Can palatal splint improve stability of segmental Le Fort I osteotomies?

Abstract

Adults presenting skeletal malocclusion frequently require three-dimensional approaches for comprehensive surgical treatment in order to correct the sagittal, vertical and transverse discrepancies. The surgically assisted rapid palatal expansion (SARPE), 1,2 multi-segment maxillary osteotomies 3 and the microimplant-assisted rapid palatal expansion (MARPE) are the main approaches for correction of the transversal deficiency in adults. 4,5 Multi-segment maxillary osteotomies surgery allows great versatility in three-dimensional treatments in a single surgery. The advantages of multiple piece maxillary osteotomies include the capacity to expand the maxilla, correct the dentoalveolar inclination in the anterior segment, compensate dental size discrepancies and level of the dentoalveolar segments. However, its stability is still a concern among surgeons, 3,6-9 and the maxillary widening through this procedure has been reported to be the most unpredictable procedure among all orthognathic surgical modalities. 7,9

Is three-piece maxillary segmentation surgery a stable procedure?

“… 33 During the postoperative period, this group used a splint without occlusal coverage to eliminate the instability factor. 21 This clinical practice can be considered a factor in stability improvement and perhaps could be one of the factors contributing to stability, aligning with findings from other studies. 11 , 34 , 35 T2 scans were performed within a maximum of 19 days postoperatively to reduce the possibility of adaptive responses during this period.…”

“…A palatal splint was used as a stability tool. 21 Considering that dental instability can be influenced by skeletal instability alone or by skeletal in addition to dentoalveolar instability, our objective was to assess skeletal component instability in overall relapse.…”

“…Despite the versatile design of the three-piece Le Fort I maxillary osteotomy, 21 the stability of three-piece maxillary segmentation surgery remains controversial in the literature. 2 , 6 , 22 Previous studies have reported relapse of incisor position changes achieved through segmentation surgical procedures in approximately 90% of the samples.…”

Retention Strategies for Segmental Lefort I Osteotomies Using Clear Aligners

“…Indications for segmental surgery may include the correction of transverse discrepancies, vertical abnormalities (such as anterior open bites with dual-plane occlusions), dentoalveolar segment angulation, arch form abnormalities, and for the closure of extraction space 1,2. Movements commonly achieved with multisegment maxillary osteotomies are at risk for increased relapse, such as increasing the transverse dimension or the closure of an anterior open bite 3,4. The reasons for increased relapse are multifactorial, although stretching of the thick and nonelastic palatal mucosa is a contributing factor 5.…”

“…1,2 Movements commonly achieved with multisegment maxillary osteotomies are at risk for increased relapse, such as increasing the transverse dimension or the closure of an anterior open bite. 3,4 The reasons for increased relapse are multifactorial, although stretching of the thick and nonelastic palatal mucosa is a contributing factor. 5 Multiple techniques can be utilized to mitigate against relapse depending on the surgical movements achieved, although frequently used techniques include: achieving an adequate presurgical orthodontic setup with the dentition ideally angulated over basal bone, intraoperative bone grafting between segments, use of rigid fixation, use of an immediate postoperative splint for 3-to 8 weeks, use of a heavy orthodontic arch wire or auxiliary labial arch wire in headgear tubes to maintain expansion during finishing orthodontics, guiding elastics, and long-term retention with a Hawley-type retainer or lingual fixed retainers.…”