In all patients with orthognathic surgery, the surgery required by the patient must be taken into account: Does the upper jaw want to move forward or backward? Or does the lower jaw want to move forward or backward? Is the lower jaw supposed to rotate to correct the deviation? Does the jaw need to be impacted? Or scroll down? Should the upper jaw be wider or narrower? The same is true for patient Cl III, but the opposite is true, because patient Cl II has a small, retracted jaw. The lower incisors always lean towards the lip, which means that nature wants to pull the lower jaw forward, but since the whole lower jaw is set back, and nature could not move the lower jaw forward, it was able to push the lower incisors forward. Therefore, in a Cl II patient, the mandibular incisors are inclined toward the lip. With preoperative orthodontics, the lower incisors should be moved toward the tongue so that the teeth are on a healthy base. This means that the patient must be given more Overjet so that the surgeon has more freedom and ability to push the lower jaw forward. This means that for the Cl II patient’s mandibular incisors, which are inclined towards the lip due to Compensation, casts should be taken from the Maxillofacial Decompensate, and the casts should be sent to the surgeon and operated according to the type of surgical deformity.
Therefore, in patients with orthodontics, we first perform orthodontics, whose procedures are completely different from regular orthodontics, and then the patient undergoes surgery. After surgery, orthodontics continues, which may take from 6 months to a year. Then, compensatory treatments are performed by placing a Pontic for cases in which the patient has no teeth (such as litral). Sometimes rhinoplasty is performed. Orthodontists, prosthodontics and maxillofacial surgeons are members of this team.
Pre.Sur: When a patient comes for orthopedic surgery, we must first Align, Level his teeth. Level means that the teeth are in the same direction in terms of vertical dimension, that is, one of them should not be Intrude and the other Extrude. The patient may suffer from tooth crowding. Extraction. In the absence of Crowding, Extraction is not performed, so the teeth must first be lined up. That is, Aligning, Leveing, must be done to summarize from Crowding, then Dental Decompensation must be performed. For example, we have to operate a Brookline of mandibular teeth in a Cl III patient that have been lingual in nature.
That is, decompensation must be done. This means compounded Cl III. Because the incisors return to normal after surgery. Unfortunately, sometimes Arch Decompensation is not performed, so the surgeon does not have freedom in the operating room and the patient chooses between the surgeon and the specialist, but if the patient Cl III can be treated with orthodontics without surgery, the anterior teeth of the lower jaw must be lingual, ie With some devices we have to pull back the mandibular incisors and the entire mandible.
The next step is to make the Coordinate of the up and down arc. So, after Aligning, Leveling, Decrowding, and Dental Decompensation, the brackets are aligned and the surgery is performed.
After the surgery, IMF is done for the jaws, that is, Intermaxillary Fixation is performed, in this case, the upper and lower jaws are joined for eight weeks, and the patient eats using a lollipop. It is possible to use screws and plate, in which case we resort to Rigid Fixation and the jaws will not be wire connected.
Slide of a Typical Patient: The slides show a patient who was wrongly treated with orthodontics when he needed jaw straightening surgery. The patient is bothered by the height of the face. He suffers from Lip Incompeyency. The lips are open more than 3-4 mm in the resting position. He can only close the lips in a tense state with the lower jaw retracted. The previous dentist did a Flare for the upper and lower teeth to bring the lips together. But the patient is not satisfied with the shape of the face, not satisfied with the retracted jaw. We consider the patient Cl II. The first premolars of the lower jaw should be extracted and the patient given more overjet. In this patient, the upper jaw is not very forward, we extract the second premolars from the upper jaw, which has less effect on the shape of the upper jaw. So we extract two units of the upper jaw (maxillary second premolars) and two units of the lower jaw (mandibular first premolars) in the patient.
