Evolution of the Human Craniofacial Skeleton, Frequency of Dentofacial Deformities, and Implications for Treatment

Abstract

J aw disharmonies recognized after birth, that present either in the mixed dentition or in association with the pre-pubertal growth spurt are called developmental dentofacial deformities (DFDs). These deformities occur during the normal growth phase of the face primarily with degrees of deficiency and less commonly with excess in 1 or more vectors of jaw growth. Studies confirm that, at a minimum, 5% of humans will have a DFD associated with a significant degree of malocclusion, airway obstruction, and/or facial dysmorphology to the extent that orthognathic surgery is required. 1 It is likely that as high as 20% of individuals who present for orthodontic assessment will fall into this category. 2

Knowledge and Misconceptions of Orthognathic Surgery: A Quick Poll Survey of the National Dental Practice-Based Research Network

“…Orthognathic surgery is an underutilized resource to treat congenital, developmental, and post-traumatic skeletal abnormalities of the maxillomandibular complex. [1][2][3][4] Dentofacial deformities (DFDs) may compromise a patient's head and neck functions, including speech, swallowing, breathing, and mastication, as well as their dental and psychosocial health. 1,5 The sequelae of DFDs that are managed with orthognathic surgery include sleep-disordered breathing (ie, obstructive sleep apnea), 6 malocclusion compromising mastication and nutritional intake, suboptimal facial aesthetics, psychosocial disorders resulting from self-consciousness regarding facial appearance, 7,8 and speech impairments.…”

“…5 It is estimated that at a minimum 5% of Americans have a significant DFD that would best be treated with a combined orthodontic and a surgical approach. [1][2][3][4] An estimated 3 to 4000 teenagers coming of age each year in the United States have a cleft jaw deformity secondary to cleft lip and palate repair that requires surgical correction. 4 Additionally, an estimated 13% of men and 6% of women with moderate to severe obstructive sleep apnea (OSA, defined as an AHI ≥ 15) 9 would benefit from orthognathic surgery (maxillomandibular advancement) as a primary surgical modality.…”

“…1,11,12 Of these, an estimated 76% were for correction of a developmental DFD, 19% were for a syndromal jaw deformity, and 6% of these patients were cleft adolescents/adults. 1 Although this number does not FACE 4 (3) account for surgeries taking place in an outpatient setting, approximately 95% of patients who could benefit from orthognathic surgery for aesthetic and functional correction of their dentofacial deformity are not receiving treatment. 1 To provide better access and treatment for patients who could benefit from orthognathic correction, barriers to surgery should be identified and addressed.…”

Evolutionary Origins of Toothache

“…Our hunter-gatherer ancestors subsisted on wild grains and raw meat had larger and stronger teeth, which they used to tear meat and crack the shell of nuts [12,13]. However, evolution has so badly "designed" our heads that there is no longer enough room in our jaws for our teeth [14]. Due to a lack of space in the dental arches, dental fusion and malocclusion occurred [15].…”

Revisão sistemática comparando a acurácia do planejamento cirúrgico convencional e planejamento virtual para cirurgia ortognática

“…O planejamento cirúrgico virtual assistido por computador e guias cirúrgicos impressos em três dimensões têm sido cada vez mais usados em cirurgia ortognática durante as últimas décadas (FARREL et al, 2014). A utilização desse Introdução planejamento tornou-se possível a partir do advento da tecnologia das tomografias computadorizada de feixe cônico (TCFC), esta tecnologia 3D traz uma representação mais realista da cabeça do paciente, permitindo a simulação e avaliação dos procedimentos cirúrgicos e ortodônticos utilizando a possibilidade dos vários recursos (POWER et al, 2005).…”