Three-dimensional stability analysis of maxillomandibular advancement surgery with and without articular disc repositioning

Abstract

This retrospective cohort study aimed to assess, three-dimensionally, mandible and maxilla changes following maxillomandibular advancement (MMA), with and without repositioning of TMJ articular discs. The sample comprised cone-beam computed tomography data from 32 subjects: group 1 (n = 12) without disc displacement and group 2 (n = 20) with bilateral disc repositioning. An automatic cranial base superimposition method was used to register the images at three time points: T1 (preoperative), T2 (postoperative), and T3 (at least 11 months follow-up). To assess surgical changes (T2-T1) and adaptive responses (T3-T2), the images were compared quantitatively and qualitatively using the shape correspondence method. The results showed that surgical displacements were similar in both groups for all the regions of interest except the condyles, which moved in opposite directions - group 1 to superior and posterior positions, and group 2 to inferior and anterior positions. For adaptive responses, we observed high individual variability, with lower variability in group 2. Sagittal relapse was similar in both groups. In conclusion, there were no significant differences in skeletal stability between the two groups. The maxillomandibular advancement surgeries, with rotation of the occlusal plane, had stable results for both groups immediately after surgery and at 1-year follow-up.

Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles

“…Compared with mini-screw anchor, open suturing had more condylar bone deposition (66.7% vs. 37.5%), and less bone resorption (8.3% vs. 11.1%) with an overall more condylar bone stability (91.7% vs. 87.5%). Gomes et al found after disc repositioning by Mitek anchors when combined with orthognathic surgery, the overall condylar volume tended to reduce and over 30% of the cases showed more than 1.5 mm of bone resorption on at least one surface of the condyle [ 8 ]. But he did not describe the jaw stability.…”

“…Studies have showed that ADD may increase jaw instability when combined with orthognathic surgery [ 5 ], especially for idiopathic condylar resorption (ICR) patients where the relapse rate has been reported from 83.3% to 100% [ 6 ]. To solve this problem, Wolford proposed disc repositioning when combined with orthognathic surgery [ 7 ] by Mitek anchors and gained more stable results than when disc repositioning was not performed [ 8 – 11 ]. Later, Yang et.…”

Literature Review of the Concepts of Condylar Resorption, Incidences during Orthodontic and after Orthognathic Surgery and Treatment Measures

“…In contrast, several authors deal with this type of patients using orthognathic surgery only and reporting an uneven amount of progressive resorption and relapse [26,[45][46][47][48]. Furthermore, Bianchi J, et al, [49] reported no significant differences in skeletal stability between the patients treated by maxillomandibular advancement surgeries with disc repositioning versus those without disc repositioning.…”

“…They concluded that counterclockwise rotation of the maxillomandibular complex of patients with healthy joint or simultaneous disc repositioning surgery shows stable postsurgical outcomes. However, Bianchi J, et al, stated no significant difference in skeletal stability between the patients subjected to TMJ disc repositioning followed by orthognathic surgery compared to those undergone orthognathic surgery alone [49].…”

Estabilidad del avance mandibular después de una cirugía ortognática en Clase II esquelética

“…al, 2021), otra combinación es con una rotación en sentido antihorario de la mandíbula la cual genera un cambio en el patrón oclusal del paciente (Balasubramanian et. al, 2021;Bianchi et. al, 2018;Ruslin et.…”