Positional changes in the mandibular proximal segment after intraoral vertical ramus osteotomy: Surgery-first approach versus conventional approach원문보기
Jung, Seoyeon
(Department of Dental Education, Yonsei University College of Dentistry)
,
Choi, Yunjin
(Department of Statistics, University of Seoul)
,
Park, Jung-Hyun
(Department of Oral and Maxillofacial Surgery, Ewha Womans University Medical Center)
,
Jung, Young-Soo
(Department of Oral and Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry)
,
Baik, Hyoung-Seon
(Department of Orthodontics, Yonsei University College of Dentistry)
Objective: To compare postoperative positional changes in the mandibular proximal segment between the conventional orthognathic surgery (CS) and the surgery-first approach (SF) using intraoral vertical ramus osteotomy (IVRO) in patients with Class III malocclusion. Methods: Thirty-eight patients wit...
Objective: To compare postoperative positional changes in the mandibular proximal segment between the conventional orthognathic surgery (CS) and the surgery-first approach (SF) using intraoral vertical ramus osteotomy (IVRO) in patients with Class III malocclusion. Methods: Thirty-eight patients with skeletal Class III malocclusion who underwent bimaxillary surgery were divided into two groups according to the use of preoperative orthodontic treatment: CS group (n = 18) and SF group (n = 20). Skeletal changes in both groups were measured using computed tomography before (T0), 2 days after (T1), and 1 year after (T2) the surgery. Three-dimensional (3D) angular changes in the mandibular proximal segment, condylar position, and maxillomandibular landmarks were assessed. Results: The mean amounts of mandibular setback and maxillary posterior impaction were similar in both groups. At T2, the posterior portion of the mandible moved upward in both groups. In the SF group, the anterior portion of the mandible moved upward by a mean distance of 0.9 ± 1.0 mm, which was statistically significant (p < 0.001). There were significant between-group differences in occlusal changes (p < 0.001) as well as in overjet and overbite. However, there were no significant between-group differences in proximal segment variables. Conclusions: Despite postoperative occlusal changes, positional changes in the mandibular proximal segment and the position of the condyles were similar between CS and SF, which suggested that SF using IVRO achieved satisfactory postoperative stability. If active physiotherapy is conducted, the proximal segment can be adapted in the physiological position regardless of the occlusal changes.
Objective: To compare postoperative positional changes in the mandibular proximal segment between the conventional orthognathic surgery (CS) and the surgery-first approach (SF) using intraoral vertical ramus osteotomy (IVRO) in patients with Class III malocclusion. Methods: Thirty-eight patients with skeletal Class III malocclusion who underwent bimaxillary surgery were divided into two groups according to the use of preoperative orthodontic treatment: CS group (n = 18) and SF group (n = 20). Skeletal changes in both groups were measured using computed tomography before (T0), 2 days after (T1), and 1 year after (T2) the surgery. Three-dimensional (3D) angular changes in the mandibular proximal segment, condylar position, and maxillomandibular landmarks were assessed. Results: The mean amounts of mandibular setback and maxillary posterior impaction were similar in both groups. At T2, the posterior portion of the mandible moved upward in both groups. In the SF group, the anterior portion of the mandible moved upward by a mean distance of 0.9 ± 1.0 mm, which was statistically significant (p < 0.001). There were significant between-group differences in occlusal changes (p < 0.001) as well as in overjet and overbite. However, there were no significant between-group differences in proximal segment variables. Conclusions: Despite postoperative occlusal changes, positional changes in the mandibular proximal segment and the position of the condyles were similar between CS and SF, which suggested that SF using IVRO achieved satisfactory postoperative stability. If active physiotherapy is conducted, the proximal segment can be adapted in the physiological position regardless of the occlusal changes.
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가설 설정
Evaluation of angular changes in the mandibular proximal segment before (T0), immediately after (T1), and 1 year after (T2) treatment with the surgery-first approach (SF) or the conventional orthognathic surgery approach (CS) using intraoral vertical ramus osteotomy. A, Horizontal change. B, Sagittal change.
(+), Lateral flaring from the midsagittal plane (MSP). B, Sagittal change. (+), Clockwise rotation.
Mimics 16.0 (Materialise NV, Leuven, Belgium), a 3D medical image program, was used to reconstruct the 3D images as stereolithography (STL) files and separate the reconstructed mandible from the skull for accurate measurement of condylar reference points.
Accordingly, the aim of this study was to use 3D CT analysis to compare postoperative positional changes in the mandibular proximal segment, which might affect postoperative stability, between CS and SF using IVRO in patients with Class III maloccusion.
Intermaxillary fixation was performed with the cortical bone of the external area of the distal bone segment and the internal area of the proximal bone segment remaining in contact without rigid fixation. All patients underwent 5 weeks of active physiotherapy after removal of the fixation followed by postoperative orthodontic treatment.
CT images (SOMATOM Definition AS; Siemens, Erlangen, Germany) were obtained and evaluated before (T0), 2 days after (T1), and 1 year after (T2) the surgery for all patients. Images were acquired under the following conditions: 120 mA, 100 kV, scanning time of 1 second, slice thickness of 0.
A positive value was assigned when the proximal segment rotated laterally from MSP, clockwise in the sagittal plane, and outward from MSP in the horizontal plane (Figure 4). For the assessment of condylar head displacement, mediolateral, anteroposterior, and vertical displacements of CON were measured at T0, T1, and T2. For measurement of the angular change between the proximal and distal segments, the angle between the proximal segment plane (PxP) and the mandibular plane (MP) was separately measured on the right and left sides.
Mixed model repeated measures analysis of variance was performed to detect statistically significant betweengroup differences in changes in the mandibular proximal segment during T1–T0 and T2–T1.
0 (Materialise NV, Leuven, Belgium), a 3D medical image program, was used to reconstruct the 3D images as stereolithography (STL) files and separate the reconstructed mandible from the skull for accurate measurement of condylar reference points. The 3D cranial models were superimposed using the Rapidform 2006 (INUS Technology, Seoul, Korea) program at T0, T1, and T2, so that all measurements were obtained using a common reference plane. Guiding points, including the two supraorbital foramina, two zygomaticofacial foramina, and lambda point (Figure 1), were used for the overlapping process, with an error of < 0.
The inclusion criteria were as follows: diagnosis of skeletal Class III malocclusion; menton deviation within 3 mm of the midsagittal plane (MSP); requirement of nonextraction orthodontic treatment; and availability of preoperative, immediate postoperative, and 1-year postoperative multi-detector CT records obtained under informed consent. The exclusion criteria were as follows: menton deviation over 3 mm, cleft lip and palate or other severe maxillofacial congenital deformities, and metabolic diseases that could affect the bone healing process. The subjects were divided into two groups according to the use of preoperative orthodontic treatment.
05 was considered statistically significant. The independent t-test was used to detect significant differences between the CS and SF groups, and the paired t-test was used to detect changes in the measurements during each time interval. Mixed model repeated measures analysis of variance was performed to detect statistically significant betweengroup differences in changes in the mandibular proximal segment during T1–T0 and T2–T1.
대상 데이터
Thirty-eight patients who underwent bimaxillary orthognathic surgery performed by the same surgeon in the Department of Oral and Maxillofacial Surgery at Yonsei University Dental Hospital from 2010 through 2014 were recruited. The inclusion criteria were as follows: diagnosis of skeletal Class III malocclusion; menton deviation within 3 mm of the midsagittal plane (MSP); requirement of nonextraction orthodontic treatment; and availability of preoperative, immediate postoperative, and 1-year postoperative multi-detector CT records obtained under informed consent.
데이터처리
CS, Conventional orthognathic surgery; SF, surgery-first approach; ANOVA, analysis of variance; SD, standard deviation; COR, angular changes in the proximal segment in the coronal view: (+) lateral flaring from midsagittal plane (MSP), (−) medial flaring from MSP; SAG, angular changes in the sagittal view: (+) clockwise rotation, (−) counterclockwise rotation; HOR, angular changes in the horizontal view: (+) outward rotation, (−) inward rotation; SS, sum of squares; MS, mean squares; F, test statistic.
Independent t-test or †paired t-test were performed.
Independent t-test was performed.
성능/효과
9° in the SF group (see Figure 4 for descriptions of the directions). At 1 year after surgery, the line showed a tendency to recover by moving 27.7% and 31.3% medially in the CS and SF groups, respectively, with no significant between-group difference. In the sagittal plane, the line passing through Cp and G-Post showed clockwise rotation of 8.
We speculate that a subperiosteal, cortical bone-derived, and endosseous callus was formed, remodeled during physiotherapy, and adapted at the new position. The final CON position in the SF group demonstrated that the condyles were set in the physiological position regardless of the postoperative occlusal changes; this verified that SF using IVRO results in stability after treatment.
후속연구
Because the observation period in the present study was only 1 year, studies with longer follow-up durations are required. In addition, a study with an additional detailed classification of the subjects by the degree of vertical dimensional changes in a larger sample would make a valuable contribution to research regarding the stability of SF.
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