Problem of orthodontic braces
The profile results of a patient, who had undergone orthopaedic treatment of the jaw elsewhere through the so-called bimaxillary intervention, that is, an operation on the upper and lower jaws. The position of the teeth is normal.
Condition after renewed operation by Prof. Sailer (rotation advancement of the lower and upper jaws, bimaxillary advancement), giving rise to an attractive ante-face according to Prof. Sailer), as per the pre-operative plans.
Millions of children and youngsters wear orthodontic braces, so that they can display a flawless set of teeth later when they smile. Brackets and headgear force the crooked teeth over months and years gently into the desired position. Sometimes, individual teeth are even extracted to make enough room for the remaining teeth, to form neat rows.
Treatment in the case of skeletal growth impairments
However, if skeletal developmental flaws exist, e. g. lower jaw that is too small or receding or receding upper jaw, a jaw bone and facial surgery specialist should be enlisted. Orthodontic braces basically correct irregularities in the positioning of teeth. Surgical measures on the contrary normalise wrong positioning of the jaw bones, but the irregularities in the positioning of teeth will not be corrected.
Example of a treatment
We would like to show with the help of an example how important combined surgical and orthodontic treatment of the jaw is in the case of very small jaws. Only treatment with orthodontic braces was given to the patient despite the disproportionately small lower jaw. Teeth were extracted in the upper and lower jaws, and the correctly positioned front upper teeth were adjusted to match the wrong positions of the front teeth on the lower jaw through backward tilting.
After this, there was no doubt a very nice dental occlusion, but the appearance of the patient proved to be highly unattractive. It is only after surgical advancement of the jaw, many years after the orthodontic treatment of the teeth, that it was possible to restore an attractive shape to the face with a so-called ante-face according to Prof. Sailer, keeping the position of the teeth completely identical.
Two phase treatment
Treatment in the case of a lower jaw that is too small or other skeletal growth problems of the jaw should be planned with a well thought out concept, that is, the the concerned orthodontist and the maxillofacial surgeon should always give a comprehensive explanation first. The parents must be first made to understand that often, only a combination of treatments can give satisfactory aesthetic and functional results.
During the two phase treatment, initially for the first 6 to 24 months or so, depending on the dental situation, orthodontic braces are worn. After that the facial surgeon will perform a jaw re-positioning operation, i. e. the jaw will be positioned correctly with an accuracy of millimetres using surgical measures, as per the model operation.
These interventions are routine operations. Girls can be operated on after about 16 years of age, boys at about 18 years. Planning is particularly important. The planning is done with the help of a teleradiograph (cephalometric x-ray) and a simulation of the operation and has a major impact on the results. The actual operation is performed under general anaesthesia and lasts three to five hours, depending on the degree of difficulty and the possible additional operations such as nose corrections etc. The jaw can be aligned in any desired position in three dimensions.
Once the jaws are positioned correctly, they are fixed with small screws and plates. Since the intervention is done from inside the oral cavity, no visible scars are generated. The patient stays for about four to six days in the clinic. In the first few days, the face is often swollen heavily. Based on our many years of experience in perioperative management the patient will not experience any pain.
After the operation
For two to three weeks, the patient feeds on a liquid diet, after which he or she can go back to his accustomed life, that is, start working again. Formation of abscesses is extremely rare, especially since a prophylactic treatment with antibiotics is always administered and special importance is given to a perfect oral hygiene. The immunological resistance in the oral cavity is particularly high.
The nerve that passes through the lower jaw below the roots of the teeth is irritated at times, but recovers within a few weeks or months. To minimise irritations of the nerves, we use the piezo-device in the operation, whose ultrasound waves can cut through the bone but does not damage the soft structures such as the nerve that runs within the lower jaw. In extremely rare cases, there could be a permanent loss of feeling in the region of the lower lip, according to sources in literature.
The operation can also be done in later years. This will also result in a simultaneous optimisation of the ageing process. This spells the end of a long path of suffering during the ageing process for several people with sagging cheeks and double chin, because the appearance is optimised, on the one hand, and the functions of breathing, chewing and speaking can be improved, on the other hand. By optimising the appearance, the sense of self worth and confidence are enhanced. Often, this not only brings about a positive change in the private life of the patient, but the chances of professional success also go up through visible improvement in the physiognomy. A new feeling for life is engendered.