Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
Odontology. 2024 Apr;112(2):640-646. doi: 10.1007/s10266-023-00860-7. Epub 2023 Oct 25.
The treatment of mandibular deformities with an anterior open bite is challenging. In this study, skeletal stability after mandibular osteotomies was evaluated to determine the best treatment for mandibular prognathism with an anterior open bite in three procedures: intraoral vertical ramus osteotomy (IVRO), conventional sagittal split ramus osteotomy (conv-SSRO), and SSRO without bone fixation (nonfix-SSRO). Patients who underwent mandibular osteotomy to correct skeletal mandibular protrusion were included. Changes in skeletal and soft tissues were assessed using lateral cephalograms taken before (T1), 3 ± 2 days (T2), and 12 ± 3 months (T3) after surgery. Thirty-nine patients were included: nine in the IVRO group and 11 and 19 in the conv- and nonfix-SSRO groups, respectively. The mandibular plane angles (MPAs) of the T2-T1 were - 2.7 ± 2.0 (p = 0.0040), - 3.7 ± 1.7 (p < 0.0001), and - 2.3 ± 0.7 (p < 0.0001) in the IVRO, conv-SSRO, and nonfix-SSRO groups, respectively. The skeletal relapse of the MPAs was not related to the MPA at T2-T1, and it was approximately 1.3° in the conv-SSRO group. The skeletal relapse of the MAPs was significantly correlated with the MPA of T2-T1 in the IVRO (p = 0.0402) and non-fix-SSRO (p = 0.0173) groups. When the relapse of the MPAs was less than 1.3°, the MPA of T2-T1 was calculated as 2.5° in the nonfix-SSRO group. When the MPA of T2-T1 is less than 2.5°, non-fix SSRO may produce a reliable outcome, and when it is more than 2.5°, conv-SSRO may produce better outcomes.
治疗下颌畸形伴前牙开颌具有挑战性。本研究评估了下颌骨截骨术后的骨骼稳定性，以确定三种手术方法治疗下颌前突伴前牙开颌的最佳方法：口内垂直下颌支劈开术（IVRO）、传统矢状劈开下颌支截骨术（conv-SSRO）和不固定 SSRO（nonfix-SSRO）。纳入接受下颌骨截骨术矫正骨骼下颌前突的患者。使用术前（T1）、术后 3 ± 2 天（T2）和 12 ± 3 个月（T3）的侧位头颅侧位片评估骨骼和软组织的变化。共纳入 39 例患者：IVRO 组 9 例，conv-SSRO 组 11 例，nonfix-SSRO 组 19 例。T2-T1 时下颌平面角（MPA）分别为 -2.7 ± 2.0（p=0.0040）、-3.7 ± 1.7（p<0.0001）和 -2.3 ± 0.7（p<0.0001），在 IVRO、conv-SSRO 和 nonfix-SSRO 组中。MPA 的骨骼复发与 T2-T1 时的 MPA 无关，conv-SSRO 组约为 1.3°。MAPs 的骨骼复发与 IVRO（p=0.0402）和 non-fix-SSRO（p=0.0173）组 T2-T1 时的 MPA 显著相关。当 MAPs 的复发小于 1.3°时，nonfix-SSRO 组 T2-T1 时的 MPA 计算为 2.5°。当 T2-T1 的 MPA 小于 2.5°时，non-fix SSRO 可能产生可靠的结果，当 T2-T1 的 MPA 大于 2.5°时，conv-SSRO 可能产生更好的结果。
