A novel technique to improve postoperative stability of orthognathic surgical anterior open bite correction using temporary anchorage devices: a case report.

Abstract

Background: Postoperative stability is a significant problem in the orthognathic management of anterior open bite malocclusion. The general tendency of modern preadjusted fixed appliances is towards unwanted and unplanned extrusion of the maxillary incisor and canine teeth as the dental arch is levelling. Following surgical repositioning of the jaws, the relapse potential of the extruded anterior dentition will be to intrude, leading to some reopening of the surgically corrected anterior open bite.

Case presentation: A 19-year-old male white Caucasian patient presented with a clinically significant anterior open bite of predominantly skeletal aetiology. The objective of preoperative levelling in the maxillary dental arch was to avoid any extrusion of the anterior dentition. To achieve this aim, two temporary anchorage devices (TADs) were placed in the maxillary alveolar bone, and relatively passive elastic force was applied from the archwire to the TADs in order to prevent maxillary incisor extrusion during arch levelling. This elastomeric chain was maintained throughout the alignment and levelling of the maxillary dental arch. The patient had a Le Fort I osteotomy of the maxilla with differential posterior impaction and advancement, and mandibular forward autorotation and small setback of the mandibular body with bilateral sagittal split osteotomy, to achieve a Class I incisor and skeletal position. No vertical movement of the teeth was carried out or required following surgery. The patient was debonded 3 months following surgery and fitted with removable retainers. Cephalometric superimpositions demonstrated that no extrusion of the anterior maxillary dentition occurred, which is the main parameter to improve postoperative stability of the anterior open bite correction.

Conclusions: To improve the potential stability of anterior open bite correction with orthognathic surgery, TADs in the anterior maxillary alveolar bone region may be used with elastomeric chains to prevent any unintended and unplanned extrusion of the maxillary incisor teeth in the preoperative orthodontics.