Asociación Mexicana de Ortopedia Maxilar A.C.
Prof. Dr. Dietmar Segner, (UKE).
Former Profesor and Director Department of Dentofacial Orthopedics,
University of Hamburg Germany
23 al 26 de Nov. del 2000 Acapulco, Gro. México 5a Reunión
Anual de Ortopedia Dentofacial AMOM 2000
Resumen de Conferencias
1.- The interdiciplinary team approach to orthodontic surgery
To be optimally effective and successful an orthognathic surgery treatment requires
a precisely defined course of treatment steps and the communication and joint
planning of maxillofacial surgeon and orthodontist. A true inter-disciplinary
treatment goes beyond the fact that a patient receives treatment from two different
professionals. It involves the knowledge of treatment modalities and problems
and as measures in one discipline influence the treatment objectives in the
other a collective treatment planning before any treatment is initiated is an
absolute necessity. First the skeletal and esthetic requirements are established,
then on this basis the orthodontic objectives can be put down.
2. Aspects of class II treatment.
The correction of patients with a class II occlusion has become one of the main
applications of orthognathic surgery for our team. Advantages in the areas of
profile esthetics, long term stability, reduction of operating risks, and decrease
of root resorptions have led to an increase in the frequency of such operations.
Good and consistent results can only be achieved if a number of aspects in diagnosis,
treatment are obeyed. Among these are.
- patient information and selection
- vertical relationship
- which jaw to operate on
- what type of surgical procedure
- incisor position
- timing of surgery within orthodontic treatment
- orthodontic decompensation treatment
- post-surgical treatment
- relapse prevention
The relevance of these items will be explained using some typical orthognathics
surgery treatments of
class II patients.
3, The borderline between conventional orthodontics
and orthognathic surgery cases.
What makes a case an orthognathic surgery case and what allows the case to be
conventional orthodontics? The treatment of a great number of combined cases
during the last 15 years has shown the great importance of a precise individualized
cephalometric analysis in combination with an analysis of the soft tissue profile.
The skeletal diagnosis is of paramount importance as it can be shown that a
number of severe dental malocclusions cannot easily be treated using orthognathic
surgery because of the absence of skeletal discrepancies. On the other hand
the combination of relatively small skeletal deviations in more than one dimension
can lead to an indication for a surgery.
Of special importance in this behalf are transverse and vertical discrepancies.
The analysis of the profile and facial appearance is gaining importance in general
orthodontics and espeially in adult orthodontics. The times were treatment results
could be evaluated by plaster models only are gone. But in orthognathic surgery
the profile diagnosis is even more important because of the significant changes
that can be effected by orthognathic surgery.
Sometimes orthognathic surgery is indicated for functional reasons like enabling
lip closure and
improving facial esthetics although the dental relation might be considered
Diagnostic toos for the important decision between combined treatment and pure
orthodontics will be
shown and applied in a number of exemplary cases.