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Evaluation of relapse after orthodontic therapy combined with orthognathic surgery in the treatment of skeletal class III

Rezidivbeurteilung nach kombiniert kieferorthopädisch-kieferchirurgischer Behandlung der skeletalen Klasse III

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

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Abstract

Introduction

Multidisciplinary treatment of skeletal malocclusion by orthognathic surgery in addition to orthodontics is a routine strategy believed to offer good functional and esthetic outcomes. Postoperative relapse is, however, a problem. The present study was conducted to analyze the stability of outcomes achieved by surgical treatment of skeletal class III patients in terms of the rate and extent of relapses.

Patients and methods

A total of 30 patients who had undergone orthodontic treatment combined with orthognathic surgery were included. The primary inclusion criterion was a skeletal class III treated by mandibular setback (Obwegeser/Dal Pont) surgery alone or combined with maxillary advancement (Le Fort I) surgery. Analysis was based on one preoperative and two postoperative cephalograms per patient.

Results

We observed relapse (defined, in accordance with Proffit, as changes >2 mm or 2°) at a rate of 24% after bimaxillary procedures, compared to a lower rate of 21% after mandibular setback procedures only. The relapse rate was 21% among patients who had undergone upper-jaw surgery versus 27% among those who had undergone lower-jaw surgery, which was statistically significant.

Conclusion

The majority of patients exhibited stable treatment outcomes. Maxillary advancement procedures were found to be less susceptible to relapse—resulting in more stable outcomes—and mandibular setback distances correlated positively with the degree of the relapse. No statistically significant differences were observed between the procedures conducted in both jaws versus in the lower jaw only, or in the extent of upper-jaw repositioning.

Zusammenfassung

Einleitung

Die interdisziplinäre kieferorthopädisch-kieferchirurgische Therapie von skeletalen Dysgnathien gilt als Routineverfahren mit guten funktionellen und ästhetischen Ergebnissen. Ein Problem ist das postoperative Rezidiv. Ziel unserer Untersuchung war die Analyse der Rezidivrate und des Gesamtergebnisses, der Stabilität und der Ausprägung möglicher Rezidive nach Dysgnathieoperation der skeletalen Klasse III.

Patienten und Methoden

Eingeschlossen wurden 30 Patienten mit kombinierter kieferorthopädisch-kieferchirurgischer Behandlung. Primäres Einschlusskriterium war eine skeletale Klasse III, eine Unterkieferrückverlagerung nach Obwegeser/Dal Pont und die Vorverlagerung des Oberkiefers nach Le-Fort-I. Die Auswertung erfolgte anhand einem prä- und zwei postoperativen Fernröntgenseitenbildern.

Ergebnisse

Das Rezidiv (definiert nach Proffit, Veränderungen von mehr als 2 mm oder 2°) lag insgesamt in bimaxillären Eingriffen bei 24% und bei monomaxillärer Vorgehensweise deskriptiv niedriger bei 21%. Im Oberkiefer operierte Patienten zeigten ein Rezidiv von 21% und bei im Unterkiefer operierten Patienten trat statistisch signifikant häufiger ein Rezidiv in 27% aller Fälle auf.

Schlußfolgerung

Der überwiegende Anteil der Patienten zeigte ein stabiles Behandlungsergebnis. Die Oberkiefervorverlagerung war weniger rezidivanfällig und stabiler. Das Ausmaß der Unterkieferrückverlagerung korrelierte positiv mit der Rezidivausprägung. Keine statistisch signifikanten Unterschiede traten zwischen bimaxillären und monomaxillären Operationen sowie im Ausmaß der Verlagerung im Oberkiefer auf.

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Authors and Affiliations

  1. Department of Orthodontics, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany

    I.F. de Haan, R. Ciesielski &  B. Koos

  2. Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany

    T. Nitsche

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  1. I.F. de Haan
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  2. R. Ciesielski
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  3. T. Nitsche
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  4. B. Koos
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Correspondence to B. Koos.

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de Haan, I., Ciesielski, R., Nitsche, T. et al. Evaluation of relapse after orthodontic therapy combined with orthognathic surgery in the treatment of skeletal class III. J Orofac Orthop 74, 362–369 (2013). https://doi.org/10.1007/s00056-013-0161-0

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