Orthodontics

Abstract

In correcting dentofacial skeletal deformities, the role of the orthodontist and surgeon are equally important. The responsibility of the orthodontist is to diagnose and treatment plan the case, decompensate the dentition, and provide the surgeon a stable intra-arch dental framework. The surgeon must then place the skeletal components into the most pleasing and functional position possible to achieve the pretreatment goals established for the patient. Clear communication is essential as the goals of presurgical orthodontic treatment generally are opposite that of the routine orthodontic regimen used to camouflage the skeletal discrepancies in patients who choose not to pursue surgery. Successful occlusal relationships can be achieved with orthodontic treatment alone in minor skeletal discrepancies and at times even in more significant deficiencies; however, it is frequently at the expense of a pleasing facial appearance or a precarious position of a tooth that can risk its vitality relative to its position within the cortical and cancellous bone alveolus. These same patients who have had orthodontic treatment without consideration for combined surgical-orthodontic management may seek plastic surgical procedures later in life to address this residual skeletal deformity. Skeletal correction, once the occlusion is achieved, is compromised and frequently requires the use of prosthetic implants and soft tissue procedures to camouflage the deformity: the results of which are less than ideal.