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FIG 5a: Follow up after 2 years
FIG 5b: Comparison between before and after
guided to perform opening and lateral jaw movements. No breath-
ing issues was observed postoperatively. Patient was discharged on
third postoperative day and IMF was released after 1 week of follow
up. The surgical and post-surgical phases were passed without any
complications.
Follow up after 1 week which showed uneventful healing and
occlusion not yet achieved. (Figure 3)
For first few days, width of mouth opening is reduced as conse-
quence of immobilization and new occlusal position with different
skeletal orientation and consequent alteration in dental, skeletal,
and muscular functioning. After 2 weeks, patient usually opens his
mouth enough, following muscular reprogramming carried out
under guidance. Patient is asked to perform opening and closing
with lateral and protrusive exercises three times a day.
After 3-4 weeks, good functional rehabilitation is obtained, per-
mitting with progression to the final occlusal stabilization. This
principally involves postsurgical orthodontic treatment aimed at
achieving the satisfactory occlusion after surgery.
Post-surgical Orthodontics was initiated after a period of 4 weeks
and with the arch wires sequentially changed from 0.017” × 0.025″
NITI to 0.021″ × 0.025″ SS wires to refine occlusion for establishing
class I molar relationship. Because occlusal conditions have
changed, new strategic position of brackets aimed at obtaining final
occlusal relationship often becomes important. Completion of treat-
ment does not differ from that of any other traditional orthodontic
therapy.
In this phase, maintenance of good periodontal conditions
becomes more important. Upper and lower Hawley's type of retain-
ers was given for 4-6 months with instructions to wear full time.At
the beginning of the retention phase and periodical check-ups, selec-
tive occlusal grinding is done to stabilise the centric position and to
remove any prematurities or interferences with the centric and
eccentric movements. Long term follow up on monthly visits was
done which showed satisfactory results. (Figure 4)
After almost 2 years of follow-up occlusion was stable and patient
was satisfied and happy with before and after treatment results.
(Figures 5a and 5b)
DISCUSSION
Orthognathic surgery is reserved for dentoskeletal disproportions
that are so severe that they cannot be corrected using orthodontic
Dental Practice // July-August 2022 // Vol 18 No 4 57