Comparison Of Surgical And Non Surgical Orthodontic Treatment Approaches On Occlusal And Cephalometric Outcomes In Patients With Severe Class Ii Division I Malocclusions PDF Download

Class II malocclusions can be treated with a combination of orthodontics and orthognathic surgery. The severity of the malocclusion and growth potential play an important role in the treatment decision. Treatment involving orthognathic surgery is usually recommended after active growth is over to minimize relapse. On the other hand, improvement of a severe skeletal deformity and associated esthetic imbalance during adolescence can increase the patient’s quality of life and, in some cases, early treatment may decrease the financial burden due to changes in insurance coverage. Also, surgery and recovery from surgery may be easier and with less complications in younger individuals. The purpose of this study is to evaluate the effect of timing on treatment outcomes and the surgical complications of orthognathic surgery between younger and older Class II malocclusion patients. Methods Records of local orthodontists and oral surgeons were screened for inclusion in the study: Class II malocclusion treated with a combination of orthodontics and orthognathic surgery of the mandible (with or without maxillary surgery). Syndromic patients were excluded. Lateral cephalograms (initial, pre-surgical, post-surgical and final) as well as surgical notes were obtained. Patients were divided in 3 groups based on chronological age: 13-19, 20-25, 33-40. Dolphin imaging software was used and landmarks identified for cephalometric analysis. Cephalometric measurements were used to analyze the dental and skeletal changes associated with surgical and orthodontic treatment. Immediate and post-surgical complications were evaluated. A total of 112 patients were identified who fit the inclusion criteria. Only 35 patients had available cephalometric data (T1 pre-orthodontics; T2 pre-surgical; T3 postsurgical and T4 post treatment) which were used to compare anteroposterior (A-P) changes between the adolescent and adult patients. Less changes in cephalometric measurements were observed between T1-T2 and T3-T4 in the younger patients. Surgical data for 104 patients were included in the study, 8 patients were excluded due to missing data. For 1-jaw surgery, blood loss in the older group was greater than in the younger group. Limited TMJ opening (24-31 mm) at 6 weeks and more post- surgical complications after 1 jaw surgery were observed in the older group. More post-surgical complications after 2 jaw surgery (condylar resorption, infection, residual sensory loss and TMJ pain) were observed in the younger patient group. Younger patients who underwent orthognathic surgery to correct a Class II malocclusion had similar orthodontic treatment outcomes and similar immediate surgical complications compared to older patients. Possible continued mandibular growth contributed to improved skeletal relationships after the orthognathic surgery in the younger patients. Overall, there was no statistical or clinical difference in A-P changes of mandibular advancement surgery, nor differences in surgical complications between young and older patients.