment and returned to the original angulation. The expansion of intermolar width stayed stable across the time scheme after treatment It was suggested that the maintenance of intercanine width of lower was pertinent to perform the postretention stabilityv and the expansion of dental arch shoed be confined within physiologic boundaries of the patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.33 no.5
• /
• pp.559-566
• /
• 2007

Distraction osteogenesis(DO) is a surgical method of bone formation that involves an osteotomy and sequential stretching of the healing callus by gradual movement and subsequent remodeling. DO is used to correct facial asymmetry, such as in patients with hemifacial microsomia, maxillary or mandibular retrusion, cleft lip and palate, alveolar defects, and craniofacial deficiency. It is accomplished with the aid of a distraction device, which is secured with screws placed directly into bone, for a predetermined length of time. Hemifacial microsomia is characterized by unilateral facial hypoplasia, often with unilateral shortening of the mandible and subsequent malocclusion. Patients with hemifacial microsomia and facial asymmetry have a vertically short maxilla, tilted occlusal plane, and short mandible. Early treatment is necessary to avoid subsequent impaired midfacial growth. The standard treatment of these malformations consists of the application of bone grafts, which can lead to unpredictable growth. The new bone-lengthening procedure represents a limited surgical intervention and opens up a new perspective for treatment, especially in younger children with severe deformities. This report describes a case of hemifacial microsomia(Type-II left-sided hemifacial microsomia). The patient, a 10-year-old child, visited our clinic for facial asymmetry correction. He had a hypoplastic mandible, displaced ear lobe, 10 mm canting on the right side, and malocclusion. We planned DO to lengthen the left mandible in conjunction with a Le Fort I osteotomy for decanting and then perform a right intraoral vertical ramus osteotomy(IVRO). Progressive distraction at a rate of 0.5 mm/12 hours was initiated 7 days postoperatively. The duration of DO was 17 days. The consolidation period was 3 months. Satisfactory results were obtained in our case, indicating that DO can be used successfully for functional, aesthetic reconstruction of the mandible. We report a case involving DO in conjunction with orthognathic surgery for correcting mandibular hypoplasia with a review of the literature.