Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan.
J Craniomaxillofac Surg. 2021 Oct;49(10):898-904. doi: 10.1016/j.jcms.2021.04.011. Epub 2021 May 4.
The aim of this retrospective study was to compare three-dimensional (3D) soft tissue and hard tissue changes between orthodontics-first approach (OFA) and surgery-first approach (SFA) after mandibular setback surgery. All patients underwent bilateral sagittal split osteotomy, and were examined by lateral cephalograms and 3D optical scanner before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Three standard angles (FMA, U1 to FH, IMPA) were measured as hard tissue change and the 2 sets of 3D data were superimposed, and volumetric differences were calculated as soft tissue change. Statistical analyses were performed by using unpaired t-tests. Differences with P < 0.05 were considered significant. A total of 39 patients with mandibular prognathism were included in this study. The OFA group consisted of 24 patients and the SFA group of 15 patients. The SFA group exhibited more labial inclination from T1 to T2 (p = 0.008) and T2 to T3 (p = 0.003) than did the OFA group. There were no significant changes at maxilla and mandible at each term of T0, T1, T2 and T3 (p > 0.05), but compared to before surgery, mandibular volume in SFA group significant increased at 1year (p = 0.049) after surgery. We found that the soft tissue changes after the SFA differed significantly from those after the OFA; thus, soft tissue predictions require more care. An analysis of our data compared with OFA and SFA for the patient with mandibular prognathism confirm that the mandibular soft tissue changes by postoperative orthodontic treatment and occlusal relationship in SFA.
本回顾性研究旨在比较下颌后退术后正畸优先法（OFA）和手术优先法（SFA）的三维（3D）软组织和硬组织变化。所有患者均接受双侧矢状劈开截骨术，术前（T0）、术后 1 个月（T1）、3 个月（T2）和 12 个月（T3）时通过侧位头颅侧位片和 3D 光学扫描仪进行检查。测量了三个标准角度（FMA、U1 至 FH、IMPA）作为硬组织变化，并对两组 3D 数据进行叠加，计算体积差异作为软组织变化。使用配对 t 检验进行统计学分析。P 值<0.05 认为差异有统计学意义。本研究共纳入 39 例下颌前突患者。OFA 组 24 例，SFA 组 15 例。SFA 组从 T1 到 T2（p=0.008）和 T2 到 T3（p=0.003）的唇倾度较 OFA 组更大。T0、T1、T2 和 T3 各期上颌和下颌均无显著变化（p>0.05），但与术前相比，SFA 组下颌体积在术后 1 年（p=0.049）显著增加。我们发现 SFA 后的软组织变化与 OFA 后的明显不同；因此，软组织预测需要更加小心。我们的数据与 OFA 和 SFA 进行的分析，对下颌前突患者的比较，证实了 SFA 中术后正畸治疗和咬合关系对下颌软组织的影响。
