Ortho-surgical treatment of maxillary in Class III patients with severe mandibular protrusion and middle line deviation: a systematic review

Introduction: In Brazil, malocclusion is found in ages between 7 and 15 years with a prevalence of 6%. In this scenario, Class III malocclusion affects between 5% and 15% of the entire Brazilian population. Orthodontics stands out due to its strong aesthetic compromise and unfavorable treatment prognosis, especially when there is a hereditary component. It is suggested that most cases of Class III malocclusion have maxillary retrusion or hypoplasia, which may or may not be associated with mandibular prognathism. Thus, several treatment modalities are proposed for the correction of Class III malocclusion. Objective: To explore the literary findings of the importance of knowing advances in orthodontics for the treatment of class III malocclusion. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. 289 articles were initially found and, after selection, 54 articles were used to compose this study. Results and conclusion: According to the literary findings, the treatment of Class III should be fundamentally based on the diagnosis so that the treatment can be installed in order to correct the compromised structures instead of being compensated in places not affected by this malocclusion. In other words, the degree of involvement of the maxilla and mandible must be evaluated so that the treatment is directed to that bone base and really achieves its goals and impacts of facial improvement. Redirection of growth in Class III cases is indicated as soon as the anomaly is diagnosed, as the displacement processes that occur in the middle face can only be affected with treatment while the growth zones are able to respond to the biomechanical stimulus. Therefore, the younger the Class III patient is treated, the better the facial correction effects

Advance in contemporary orthodontics: a systematic review

Introduction: During orthodontic treatment, careful planning is essential for its success, taking into account aspects such as facial harmony, functional occlusion, and esthetics. The anchorage system has been widely used by orthodontists due to its high level of success. In addition to replacing the use of extra and intraoral devices, mini-implants show a simple technique that does not require patient cooperation and less discomfort, enabling more movements predictable and balanced in a short treatment time. Objective: To report the types of mini-implants and their characteristics, addressing their advantages and disadvantages, insertion locations, indications, and contraindications, in order to promote general knowledge of orthodontic treatment with skeletal anchorage. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: The mini-implants are made in two types, such as self-tapping requires a drill and self-drilling that has a cut. Their use provides advantages such as a set of more agile, simple, and less invasive techniques, with minimal anatomical limitations, less cost, not depending on the patient's contribution, allowing the application of immediate load and increased predictability of movements. Disadvantages are considered when there is movement and loosening of the mini-implant, involvement of nerves and blood vessels during surgery, mucosal irritation, and gingival hyperplasia caused by poor hygiene causing pain and swelling. Conclusion: It is concluded that the mini-implant emerged to revolutionize orthodontic treatment through more precise movements, in a short time, facilitating more complex movements that other devices had difficulty performing. Its main characteristic is a high success rate, in addition to having a reduced size, which allows its insertion in several sites. Consequently, the skeletal anchorage device is an excellent method, as long as it is used according to indications and taking meticulous care from the ideal choice of the device to the moment of its insertion

Ortho-surgical procedure involving mandible, maxilla, mento and associations: a systematic review

Introduction: Orthognathic surgery (OS) consists of the surgical procedure that aims to correct deformities of the bones of the maxilla and mandible. The records of the first surgeries for the correction of dentofacial deformities date from the mid-nineteenth century and were initially limited to mandibular surgeries. The malocclusion has as one of the primary etiological factors the facial growth pattern. Angle's statement already said that the only possibility of correcting true dentofacial deformities was the combination of orthodontics with surgery, and the importance of the combined effort of these two distinct areas in the approach to dentofacial disharmony in patients with problems was recognized skeletal. Objective: This study aimed to review the literature on OS involving mandible, maxilla, mento and associations. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: A total of 107 articles were found involving “orthognathic surgery". A total of 47 articles were evaluated in full, and 33 were included and discussed in this study. Individuals with class III dentofacial deformities are those that normally present greater aesthetic and functional impact, and for this reason, are the ones that more frequently seek treatment. However, some studies have shown a tendency for complications to occur in older patients submitted to orthognathic surgeries. Mandibular surgical procedures with maxillary segmentation and combining three types of osteotomies should be carefully planned and trained to reduce the occurrence of complications. The surgeon, orthodontist, and all staff involved should be focused on avoiding complications during all phases of treatment. Conclusion: It was concluded that there was an increase in the cases of OS in the last years, and with homogeneous samples between the masculine and feminine genres, and the advances in maxillary surgery corresponded to the greater number of surgical treatments

Main clinical approaches to orthognathic surgery for class II open bite and genioplasty patients: a brief systematic review

Introduction: Orthognathic surgery (OS) is used to improve the patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusions, disease, or trauma. In this context, genioplasty is a procedure to correct an aesthetic and functional deformity of the chin region, improving the contour. Moreover, anterior open bite (AOB) is the lack of vertical contact or negative overbite between the anterior teeth of the superior and inferior arches when the posterior teeth are in occlusion. Objective: The present study aimed to perform a brief systematic review with risk of bias analysis by funnel plot to highlight the main clinical approaches of orthognathic surgery in class II patients with open bites and also concerning genioplasty. Methods: The research was carried out from February 2022 to May 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 115 articles were found. In total, 57 articles were fully evaluated and 34 were included and evaluated in this study. And of the total of 34 articles, only 11 articles were developed as the main clinical results. A total of 32 articles were excluded because they did not meet the GRADE classification, and 16 were excluded because they were at risk of bias. The symmetric funnel plot does not suggest a risk of bias between the small sample size studies. A retrospective observational study compared 57 patient charts on treatment outcomes for anterior occlusion and vertical skeletal stability after maxillary or mandibular surgery to correct Class II malocclusion with a mild to moderate open bite. After surgery, 87% of Le Fort I patients and 63% of patients with bilateral sagittal split osteotomy had a positive overbite, and at the 6-month follow-up, the percentages were 90% and 74%, respectively. Another study showed Class II patients had significantly greater amounts of lateral and lower translation than class III patients. Also, genioplasty represents one of the most common auxiliary procedures and may be associated with corrective surgery for dentofacial dysmorphisms. However, care must be taken with mental nerve injuries, asymmetries, and intraoperative bleeding are the main immediate complications

Orthognathic surgery in the mandibular advance: a systematic review

Introduction: Orthognathic surgery is a standardized procedure used to improve a patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusions, disease or trauma. Bilateral sagittal osteotomy of the mandibular ramus is a technique widely used in orthognathic surgery to correct mandibular deformities. Mandibular advancement is a procedure with a high risk of skeletal recurrence, due to the difference between the proximal and distal bone segments. Objective: To carry out a systematic review of orthognathic surgery in the mandibular advance, focusing on the main challenges and importance. Methods: The present study was followed by a systematic literature review model - PRISMA rules. The quality of the studies was based on the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: Bilateral sagittal osteotomy is the most used technique in mandibular orthognathic surgery, allowing mandibular movements in the sagittal, vertical and transverse directions, with good results and few complications. However, this technique can cause mandibular advancements above 10 mm, strongly pointing to the placement of a bone graft in order to avoid defects and their complications. Therefore, in orthognathic surgery, bone grafting can accelerate bone formation

Ortho-surgical treatment in Class II skeletal patients with mandibular retrognathism: a concise systematic review

Introduction: In the setting of class II malocclusion corrections, the union of orthodontic and surgical procedures was developed. Bilateral sagittal split osteotomy is standard protocol for correcting mandibular retrognathism. Class II dental malocclusion with deep bite needs to be treated early by orthodontics. Thus, the commonly used technique combines BSSO for mandibular advancement and recoil genioplasty to correct the resulting chin protrusion. Objective: To carry out a systematic review of the main considerations of ortho-surgical treatments in class II patients with mandibular retrognathism. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 128 articles was found involving class II malocclusion and ortho-surgical treatments. After, a total of 64 articles were fully evaluated and 24 were included and discussed in this study. A meta-analysis study evaluated the best functional appliance improving mandibular length in individuals with retrognathism. Sander Bite Jumping reported the greatest increase in mandibular length, with 3.40 mm. Another meta-analysis study compared dental, skeletal, and aesthetic outcomes between orthodontic camouflage and orthodontic-surgical treatment in patients with Class II skeletal malocclusion and retrognathic mandible with anterior growth. The difference between treatments was not statistically significant regarding SNA angle, linear measure of the lower lip to the Ricketts aesthetic line, convexity of the skeletal profile or soft tissue profile excluding the nose. In contrast, orthodontic-surgical treatment was more effective to the ANB, SNB and ML/NSL angles and the soft tissue profile including the nose

Multi-segmented maxillary ortho-surgical treatment in Class II patients with maxillary protrusion and open bite: a concise systematic review

Introduction: Anterior open bite is the lack of vertical contact or negative overbite between the anterior teeth of the upper and lower arches when the posterior teeth are in occlusion. Its etiology is multifactorial, including heredity, oral habits, unfavorable growth patterns, and increased lymphatic tissue along with mouth breathing and functional oral matrices. The characteristics of individuals with anterior open bite include excessive gonial, mandibular, and occlusal plane angles, mandibular small body, and ramus increased lower anterior facial height, decreased upper anterior facial height, retrusive jaw, Class II tendency, divergent cephalometric planes, lingual position, and inadequate lip seal. Objective: To carry out a concise systematic review of multi-segmented maxillary ortho-surgical treatment in class II patients with maxillary protrusion and open bite. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. A total of 289 articles were initially found and, after selection, 17 articles were used to compose this study. Results and conclusion: Significant improvement in anterior occlusion can be expected in most patients when maxillary or mandibular surgery is used for Class II open bite correction. However, there will be individual patients in whom there will be considerable post-treatment changes in the anteroposterior and vertical dimensions. Although individual morphology needs to be taken into account, it appears that both short-term and long-term stability are likely to be greater after Le Fort I surgery compared to bilateral sagittal split osteotomy

Skeletal class III malocclusion and bilateral sagittal osteotomy: a concise systematic review

Introduction: In the context of skeletal class III malocclusion, orthognathic surgery is a standardized procedure used to improve the patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusions, disease, or trauma. Thus, bilateral sagittal osteotomy of the mandibular ramus is a technique widely used in OS for the correction of mandibular deformities. Objective: the present study evaluated, through a concise systematic review, the main considerations of mandibular advancements through mandibular bilateral sagittal osteotomies in patients with skeletal class III malocclusion. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: A total of 115 articles were found involving “skeletal class III malocclusion". A total of 45 articles were evaluated in full, and 22 were included and discussed in this study. Bilateral sagittal osteotomy (BSO) is the most used technique in mandibular OS, allowing mandibular movements in the sagittal, vertical, and transverse directions. Several studies show good results and few complications. The size of this space is proportional to the mandibular advancement and/or rotation movements required by the patient's maxillomandibular discrepancy. The prevention of inferior mandibular edge defects is an important issue when planning an BSO traditional non-grafted BSO technique produces a large proportion of defects in the lower edge of the mandible. In cases where the advancement is greater than 10 mm and/or the patient is over 30 years old, the risk of the mandibular defect increases significantly. Also, using a bone graft in the intersegmental gap of a sagittal branch osteotomy is considered an effective clinical method to ensure the desirable intersegmental position as it helps to easily maintain the space. Conclusion: The results showed that bilateral sagittal osteotomy is the most used technique in mandibular orthognathic surgery, allowing mandibular movements in the sagittal, vertical, and transverse directions, with good results and few complications. Furthermore, a bone graft can accelerate bone formation in orthognathic surgery

Main approaches of three-dimensional (3D) imaging examinations in the assessment, treatment, and follow-up of patients with skeletal Class III: a concise systematic review

Introduction: Class III malocclusion presents with several skeletal and dental factors, highlighting the large or protruding jaw, retrusive maxilla, protrusive mandibular dentition, retrusive maxillary dentition, or combinations. The importance of evaluating class III malocclusions, as well as their treatments, through three-dimensional (3D) images are highlighted. Objective: To present a concise systematic review of the approach of 3D imaging exams to conduct class III malocclusion treatments, as well as to follow up after orthognathic surgery. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 105 articles was found involving class III malocclusion and ortho-surgical treatments guided by three-dimensional (3D) images. A total of 44 articles were fully evaluated and 16 were included and discussed in this study. Positional, structural, and volumetric condylar changes after orthognathic surgery in skeletal Class III patients have been well elucidated using cone-beam computed tomography. In addition, the virtual surgical planning and the surgical splint manufactured in CAD/CAM facilitate treatment planning and offer an accurate surgical result in orthognathic surgery. The application of pre-engineered bone guidance splints allows the treatment of craniofacial deformities with precision. Therefore, the three-dimensional (3D) tool allows for the accuracy of treatments and planning of orthognathic surgery, as well as the best postoperative follow-up

Main approaches to malocclusions and orthognathic surgery in facial aesthetic: an integrative review

Introduction: In the scenario of orthodontic corrections, orthognathic surgery makes it possible to restore the functional and aesthetic patterns of the face, and non-surgical or minimally invasive procedures have optimized the results of ortho-surgical facial treatments. Objective: the present study aimed to perform a systematic review of the main information about orthognathic surgery in malocclusions, as well as to present the aesthetic importance. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 107 articles were found involving "malocclusions and orthognathic surgery". A total of 47 articles were evaluated in full, and 33 were included and discussed in this study. Aesthetic/functional rehabilitation is necessary until the eruption of permanent successor teeth occurs. A practical option to obtain this rehabilitation is through the installation of aesthetic or functional space maintainers. These are orthodontic devices that replace one or more deciduous teeth and are used to preserve the space destined for the permanent tooth successor, preventing it from suffering deviations during its eruption. The facial typology seeks to redefine the relationships between deleterious habits and malocclusions, through the valuation of individual morphological characteristics, which will lead to craniofacial growth and development to assume certain facial types. Therefore, due to the aging of the stomatognathic apparatus the orofacial functions can be modified, such as malocclusion, therefore for greater effectiveness and longevity of the final result of the orthodontic treatment, the indefinite use of fixed inferior containment should be established and accompanied by the professional