Two Cases of Skeletal Mandibular Protrusion Who Underwent Orthognathic Treatment after Middle Age

Abstract

Patients diagnosed with jaw deformity after middle age often have periodontal disease and missing teeth.In such cases, periodontal and prosthetic treatment is required in addition to orthodontic treatment. Therefore, surgical orthodontic treatment for middle-aged patients requires a more careful approach than for younger patients. This is a report of two representative cases.Case 1 : A 51-year-old male patient with the chief complaint of masticatory dysfunction by anterior cross bite was referred to our hospital. A diagnosis of mandibular prognathism was made and surgical orthodontic treatment was initiated. This patient had severe periodontal disease and missing teeth, which required periodontal treatment combined with periodontal surgery and prosthetic treatment before the surgical orthodontic treatment. In the surgical orthodontic treatment, anchor screws were used to support the vertical occlusal stop lost due to the missing teeth. After the presurgical orthodontic treatment, sagittal split ramus osteotomy was performed. Finally, partial dentures for the upper and lower jaws were fabricated for the final prosthesis.Case 2 : A 62-year-old female patient with the chief complaint of masticatory dysfunction by anterior cross bite was referred to our hospital. A diagnosis of mandibular prognathism was made and surgical orthodontic treatment was initiated. The periodontal disease was mild, but multiple teeth were missing. To shorten the treatment period, presurgical orthodontic treatment was minimized and prosthetic treatment was also applied. In the surgical orthodontic treatment, anchor screws were also used in this case to restore the vertical occlusal stop lost due to the missing teeth.After the presurgical orthodontic treatment, sagittal split ramus osteotomy was performed. Finally, partial dentures on the left side for the upper and lower jaws were fitted for the final prosthesis.Key words : jaw deformity ( 顎 変 形 症 ) ，periodontitis (歯周病) ，missing teeth (欠如歯) ［Received Nov. 12, 2021］ 1) 釧路赤十字病院歯科口腔外科(主任：道念正樹部長) 2) 旭川赤十字病院歯科口腔外科(主任：岡田益彦部長) 3) 北海道大学病院高次口腔医療センター顎口腔機能治療部門(主任：山口泰彦教授) 4) 北海道大学大学院歯学研究院口腔医学専攻口腔機能学分野歯科矯正学教室(主任：佐藤嘉晃教授) 1) Department of dentistry and oral surgery, Kushiro Red Cross Hospital