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ortho-surgery section

appliances alone. It is generally accepted that main benefits of plex surgical procedures during adulthood for attainment an opti-
orthognathic treatment is likely to be psychosocial in nature and mal aesthetic and functional result in class III patients. [30]
that the majority of patients who seek treatment do so because of The surgical-orthodontics combination approach has been suc-
concerns about their dentofacial aesthetics [14] . cessful in this case of skeletal Class III malocclusion. Postoperative
Johnston et al [15] reported that patients requiring orthognathic orthodontic therapy is used to finalize and perfect the dental occlu-
surgery were less happy with appearance of their face, teeth, and sion relative to the new skeletal relationships It is also evident that
profile when compared with controls. This patient was a 22-year-old the self-confidence of the individual was raised considerably follow-
man who was deeply concerned about his facial appearance. Growth ing the total change in the perception after achieving the desired
modification was no longer feasible while camouflage treatment outcome.
would not be sufficient to address the patient’s aesthetic concerns.
The presence of a prognathic mandible influenced decision in CONCLUSION
favour of a single-jaw surgery. In surgical-orthodontic treatment, correct control of postsurgical
Orthodontic treatment helps to achieve satisfactory occlusion orthodontic phase is very important as presurgical orthodontic
thus, ensuring healthy functioning of stomatognathic system’s phys- phase. A good final result depends not only on initial diagnosis, but
iological routine, an optimal facial, oral, and dental aesthetics, also on exact planning and execution of orthognathic surgery. A
resulting in a long-term stability. [16] Skeletal Class III malocclusion profound improvement in facial aesthetics was achieved, along with
is easy to recognize and leads to conspicuous impairment of facial near-normal dental, skeletal and soft tissue relationships. Skeletal
aesthetics. Depending on the severity may cause gross reduction in class III anomalies are one of most complicated problems in both
masticatory performance. [17] Children having aberrant growth pat- childhood and adulthood of all dentofacial abnormalities. Surgical
tern can be treated with growth modulation at early age, but unfor- orthodontic treatment with individualized sequence achieved suc-
tunately, adults do not have such option and often require orthog- cessful results in Class III young adult with transversal, sagittal, and
nathic surgery. In present case also it was difficult to treat patient vertical skeletal discrepancy.
without surgery.
Studies suggest that orthognathic surgery should be done at ear- For a complete list of references, email: info@dental-practice.biz
liest age of 16.5 years in boys as circumpubertal growth is complete
or nearly complete, [18] but chances of late mandibular growth can-
not be denied up to age of 20 years, so termination of growth should
be determined before commencing with ortho-surgical treatment.
Although isolated surgery of mandible for prognathic lower jaw has About the AUTHORS
long been most commonly applied procedure for Class III correc-
tion. [19] Dr. D. K. Gupta is a Senior Consultant at Wisdom Dental Clinics.
In order to preserve the inferior alveolar neuro-vascular bundle, With more than 38 years of clinical and academic experience, he
many modifications were proposed like inverted L-osteotomy of has been Ex Principal of Govt Dental College, SMS, Jaipur. He was
Trauner and Obwegeser, Converse and Shapiro’s step ladder also Pro-VC of Rajasthan University of Health Sciences. He was
osteotomy and functionally stable osteosynthesis of Cesteley and and HOD in Dept of Oral and Maxillofacial surgery at Govt Dental
Boateng. [20-23] In recent years, with popularity of mandibular College fo rmore than 15 years. Presently, he is the Registrar of
Ramal osteotomies, mandibular body osteotomy is performed less Rajasthan State Dental Council andmaintains his private practice
often. at Wisdom Dental Clinics, Jaipur. He has been DentalSurgeon to his Excellency Governor
As shown in our case, if the mental neurovascular bundle is pres- of Rajasthan for more than 18years.
ent in osteotomy site, then there is a higher risk of inferior alveolar Dr. Abhishek Kshetrapal is BDS from MCODS Manipal and secured
nerve injury. [24-25] It also carries risk of damage to roots and peri- 1st rank in Manipal PG entrance exam and did MDS from MCODS
odontal health of teeth involved in osteotomy site, which might Mangalore, cleared MOrth from the Royal College of surgeons
require post-surgical endodontic and periodontal treatment of Edinburgh in 2007 and was awarded fellowship FDS from Royal
involved teeth. There is also deficit of sufficient bony contact area College of surgeons Edinburgh in 2013, running exclusive ortho-
for fixation and osteogenesis. [25-27] . Complications of inferior alve- dontic practice in Kota Rajasthan since 2006, has been speaker in
olar nerve injury can be drastically reduced by creating bony win- various national and international conferences.
dow to enclose inferior alveolar neurovascular bundle, by surgical
repositioning or by creating enough room for osteotomy in pre sur- Dr. Gaurav Gupta completed his graduation from Govt Dental
gical orthodontic treatment, which also reduces incidence of root College, SMS, Jaipur in2007 and masters in Pediatric and
Preventive Dentistry. Attained fellowship in Implantology of both
damage and invasion of periodontal spaces of involved teeth. [28-29] ISOI and AOI. He is a POS (Progressive Orthodontic seminar, USA)
We kept osteotomy lines away from mental foramen to avoid injury graduate. A university gold medalist with over 30 scientific pre-
to mental neurovascular bundle. Noneurosensory disturbance was sentations innational and international conferences and more
noticed after week of surgery. than 75 publications in national andinternational journals to his
Class III Skeletal problems are treated with combination of credit. He has won 5 times Best Scientific Paper Award atnational and international
orthodontic and orthopaedic mechanics in growing individuals platforms. A keen CEREC user with special interest in Digital Dentistry.
whereas, correction of class III malocclusion usually requires com- Contact: dr.gauravgupta99@gmail.com

58 Dental Practice // July-August 2022 // Vol 18 No 4