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Orthognathic surgery has as its objective the repositioning of basal bone in the framework of maxillo-mandibular deformities. Its results are both esthetic and functional. For adults, improved aesthetics results is becoming increasingly important in these procedures to the point where some patients seek only an esthetic amelioration and not a functional one. To achieve their aesthetic purpose, it is becoming progressively more necessary for orthodontists, oral surgeons, and general dentists to collaborate effectively in a well-coordinated effort. In what has now become a true sub-specialty, orthognathic surgeons must master the complementary techniques of rhinoplasty, osseous apposition, aesthetic facial surgery, fat injection or injectable anti-aging tratments. In this article we propose a diagnostic classification based on the aesthetics of the adult smile and describe the therapeutic modalities appropriate for each element.
Indications for orthodontic treatments are in constant augmentation in the adult population. Patients want the shortest possible treatments. Alveolar corticotomies speed up the tooth movement in comparison to conventional orthodontic treatments, therefore decrease treatment duration.
This technique consists in the surgical section of cortical bone that leaves the medullar bone uninjured. The biological effects of corticotomies rely on decreasing medullary bone density and increasing bone remodelling activity (RAP regional acceleratory phenomenon).
We are currently testing this combined approach of alveolar corticotomies and orthodontic treatments on a pig model with special attention given to potential secondary effects on pulp vitality, dental root morphology and length.
We also present here two adult patients with malocclusion cases who underwent alveolar corticotomies as part of their surgical-orthodontic treatments.
These experimental and clinical preliminary studies confirm that corticotomy requires a shorter time of orthodontic movement. Our clinical results showed that this technique resolves malocclusion at least twice as fast as conventional orthodontic treatment.
No secondary effects of corticotomies on pulp vitality dental root morphology were observed.
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