Dentofacial deformity

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It is estimated that nearly 30% of the general population present with malocclusions that are in great need of orthodontic treatment. [1] However, the term dentofacial deformity describes an array of dental and maxillo-mandibular abnormalities, often presenting with a malocclusion, which is not amenable to orthodontic treatment alone and definitive treatment needs surgical alignment of upper/lower jaws or both (orthognathic surgery). Individuals with dentofacial deformities often present with lower quality of life and compromised functions with respect to breathing, swallowing, chewing, speech articulation, and lip closure/posture. [2] [3] [4] It is estimated that about 5% of general population present with dentofacial deformities that are not amenable to orthodontic treatment only and required sugical correction (orthognathic surgery) as well [5] [6] [7] [8] and patients with Class III malocclusion appear to form the mojority of these patients. [9] [10] [11]


Facial skeletal deformity can be in the form of maxillary prognathism/retrognathism (pushed out or deficient upper jaw), mandibular prognathism/retrognathism (pushed out or deficient lower jaw/receding chin), open bite (upper and lower front teeth do not meet), transverse discrepancies and asymmetry of the Jaws (very narrow/wide upper or lower jaws, shifting upper/lower jaws to right/left side), and long/short faces. [12] [13] [14]

Surgical correction of dentofacial deformities started around 1849 in the USA by S. R. Hullihan, a general surgeon, and was limited to the correction of the mandible (prognathism). Later on, around the turn of the twentieth century, early orthognathic surgery was born, when in St. Louis Edward Angle (orthodontist) and Vilray Blair (surgeon) started to work together and Blair stressed the importance of collaboration between surgeon and orthodontist. However, modern orthognathic surgery started to develop in central Europe by surgeons such as R. Trauner (Graz), Martin Wassmund (Berlin), Heinz Köle (Graz) and Hugo Obwegeser (Zurich). [15]

Detecting patients with dentofacial deformity by clinicians using an index is a new development in orthodontics and orthognathic surgery; Dr Anthony Ireland and his colleagues developed a new index called the index of orthognathic functional treatment need (IOFTN) that detects patients with the greatest need for orthognathic surgery as a part of their comprehensive treatment. [16] IOFTN has been validated internationally and when used on retrospective samples of patients who had orthognathic surgery, detected over 93% of patients with the greatest need for orthognathic surgery (IOFTN score≥4). [17]

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<span class="mw-page-title-main">Orthodontics</span> Correctional branch of dentistry

Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial orthopedics.

<span class="mw-page-title-main">Dental braces</span> Form of orthodontics

Dental braces are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

<span class="mw-page-title-main">Prognathism</span> Protrusion of the upper or lower human jaw

Prognathism is a positional relationship of the mandible or maxilla to the skeletal base where either of the jaws protrudes beyond a predetermined imaginary line in the coronal plane of the skull.

<span class="mw-page-title-main">Orthognathic surgery</span> Surgery of the jaw

Orthognathic surgery, also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, and other orthodontic dental bite problems that cannot be treated easily with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries, and malproportions where correction may be considered to improve facial aesthetics and self-esteem.

<span class="mw-page-title-main">Malocclusion</span> Misalignment between upper and lower teeth as the jaws close

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855–1930), the "father of modern orthodontics", popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.

Orthodontic technology is a specialty of dental technology that is concerned with the design and fabrication of dental appliances for the treatment of malocclusions, which may be a result of tooth irregularity, disproportionate jaw relationships, or both.

<span class="mw-page-title-main">Overjet</span> Extent of horizontal overlap of the top and bottom front teeth (incisors)

In dentistry, overjet is the extent of horizontal (anterior-posterior) overlap of the maxillary central incisors over the mandibular central incisors. In class II malocclusion the overjet is increased as the maxillary central incisors are protruded.

<span class="mw-page-title-main">Crossbite</span> Left-right misalignment of upper and lower teeth

In dentistry, crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

<span class="mw-page-title-main">Craniofacial abnormality</span> Birth defects of the cranium and facial bones

Craniofacial abnormalities are congenital musculoskeletal disorders which primarily affect the cranium and facial bones.

Cephalometric analysis is the clinical application of cephalometry. It is analysis of the dental and skeletal relationships of a human skull. It is frequently used by dentists, orthodontists, and oral and maxillofacial surgeons as a treatment planning tool. Two of the more popular methods of analysis used in orthodontology are the Steiner analysis and the Downs analysis. There are other methods as well which are listed below.

<span class="mw-page-title-main">Jaw abnormality</span> Medical condition

A jaw abnormality is a disorder in the formation, shape and/or size of the jaw. In general abnormalities arise within the jaw when there is a disturbance or fault in the fusion of the mandibular processes. The mandible in particular has the most differential typical growth anomalies than any other bone in the human skeleton. This is due to variants in the complex symmetrical growth pattern which formulates the mandible.

Long face syndrome, also referred to as skeletal open bite, is a relatively common condition characterised by excessive vertical facial development. Its causes may be either genetic or environmental. Long face syndrome is "a common dentofacial abnormality." Its diagnosis, symptomology and treatments are complex and controversial. Indeed, even its existence as a "syndrome" is disputed.

Dr. William J. Clark is a Scottish orthodontist known for developing Twin Block Appliance in Orthodontics. This appliance was developed by Dr. Clark in 1977 in Scotland and since then this appliance has been used in correction of Class 2 malocclusions with retrognathic mandible. He also developed invisible TransForce Appliance in 2004.

Elastics are rubber bands frequently used in the field of orthodontics to correct different types of malocclusions. The elastic wear is prescribed by an orthodontist or a dentist in an orthodontic treatment. The longevity of the elastic wear may vary from two weeks to several months. The elastic wear can be worn from 12 to 23 hours a day, either during the night or throughout the day depending on the requirements for each malocclusion. The many different types of elastics may produce different forces on teeth. Therefore, using elastics with specific forces is critical in achieving a good orthodontic occlusion.

Open bite is a type of orthodontic malocclusion which has been estimated to occur in 0.6% of the people in the United States. This type of malocclusion has no vertical overlap or contact between the anterior incisors. The term "open bite" was coined by Carevelli in 1842 as a distinct classification of malocclusion. Different authors have described the open bite in a variety of ways. Some authors have suggested that open bite often arises when overbite is less than the usual amount. Additionally, others have contended that open bite is identified by end-on incisal relationships. Lastly, some researchers have stated that a lack of incisal contact must be present to diagnose an open bite.

Orthodontic indices are one of the tools that are available for orthodontists to grade and assess malocclusion. Orthodontic indices can be useful for an epidemiologist to analyse prevalence and severity of malocclusion in any population.

John Mew is a British orthodontist. He is the founder of orthotropics and mewing. Orthotropics is a form of oral posture training that claims to guide facial growth and is not supported by mainstream orthodontists. John Mew's son Michael Mew is also an orthodontist and has also practised and promoted the idea of orthotropics.

Surgically facilitated orthodontic therapy(SFOT) is a group of orthodontic procedures; they can be broadly divided into two main categories.

<span class="mw-page-title-main">Mandibular setback surgery</span>

Mandibular setback surgery is a surgical procedure performed along the occlusal plane to prevent bite opening on the anterior or posterior teeth and retract the lower jaw for both functional and aesthetic effects in patients with mandibular prognathism. It is an orthodontic surgery that is a form of reconstructive plastic surgery. There are three main types of procedures for mandibular setback surgery: Bilateral Sagittal Split Osteotomy (BSSO), Intraoral Vertical Ramus Osteotomy (IVRO) and Extraoral Ramus Osteotomy (EVRO), depending on the magnitude of mandibular setback for each patient. Postoperative care aims to minimise postoperative complications, complications includes bite changes, relapse and nerve injury.

<span class="mw-page-title-main">Joel Ferri</span> French doctor, academic, and author

Joel Ferri is a French Stomatologist, Oral and Maxillofacial Surgeon, academic and author. He is the chairman and head of the Department of Oral and Maxillofacial Surgery at the Lille Medical School.

References

  1. ↑ Borzabadi-Farahani, A (2011). "An Insight Into Four Orthodontic Treatment Need Indices". Prog Orthod. 12 (2): 132–142. doi:10.1016/j.pio.2011.06.001. PMID   22074838.
  2. ↑ Bourdiol P, Soulier-Peigue D, Lachaze P, Nicolas E, Woda A, Hennequin M (2017). "Only severe malocclusion correlates with mastication deficiency". Arch Oral Biol. 75 (March): 14–20. doi:10.1016/j.archoralbio.2016.12.002. PMID   27978477.
  3. ↑ Al-Asfour A, Waheedi M, Koshy S (2018). "Survey of patient experiences of orthognathic surgery: health-related quality of life and satisfaction". Int J Oral Maxillofac Surg. 6 (47): 726–731. doi:10.1016/j.ijom.2017.12.010. PMID   29373200. S2CID   13781651.
  4. ↑ Kim H, Sakamoto T, Yamaguchi H, Sueishi K (2017). "Evaluation of Chewing Movement in Skeletal Class III Patients with Orthognathic Treatment". Bull Tokyo Dent Coll. 4 (58): 213–221. doi: 10.2209/tdcpublication.2016-2300 . PMID   29269715.
  5. ↑ Posnick, Jeffrey C. (September 2013). Orthognatic Surgery: Principles and Practice. Amsterdam: Elsevier. pp. 61–68. doi:10.1016/B978-1-4557-2698-1.00003-4. ISBN   978-145572698-1.
  6. ↑ Harrington C, Gallagher JR, Borzabadi-Farahani A (2015). "A retrospective analysis of dentofacial deformities and orthognathic surgeries using the index of orthognathic functional treatment needs (IOFTN)". Int J Pediatr Otorhinolaryngol. 79 (7): 1063–6. doi:10.1016/j.ijporl.2015.04.027. PMID   25957779.
  7. ↑ Borzabadi-Farahani A, Eslamipour F, Shahmoradi M (2016). "Functional needs of subjects with dentofacial deformities: A study using the index of orthognathic functional treatment need (IOFTN)". J Plast Reconstr Aesthet Surg. 69 (6): 796–801. doi:10.1016/j.bjps.2016.03.008. PMID   27068664.
  8. ↑ Eslamian L, Borzabadi-Farahani A, Badiee MR, Le BT (2019). "An Objective Assessment of Orthognathic Surgery Patients". J Craniofac Surg. 30 (8): 2479–248. doi:10.1097/SCS.0000000000005916. PMID   31689730. S2CID   207894272.
  9. ↑ Proffit WR, Jackson TH, Turvey TA (2013). "Changes in the pattern of patients receiving surgical-orthodontic treatment". Am J Orthod Dentofacial Orthop. 143 (6): 793–8. doi:10.1016/j.ajodo.2013.01.014. PMID   23726329.
  10. ↑ Ireland AJ, Atack NE, Cunningham SJ, House K, Cobourne MT, Hunt NP, Sherriff M, Sandy JR (2019). "National British Orthodontic Society (BOS) Orthognathic Audit 2017-2018". J Orthod. 46 (4): 287–296. doi:10.1177/1465312519879934. hdl: 1983/eb2594aa-f924-4641-8eca-28d3660a225b . PMID   31595815.
  11. ↑ Borzabadi Farahani A, Olkun HK, Eslamian L, Eslamipour F (2024). "A retrospective investigation of orthognathic patients and functional needs". Australasian Orthodontic Journal. 40: 111–120. doi: 10.2478/aoj-2024-0013 .
  12. ↑ Fonseca, Raymond J. (April 2017). Oral and Maxillofacial Surgery. Amsterdam: Elsevier. ISBN   9780323414999.
  13. ↑ Eslamipour F, Borzabadi-Farahani A, Le BT, Shahmoradi M (2017). "A retrospective analysis of dentofacial deformities and orthognathic surgeries". Ann Maxillofac Surg. 7 (1): 73–77. doi: 10.4103/ams.ams_104_16 . PMC   5502519 . PMID   28713739.
  14. ↑ Olkun HK, Borzabadi-Farahani A, Uçkan S (2019). "Orthognathic Surgery Treatment Need in a Turkish Adult Population: A Retrospective Study". Int J Environ Res Public Health. 16 (11): 1881. doi: 10.3390/ijerph16111881 . PMC   6603578 . PMID   31141986.
  15. ↑ Steinhäuser EW (1996). "Historical development of orthognathic surgery". J Craniomaxillofac Surg. 24 (4): 195–204. doi:10.1016/S1010-5182(96)80002-3. PMID   8880445.
  16. ↑ Ireland AJ, Cunningham SJ, Petrie A, Cobourne MT, Acharya P, Sandy JR, Hunt NP (2014). "An index of orthognathic functional treatment need (IOFTN)". J Orthod. 41 (2): 77–83. doi:10.1179/1465313314Y.0000000100. PMC   4063315 . PMID   24951095.
  17. ↑ Borzabadi-Farahani, A (2023). "Systematic Review and Meta-Analysis of the Index of Orthognathic Functional Treatment Need for Detecting Subjects with Great Need for Orthognathic Surgery". Cleft Palate Craniofac J. doi:10.1177/10556656231216833. PMID   38037271.
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