A New Orthodontic-Surgical Approach to Mandibular Retrognathia

Abstract

(1) Background: Mandibular deficiency is one of the most common growth disorders of the facial skeleton. Recently, distraction osteogenesis has been suggested as the treatment of choice for overcoming the limitations of conventional orthognathic surgery; (2) Methods: A new custom-manufactured dental-anchored distractor was built and anchored in the first molar and lower canine. It consists of a stainless-steel disjunction screw, adapted and welded to the orthodontic bands through two 1.2 mm diameter connector bars with a universal silver-based and cadmium-free solder; (3) Results: The distractor described can be a useful tool to correct mandibular retrognathia and is better tolerated by patients, especially in severe cases; (4) Conclusions: The dental-anchored distractor increases the anterior mandibular bone segment without affecting the gonial angle or transverse angulation of the segments and avoids posterior mandibular rotation, overcoming the limitations of conventional surgical treatment.

Dental Restorations

“…Furthermore, it could also be useful to analyze forces applied in more complex situations, such as in malformations or transversal deficits. Vale et al [106] investigated mandibular hypoplasia treatment; this is the most common growth disorder of the facial skeleton in Western Europe, ranging from 41% to 56%. It could be related to congenital malformation syndromes, angle class II occlusions, convex profile, and mandibular deficiency [107]; the need of orthodontic-surgical treatment [108] to correct dental occlusion, masticatory and respiratory function in cases of class II skeletal malformations [109] must be evaluated in relation to their severity.…”

Virtual Planning and 3D Printing in Contemporary Orthognathic Surgery

“…The gradual and controlled elongation during distraction osteogenesis allows for tissue regeneration and repair to occur within the skeleton and the soft tissue associated with it, including the muscles, subcutaneous tissue, and skin. 41 Especially in the case of severe midface hypoplasia and/or upper airway obstruction 42 often seen in cleft patients, orthognathic surgery may be planned with the use of internal or external distractors. The reasons for the use of distraction within orthognathic surgery are manifold but may include concern for the increased risk of bony relapse with anticipated large maxillary or mandibular advancements, a deficient or nonpliable soft tissue envelope, or the need to provide additional functional or aesthetic benefit beyond the maxillary-mandibular relationship (e.g., exophthalmos due to shallow orbits, central midface deficiency with shortened nasal bones, etc.).…”

Soft tissue profile changes during treatment of patients with class II malocclusion

“…Small skeletal discrepancies may only need multibracket appliance treatment for the correction of existing malocclusion and teeth alignment [6]. On the other hand, more severe skeletal discrepancies may require an orthognathic surgical treatment to modify the position and length of skeletal structures, to obtain better esthetic results [7]. Despite the numerous studies conducted on the consequences of extractions, it is still a question of debate among orthodontists.…”