Surgical manipulation of the occlusal plane.

With combined surgical repositioning of the maxilla and the mandible, the occlusal plane is usually determined by the autorotation of the mandible. By manipulation of the cant of the maxillary occlusal plane, additional control of the esthetic result is obtained. In the approach discussed in this paper, prime attention is paid to repositioning of the maxilla into the most favorable situation by a deliberate rotation around points that are anterior in the face. The mandible is then surgically adjusted to secure a good occlusion. In this way, the cant of the occlusal plane becomes a priority in treatment planning, rather than simply an inevitable consequence of maxillomandibular surgery. The technique of treatment planning is discussed in detail, and three cases are presented to illustrate the concept. Of special importance is the enhancement of facial esthetics that is offered by the deliberate manipulation of the occlusal plane.