Bone Substitutes in Le Fort I Osteotomy to Promote Bone Union and Skeletal Stability

Abstract

Maxillary advancement by Le Fort I osteotomy has become the standard procedure to restore function and facial esthetics, correct skeletal and occlusal discrepancies, and treat obstructive sleep apnea in patients with facial deformities. Incomplete ossification between the bone segments at the jaw osteotomy site has proven to be a major problem in these patients. There are several studies in the literature that address orthognathic surgery, but only a limited number that discuss the use of graft materials in maxillary osteotomy. Bone grafts were introduced in recent decades in order to promote and improve bone union and prevent the formation of gaps. This study will discuss the results obtained using bone substitutes in orthognathic surgery for maxillary advancement and maxillary repositioning with Le Fort I osteotomy, in a clinical report and a literature review, covering the main indications and specifying the type of material used and the stability of the surgical procedure postoperatively.

Bioactive glass granules S53P4 in osteotomy Le Fort I

“…Factors such as age and sex interfere with tissue repair processes 4,6,7 , however, both groups presented a good gender ratio (male: female 12/13) and were young (mean age 39 years), thus these factors did not appear to exert a strong influence on our data.…”

“…Le Fort I osteotomies are indicated for maxillary mobility and repositioning, for the treatment of dento-skeletal discrepancies that affect the middle third of the face. Maxillary advancement and extrusion movements generate inter-segmental bone spaces, with a requirement for bone grafting, proportional to the size of the resulting gaps 4,[6][7][8] . Our study investigated 25 cases of bone gaps requiring bone grafting, in view of the significant surgical maxillary advancement that resulted in the incidence of considerable gaps, especially in G1 (Table 1, 2,3).…”

“…Classically, autogenous grafts are indicated for bone regeneration, but with the advent of new biomaterials, other alternatives are viable 4,[6][7][8] . Grafts based on bioactive glass granules are haloplasts materials capable of stimulating osteoblast differentiation and activation via the formation of silica phosphate layers [12][13][14][15][16][17][18] .…”

“…Other studies, with longer postoperative periods have proven biomaterial efficacy as accelerators of bone formation and biocompatibility [6][7][8][9][10][12][13][14][15][16][17][18][21][22][23][24][25][26][27][28][29] . S53P4 demonstrated potential as a non-determinant stimulator of bone repair at 6 months, and was biological compatible with maxillary sinus membrane.…”

“…Orthognathic surgery mobilizes and repositions the jaw bone base via osteotomy, to ensure functional and aesthetic results for dental-skeletal discrepancies 1 – 3 . Tridimensional surgical movements of the upper jaw are considered unstable with larger bone gaps, thus increasing the need for bone grafts, especially in upper jaw advances of > 4 mm, which normally generate bone discontinuities of > 3 mm 1 – 7 .…”