11-Nov-19

Dentofacial Deformity

The term dentofacial deformity describes an array of

Dentofacial Deformity dental and maxillo-mandibular abnormalities, often
presenting with a malocclusion, which is not amenable
to orthodontic treatment alone and definitive treatment
needs surgical alignment of upper/lower jaws or both
(orthognathic surgery).

Dentofacial deformity
Aetiology
• Common Dentofacial deformity
• Maxillary deformities
• Developmental and Congenital • Mandibular deformities
• Acquired • Combined maxillary-mandibular deformities
• Trauma
• Pathology • Uncommon Dentofacial deformities
• Cleft Lip and Palate
• Facial asymmetry
• Syndromatic deformity (e.g. Cleido-cranial-dysplasia)

Orthognathic surgery- Indications

• Forwardly placed upper or lower jaw
• Backwardly placed an upper or lower jaw
• Open bite – no proper occlusion
• Anterior Open bite affects speech and esthetics.
• Posterior Open bite affects chewing
• Cross bite
• Abnormal Asymmetry of the face – deviated jaw
• Deformity due to facial trauma
• Defective facial heights

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Evaluation and assessment

Cephalometric analysis Model analysis and model surgery

Treatment protocol
Evaluation and assessment

• Analysis of Facial Profiles Tooth

• Cephalometric Analysis
• Model preparation and model surgery occlusion
• Patient counseling
Jaw bone

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Treatment protocol Mandibular Osteotomy

1. Pre-surgical orthodontic preparation

2. Surgery •Advance
3. Post-surgical orthodontic modification
•Setback

4. Follow-up

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Bi-lateral sagittal split Ramus Osteotomy(BSSRO) Bi-lateral sagittal split Ramus

Osteotomy(BSSRO)

L-shaped Ramus osteotomy and

Sub-apical Mandibular Osteotomy(BSSRO) Bi-lateral sagittal split Ramus Osteotomy(BSSRO)

Vertical Ramus Osteotomy Genioplasty

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Maxillary Osteotomy

•Le-Fort-1 osteotomy
•Le-Fort-2 osteotomy
•Sub-apical osteotomy

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Le-Fort 1 osteotomy Le-Fort 1 osteotomy

Le-Fort 1 osteotomy Orthognathic surgery

• Single jaw surgery

• Mandibular
• Maxillary
• Double jaw / Bi-maxillary surgery
• Mandibular and Maxillary

Orthognathic surgery
• Mandibular Surgery (Advancement and Setback) Conclusion
• BSSRO (Bilateral sagittal split ramus osteotomy)
• VRO( Vertical ramus osteotomy)
• L-shaped ramus osteotomy Good planning, Communication & free flow of information
• Sub-apical osteotomy between the surgeon, orthodontist, and patient facilitate
• Genioplasty efficient and successful treatment and ensure patient
confidence
• Maxillary surgery (Advancement and Setback)
• Le-Fort 1 osteotomy
• Le-Fort 2 osteotomy
• Sub-apical osteotomy