As one of the frequent causes is heredity, it is important from very early on to visit and evaluate children with obvious signs of resemblance to the family. The problem is diagnosed and it is considered whether the child can benefit from orthopedic treatment to promote and stimulate growth or whether a monitoring process is followed during growth. If, on the other hand, it is decided that the case will require surgery, the ideal time is when the jaws stop growing, in girls around 16-18 years of age and in boys around 18-20 years of age.
The process of treating these skeletal problems can take about two years, remembering that it is a team effort between surgeon and orthodontist. It begins with a more or less long period of orthodontics, from 12 to 18 months of pre-surgical orthodontics, the idea is to place the teeth correctly so that the surgeon can reposition the bones with a stable occlusion.
The movement of the teeth can be done with different appliances, what should be very clear is what should be done with orthodontics and what should be done with surgery. Everything that is done with orthodontics that exceeds the limits of orthodontics tends to return to its initial position over time. The purpose of pre-surgical orthodontics is to undo the dental compensations that occur naturally to reduce the skeletal problem, so that at the end of the pre-surgical orthodontic phase the dental problem will have worsened, in order to obtain a correct position of the teeth after surgery. Orthodontics moves the teeth through periodic activation of the appliances until the objectives are achieved.
Orthognathic case preparation steps
Once the pre-surgical orthodontic objectives have been achieved, the design and aesthetic objectives of the surgery are reconsidered, these are discussed and accepted by the patient and the surgery is scheduled. The surgery can be performed on one bone, we will call it unimaxillary surgery, which operates the maxilla or mandible or bimaxillary surgery that operates both bones. Accessory surgeries can be performed on the chin, nose, lips, cheekbones, all to enhance the final aesthetics. It is a painless surgery, with possible swelling, with little time in hospital and initial recovery in a week and recovery of appearance in a month, the changes are completely stable in a year.
After the immediate surgery, the patient’s muscular movements begin to recover and the post-surgical orthodontic stage begins, where the occlusion and dental esthetics are detailed. This period can last between 6-12 months. At the end, as with all orthodontic treatment, retention appliances are placed to prevent relapse movements.
A new orthognathic surgery technique, SURGERY FIRST, is only a timing change, the surgery is performed almost at the beginning, so the pre-surgical orthodontic phase is almost null or minimal in time and all the orthodontic work is performed in the post-surgical phase. It should be performed by a team with a strong diagnostic and orthodontic technique for these cases. The planning must be exactly the same without forgetting any objective.
Technological advances in this surgical area are numerous, surgical techniques, mini-plates, minimize surgical time, recovery and bone recurrence. The use of digital technology, 3D records and advanced computerized guided surgery programs help to plan virtual surgery, allow greater efficiency, improve facial diagnosis by being able to assess the 3 dimensions and help predictability.