Dental Implants and Maxillofacial Surgery :
Are there any complications of Orthognathic Jaw surgery?
Orthognathic Jaw surgeries take place under general aenesthesia and may take 2-4 hours. When needed blood supply may be given during the operation. As in all surgical operations there can be complications in jaw surgeries, too.
General aenesthesia complications as in every operation might occur. Nerve damage can cause sense or function loss of the lips, tongue and artery damage can cause necrosis of the bones. The patient must be informed by his/her surgeon before the operations about the possible complications that may occur. Patients should trust the maxillofacial surgeon as well as the orthodontist.
If jaw surgery is necessary why is orthodontic treatment also required?
If the patient has a skeletal malocclusion patients have generally a naturally compromised occlusion. For example, when mandibular jaw is prognathic, the mandibular anterior teeth tend to be tilted backwards to obtain contact with maxillary anterior teeth. Such as the maxillary incisors are excessively proclined to be in contact with the antagonist incisors. Also the transversal ratios of the two jaws are not proper in size. When this is the scenario, the orthodontist’s job is to prepare proper transversal sizes of maxilla and mandible in relation to each other, and uncrowded dental arches with the anatomic incisor inclinations before the surgery. Like in the given example, the size of the tea pot (mandible) and the lit (maxilla) should be matching in harmony.
After orthodontic jaw surgery operations what are the consequences?
The first 1-2 weeks are the most critical time period. The jaws are tied to each other with elastic bands. The patient has to eat liquid nutritions via a straw. At this time period the patient has to take antibiotics and painkillers as post-operational precaution. After 1-2 weeks the patient must go to his/her orthodontist for the removal of the elastic bands, and as part of recovery he/she has to do mouth opening exercises. During this stage of recovery the patient can eat smooth and soft food which does not tire the jaws or involve too much pressure during chewing. The patient may loose some weight during these stages, which is accepted as a normal reaction. Oral hygiene and mouth care is very important during this time. Teeth brushing must be continued at all times after the operation. Water peek is very useful and can be applied with saline solution or other mouthwash. Within 3-4 months after the surgery the treatment is completed.
What is the surgical planning procedure?
The most important stage for planning is diagnosing the patient. Both the surgeon and orthodontist should clinically examine the case, and cooperate well while planning. The dental midlines, skeletal asymmetries, joint locations, shapes, tongue-lip functions, smile line, mimics and dental occlusion must be evaluated.
The positions of maxilla and mandible can only be evaluated with articulated cast models. Maxilla’s position is carried out with the help of a face bow,.The mandibles position in relation to maxilla is carried out with the help of the bite registration wax. This gives the most accurate positions of the jaws and the mandibular condyle head. Correct determination of the condyle position affects surgery’s goals.
The patients lateral and postero- anterior 2D radiographs are analized with a tracing computer programme. This computer tracing analysis helps us to evaluate the patient post operatively by showing 2d profile skeletal and soft tissue reflections. By model surgery we are able to simulate the surgery outcome and the surgical splints are prepared accordingly by the technician. It is also advisable to use 3d computer tomography analysis before the surgery. 3D plastic models can be printed using the tomography photographs.
One – or double – jaw surgery?
Each patient’ s anatomy varies, as well as each surgeons abilities. The more the asymmetry and malocclusion involves the two jaws, the more likely it is to do double jaw surgery for better aesthetic and function.
Who should do orthognathic jaw surgery operations?
Plastic surgeons who are specialised in maxilo- facial surgery should do these operations. In some countries oral surgeons who are keen in maxilla facial surgery are also allowed to do these types of surgeries. The local rules and procedures can be different in every country. It is better to discuss it with the local authorities in your country.
Can bone be regenerated by orthodontic tooth movement in toothless regions of the jaws with bone loss?
Early tooth extractions cause bone loss at the related regions. Bone loss can be seen in horizontal and vertical directions. Also edentulous regions of the jaws because of genetically missing teeth can show severe bone loss. These defects can be treated with orthodontic tooth movement. The tooth that is moved through the defect will help the bone regenerate.
When is the right time to place a dental implant at the orthodontically regenerated bone regions?
Better to wait for 3- 4 months for proper bone mineralization at the newly regenerated sides.
What should be done when there is not enough space for implants between tilted teeth at the edentulous space?
With orthodontic treatment the tilted teeth can be straightened, and needed space can be obtained for implants.
At what age are implants suitable for patients?
Not before 18. At the anterior regions better to wait until the growth period is ended.