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Orthognatic surgery

It is a modern, complex and relatively recent specialization, a branch of surgery which registered great progress over the past two decades.

It is difficult to compile an orthognatic ABC considering the complexity that defines this discipline. You can find below a “popularization” of the orthognatic field through a selection meant to facilitate the understanding of the phases comprising the entire process: from diagnosis to the setting out of the treatment plan, surgical intervention and recovery. For further details on this matter, please visit us at NAOS, the first clinic of orthognatic surgery in Romania, founded by a pioneer in this field, Dr. Ion Nicolescu.

Orthognatic surgery means the intervention on maxillary bones insufficiently or excessively, symmetrically or asymmetrically developed, with the purpose to improve three fundamental aspects: bite, breathing and esthetics. The process is complex and long lasting – however its results are worth the patience. Here are the steps:

  • Detecting the problem

    Patients of orthognathic surgery are usually easily to be identified, due to a specific facial aspect. A person may realize they have a problem when their face is too long or too short. In terms of facial profile, analyze the extent to which it is convex or concave. In case of a convex or “bird-like” profile, the inferior maxillary (mandible) is far too receding against the upper one. In a concave profile, the chin is excessively protruding. Last but not least, these anomalies are often associated with apparent asymmetries, particularly of the mandible.

    It is true however that not many accept the fact that they might be “abnormal” – although the anomalies described above are more frequent than you would imagine!

  • Which are the evaluation phases?

    If you relate to one of the situations described above, the next step would be to consult an orthodontist. To ensure a complete evaluation, a dental exam which would reveal non-functional alignments should be performed.

  • Treatment plan

    Following the evaluation, the orthodontist proposes a treatment solution. There are two possible courses of action: with or without surgery.

    The complete treatment option where orthodontic treatment is associated with surgical intervention on the bone, generates the most benefits for the patient. The option without surgery is a “border-line” situation. Functionally, in most cases this option may result in a stable bite, however this treatment does not fix the misalignment of the teeth, the breathing problems and the discontent with the esthetic appearance.

    The duration of the entire treatment is of approximately two years. Three main stages are highlighted: orthodontic preparation, surgical intervention and completion through orthodontic treatment. When prior dental conditions exist, this treatment may result in complications and may require additional dental procedures.

  • Orthodontic preparation

    This stage lasts approximately one year and is aimed at aligning the teeth according to the treatment plan.

    Throughout this period, the patient also begins to understand and express its esthetic desires. The intervention performed on the facial bone structure generates esthetic changes which are beneficial to the patient.

    Thus, prior to the surgical intervention, in-depth discussions between the patient, orthodontist and surgeon take place, using professional photos. The patient must have sufficient time to consider and self-discover him/herself esthetically.

  • Surgical intervention

    The orthognathic procedure entails the controlled fracturing of the maxillary bones, based on the pre-established plan, in order to position the fragments in the new desired structure and fix them with osteo-synthetic plates and screws.

    Special 3D software may also simplify the intervention.

    All procedures are performed through the mouth, thus preventing scaring on the exterior. To section the bone the surgeon uses an efficient toolkit and depending on the clinical situation and the desired outcome, the intervention is focused only on the maxillary, the mandible or menton, on all three or a combination of two.

    The intervention is performed under general anesthesia, in hospital care, and a complex procedure may last approximately 4 hours.

  • Recovery period

    The modern surgery technique, as well as the plates and screws used for fixation enable the patient to open his/her mouth immediately after surgery, and to resume the chewing function. This facilitates the immediate evaluation of the result and reduces the post-surgery recovery period to 10-14 days.

    The mouth is opened progressively, by adapting the musculature to the new anatomic situation, while the recovery reaches 75-80% within the first two weeks.

    The final esthetic result is assessed within 6 months after surgery.

  • Orthodontic procedures after surgery

    After operation, bones and teeth are in a correct alignment, while the orthodontic treatment will continue, so as to bring all teeth in the desired optimum contact.

Instead of conclusions

Orthognatic surgery generates extremely valuable functional and esthetic benefits for patients, as well as efficient results for orthodontists. It is crucial to develop a partnership between all three actors involved in the treatment.

Copyright Clinica NAOS - 2016