Documente Academic
Documente Profesional
Documente Cultură
BY
NIKHIL ASOK
DEFINITION
Patient concerns
History
Clinical examination
Radiographic and imaging analysis
Dental model analysis
Patient Concern
Personal information
Chief complaint
Medical Dental and orthodontic history
History of the TMJ and musculature
General facial characteristics:
David Sarver (1998) quoted that symmetry, balance and morphology are
important in production of good front face esthetics.
Clinical
Examination
PROFILE ESTHETICS
CEPHALOMETRIC ANALYSIS
1. COGS 1. Arnett et al
2. QUADRILATERAL 2. Burstone et al
3. McNAMARA 3. TOMAC – TONY G McCOLLUM
MODEL SURGERIES
Maxillary surgeries
Impressions
Wax-bite
Face-bow transfer
Mounting of the casts on a semi adjustable articulator
Vertical reference lines are drawn – A/P positioning or arch rotation
Horizontal reference lines
PREDICTION
b) Anchorage requirements.
LE FORT 1 OSTEOTOMY
TRADITIONAL LE FORT 1 OSTEOTOMY
MAXILLARY STEP OSTEOTOMY
HIGH LE FORT 1 OSTEOTOMY
MAXILLARY HORSESHOE OSTEOTOMY
SAME
Protocol
The osteotomy cuts are placed on the lateral wall of maxilla from the
pyriform aperture at the level of the infra orbital nerve.
The osteotomy is extended laterally below the level of the infraorbital nerve
to the tuberosity and pterygoid plate region.
The maxilla is down fractured after detaching the nasal septum,
pterygomaxillary disjunction and ostectomising the lateral nasal wall.
Bone grafts are used in the infra orbital region and also in the
pterygomaxillary junction.
MAXILLARY HORSESHOE OSTEOTOMY
Outline of treatment:
Presurgical
1. Consider extraction usually with 15, 25, 34 and 44.
2. Place lower appliances, utility arch and begin lower canine retraction.
3. Place upper appliances, align and level, begin upper Molar
advancement.
4. Placement of class III elastics as necessary
5. Finish lower canine retraction.
8. Coordinate arches.
Once these goals have been achieved the patient is ready for surgery.
The arch wires are now tied with ligatures wire to prevent inadvertent
disengagement of the wires and the patient is referred for surgery.
Surgical
The need for this is determined by observation after placing the models into
the desired antero-posterior position .