Orthodontic camouflage versus orthognathic surgery in the treatment of mandibular deficiency.

Clearly, there are postpubertal patients with Class II malocclusions for whom orthognathic surgery combined with orthodontics is the "best" option, but epidemiologic information suggests they are a relatively small percentage of the potential patient pool. The majority of patients fall into either an orthodontic treatment group or a borderline category. Many of these can be treated successfully with orthodontic camouflage. Research has shown psychosocial factors play a major role in determining the patient's selection of a treatment option. This emphasizes the need for careful attention to global psychologic factors, with special emphasis on patient concerns regarding body image. Morphometric criteria have been offered describing appropriate candidates for orthodontic camouflage. These are supported by a combination of research and clinical experience. Patients who do not fit these criteria should not automatically be considered candidates for surgery. Psychosocial research suggests a percentage of these individuals place less importance on facial change and are content to improve dental esthetics and function to the degree possible. To assist in the decision-making process, patients should be given the best information available regarding potential outcome. Currently this may involve treatment simulation using a combination of computer images and dental models. Caution has been suggested, given the variability associated with predicting soft tissue change. There are additional legal concerns regarding the implied guarantee of treatment outcome. Correspondingly, the influence of this technology must be kept in perspective. Recent research on the decision-making process found computer imaging to be an important factor in only 24% of the patients studied.(ABSTRACT TRUNCATED AT 250 WORDS)