Asociación Mexicana de Ortopedia Maxilar A.C.

CIRUGIA ORTOGNATICA


Prof. Dr. Dietmar Segner


Prof. Dr. Dietmar Segner, (UKE).
Ortodoncia/Cirugía
Former Profesor and Director Department of Dentofacial Orthopedics, University of Hamburg Germany
Universität-Krankenhaus-Eppendorf
AMOM




23 al 26 de Nov. del 2000 Acapulco, Gro. México 5a Reunión Anual de Ortopedia Dentofacial AMOM 2000
Resumen de Conferencias


Hamburgo, Alemania


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, planning and
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 treated using
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 acceptable.
Diagnostic toos for the important decision between combined treatment and pure orthodontics will be
shown and applied in a number of exemplary cases.








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