Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
5
MAY
20062009
VOL.14
NO.6
JUNE
Dental Bulletin
Open Bite
Bimaxillary
Protrusion
Vertical Maxillary
Excess (VME)
Patient Evaluvation
Orthognathic Surgeries
According to the diagnosis, orthognahtic surgeries can
be performed to correct the deformities. Le Fort I
osteotomy is the most commonly performed maxillary
surgery; It can move the maxilla, basically, in all
dimensions. Maxilla can also be segmentalised into two
11
Dental Bulletin
frontal and profile analyses. For the frontal view, facial
form should first be addressed. It is defined as the
relationship between the facial width and vertical
height. The general average of the height-to-width
proportion is 1.3:1 for females and 1.35:1 for males.
Short square facial types are usually associated with
class II, deep bite, vertical maxillary deficiency and
masseteric hypertrophy, while long narrow facial types
are often associated with VME, narrow nose, high
palatal vault and +/- anterior open bite. The "rule of
fifths" is a commonly used method for analysing
transverse facial proportion, where the face is divided
into five equal parts as shown in Fig. 1.
Facial asymmetry is assessed through an imaginary line
drawn from the soft tissue glabella, tip of nose, centre of
filtrum and soft tissue pogonion. (Fig. 2) Assessment
should be made not only on the chin midline, but also
to facial balance, cheek and zygomatic prominence and
level of the eyes. Vertical relationship can be assessed
by dividing the face into upper, middle and lower
thirds. Both skeleton and soft tissue should be
evaluated in details, especially the symmetry. (Fig. 3)
For the profile view, similar to frontal assessment, we
would evaluate the form, the upper, middle and lower
thirds. However, special attention is made to the nose,
cheeks, naso-labial angle, lip prominence, labial-mental
fold and the chin prominence.
Fig.1
Fig.2
Fig.3
12
Fig.4
Fig.5
VOL.11 NO.5
MAY
20062009
VOL.14
NO.6
JUNE
Dental Bulletin
to do our orthognathic workup from making the correct
diagnosis to bringing the patient to the operating
theatre.
3D Cephalometric Analysis
The traditional lateral cephalometric analysis has the
difficulty of identifying the various anatomical
landmarks projected onto a mid-sagittal plane as
mentioned before. This limitation is even more
noticeable when we are dealing with facial asymmetry.
However location of anatomical landmarks on a 3D
skull model is straight forward. Many research centres
are coming up with 3D cephalometric data for normal
population and individuals with various dentofacial
deformities so that an accurate reference is available to
make our diagnosis. (Fig. 9)
Virtual Surgery
Surgeries can be performed on the 3D virtual model. It
is possible to visualise the relative movements of
different bony segments and identify any potential
obstacles to our surgical movements. Therefore
different surgical plans can be tried out, so as to
optimise the surgical procedures and to improve the
surgical outcome. All these help to reduce the surgical
time and the chance of facing surprises on the
operating table. (Fig. 10)
13
Dental Bulletin
Fig. 14 Colour Histogram showing the difference between preand post-operative soft tissue surfaces
Fig. 13 Post-operative CBCT registered with pre- and postoperative soft tissue surfaces
14
Future