[One-stage procedure for bimaxillary correction of extremely severe malocclusions. Pretreatment, planning and operation methods with functionally stable fixation of upper and lower jaws].

The comprehensive treatment of extremely severe malocclusion, carried out up to now in more than 30 patients, is described step by step. After the removal of the third molars, orthodontic treatment is provided to align the arches. This is followed by 4 weeks of bite plane treatment to bring back the TMJ condyles into their physiologic position, which is usually lost because of the undefined occlusal relationship. Following cephalometric analysis the surgical treatment plan is established on the basis of lateral cephalometric films aimed at orthognathic repositioning of the mandible and the maxilla. In addition, the one-stage bimaxillary correction is simulated in the articulator for the construction of occlusal splints. The intraoperative use of these splints and the fixation of the condyles at the zygomatic bone via positioning plates allows, for the first time, the reproducible physiologic adjustment of the condyle during the entire length of the operation. This method also permits three-dimensional control of the position of the repositioned maxilla. The functionally stable fixation of maxilla and mandible makes long-term postoperative immobilization unnecessary.