Document Detail

Transverse stability of 3-piece le fort I osteotomies.
MedLine Citation:
PMID:  21050640     Owner:  NLM     Status:  In-Data-Review    
PURPOSE: The transverse dentoalveolar and skeletal stability of multipiece Le Fort I osteotomies with 3 different techniques was investigated.
MATERIALS AND METHODS: The records of 87 patients undergoing bimaxillary osteotomies with 3-piece Le Fort I osteotomy were evaluated. According to the surgical technique of maxillary expansion, the subjects were divided into 3 groups: unilateral palatal osteotomy (group A), bilateral palatal osteotomy (group B), and unilateral palatal osteotomy with fixation of the palatal vault with a resorbable plate (group C). In group A palatal bone grafts were used in 9 patients. Posterior-anterior cephalograms and dental casts were taken before surgery (T1), immediately after surgery (T2), and after a follow-up of 12 to 15 months (T3). The skeletal base was measured between the intersections of the lateral contour of the maxillary alveolar process and the lower contour of the maxillo-zygomatic process. Dentoalveolar width was measured between the first premolars and the first molars. According to the magnitude of expansion, the groups were divided into the following subgroups: negative (constriction), 0 to 2 mm, greater than 2 mm to 4 mm, and greater than 4 mm. An analysis of variance with Bonferroni correction was used to compare the demographic and treatment characteristics and the surgical and postsurgical transverse movements of the 3 study groups. The paired t test was run to evaluate the surgical changes (T2 - T1) and the postsurgical stability (T3 - T2). The influence of palatal bone grafts and downgrafting of the maxilla on the amount of relapse was investigated with the unpaired t test.
RESULTS: The study variables (T1), the surgical changes (T2 - T1), and the postsurgical changes (T3 - T2) showed no significant differences between the 3 study groups. However, a tendency for less relapse in cases with major expansion was seen in group C. The mean expansion of the entire sample was 2.13 mm at the skeletal base, 1.11 mm in the premolar region, and 1.99 mm in the molar region. Mean relapses of 0.20 mm (9%) at the skeletal base, 0.76 mm (68%) in the premolar region, and 1.20 mm (60%) in the molar region were seen. Palatal bone grafts had no significant effect on the postsurgical changes in group A. Anterior and posterior downgrafting did not result in significantly more relapse.
CONCLUSIONS: Surgical expansion of the maxilla provides stable results at the maxillary skeletal base but high relapse rates in the dentoalveolar area. Preoperative orthodontic expansion is one of the main sources of transverse relapse. Fixation of the palatal vault with resorbable plates is a possible technique to improve transverse stability. Larger samples are necessary to provide statistical significance.
Winfried Bernhard Kretschmer; Grigore Baciut; Mihaela Baciut; Werner Zoder; Konrad Wangerin
Publication Detail:
Type:  Journal Article     Date:  2010-11-02
Journal Detail:
Title:  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons     Volume:  69     ISSN:  1531-5053     ISO Abbreviation:  J. Oral Maxillofac. Surg.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8206428     Medline TA:  J Oral Maxillofac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  861-9     Citation Subset:  AIM; D; IM    
Copyright Information:
Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Senior Registrar, Department of Oral and Maxillofacial Surgery, Marienhospital Stuttgart, Stuttgart, Germany, and PhD Student, University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania.
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