Surgical Manipulation of the Occlusal Plane in Class III Deformities: 5 Features to Help Planning

Abstract

Class III malocclusion is one of the most common deformities that requires correction through orthodontic-surgical treatment. These patients present different facial patterns depending on the occlusal plane angulation. These patients may benefit from surgical manipulation of the occlusal plane, because only bite correction does not always lead to the improvement of the facial deformity. The purpose of this paper is to show the surgical manipulation of the occlusal plane in Class III patients based on five features: 1) facial type, 2) upper incisor display at rest, 3) dental exposure during smile, 4) soft tissue support, and 5) chin projection. The surgical manipulation of the occlusal plane can improve the esthetic outcome in the treatment of class III deformities, and careful evaluation of the five features described could be a helpful planning method.

Alteration of Occlusal Plane in Orthognathic Surgery: Clinical Features to Help Treatment Planning on Class III Patients

“…Lower lip projection was properly achieved for both patients after OP alterations, which got a better chin position regards to lower lip, without needing for genioplasty and more natural outcomes. The clinical features of orthognathic surgery were also described by Marlière et al [13] and Parente et al [14], who were successful in planning and achieved satisfactory esthetic and functional results.…”

“…The treatment planning of patients I and II was also based on the inclination of OP regarding to the Frankfort horizontal plane, but it was just qualitatively evaluated by comparing the posture of OP (Figure 3). Suchlike Parente et al [14], similar planning to patients I and II were optimized by the clinical perception of the surgeons in detriment to the use of cephalometric tracings. Since 1993, Arnett and Bergman [15] had shown that performing orthognathic surgery planning only by cephalometric analysis could generate unfavorable esthetic results.…”

“…One of the ways to benefit Class III patients such aesthetically as functionality is performed bimaxillary orthognathic surgery by means of treatment plannings based on alterations of the OP [13, 14]. Thus, Class III patients with different angulations of the OP can benefit from rotations of counterclockwise and clockwise of the maxillomandibular complex (MMC) [13].…”

“…Thus, Class III patients with different angulations of the OP can benefit from rotations of counterclockwise and clockwise of the maxillomandibular complex (MMC) [13]. In this sense, Marlière et al [13] and Parente et al [14] showed three clinical cases in Class III patients with different facial types and clinical features that performed different treatment planning in orthognathic surgery by counterclockwise and clockwise rotations of the MMC, but the authors disclosed to be more important the evaluation of the clinical features than clearly the obtainment of OP angulation during treatment planning.…”

Orthognathic Surgery Combined with Partial Lipectomy of the Buccal Fat Pad: Case Report on Optimization of Esthetic Outcome

“…Hernández-Alfaro et al [7] performed a subjective and objective three-dimensional evaluation of six patients with dentofacial anomalies and bilateral malar hypoplasia were managed with simultaneous orthognathic surgery and pedicled buccal fat pad augmentation. In conclusion, the pedicled buccal fat pad technique is a reasonable alternative for malar Therefore, the balance among the 5 aforementioned clinical characteristics described by Parente et al [16] was used in the case presented herein to achieve a reasonable esthetic outcome. The patient benefited from counterclockwise rotation because the chin rotated anteriorly, the angle of the mandibular plane decreased, the prominence of the mandibular angles increased and the mandibular contour was thereby improved.…”