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Bimaxillary Protrusion PowerPoint Presentation

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Description : Bimaxillary protrusion is a protrusion of the dentoalveolar position of maxillary and mandibular dental arches. It produces a convex facial profile ?Common dentofacial pattern in the Asian population.

Tags : Bimaxillary Protrusion, Mentalis strain, Maxillary vertical excess, proclination of incisors, dental

Published on : Dec 12, 2020 | Views : 2034 | Downloads : 5

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Bimaxillary Protrusion DR FERDAUS P1010512
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Introduction Defines as protrusion of dentoalveolar position of maxillary and mandibular dental arches Produces a convex facial profile Common dentofacial pattern in the Asian population Clinical features: Protrusive upper and lower lips Lip incompetence Excessive exposure offrontal teeth Gummy smile Mentalis strain The typical AP relationship tends to be a class II malocclusion with mandibular deficiency But it can be anything from severe class II to class III
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“We should not be assumed that all patient with incisor protrusion and lip incompetence or gummy smile are bimaxillary protrusion” Various etiology with various clinical features A strong evidence for genetic component and occurance of mouth breathing and oral habits was noted in BMP Most of cases are combined features of maxillary and mandibular discrepancy Each of them has different approach and treatments Eg: Lip incompetence can be caused by Maxillary vertical excess (skeletal) Short upper lip (soft tissue) Excessive proclination of incisors (dental) Both Etiology
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ASSESSMENT
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Assessment We must evaluate carefully various clinical features and its cause as they might be separate or coexisting problems that require different approach Careful and complete skeletal, dental, and soft tissue evaluation must be performed Analyzing cephalometric and panoramic studies, prediction tracings and dental model studies Surgical intervention will always be done to correct the skeletal discrepancy and orthodontic treatment is essential to obtain harmonized occlusion
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Assessment Skeletal assessment includes Symmetrical of face Sagital and Vertical relationship of both the maxilla and mandible. TMJ and mandibular growth Pathologic lesions must be ruled out Dental assessment consists of Verifying the occlusion type Dental crowding or spacing Incisor inclination Presence of AOB, Deep bite, Posterior cross-bite Maxillomandibular relationship Soft tissue evaluation Proportion of the face (rule of thirds) Facial profile Nasolabial angle Mentolabial fold Interlabial gap, resting lip, incisor show Presence of gummy smile
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TREATMENT PLANS
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Treatment Plans Esthetic is the most common reason patient seek for treatment for bimax protrusion Meticulous planning and execution of osteotomies for surgical planning are essential for aesthetic and functional outcome Orthodontic treatment alone or combined with orthognathic surgery are treatments of choice Orthodontic Involves extraction of the four first premolars with subsequent retraction and/or up-righting of the incisors Surgery Combination of Le Fort I osteotomy, bilateral sagittal split ramus osteotomy (BSSO), and upper and lower anterior subapical osteotomies 4 first premolar Xla + anterior segmental osteotomies of the mandible and maxilla through the extraction sites Le Fort I osteotomy with or without segmental osteotomies
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Upper Anterior Segmental osteotomy Lower Anterior Subapical Osteotomy Genioplasty
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3pieces Lefort I osteotomy Lower Anterior Subapical Osteotomy BSSO Genioplasty
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3pieces Lefort I osteotomy Lower Anterior Subapical Osteotomy Genioplasty
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Surgical Steps in Bimax Protrusion
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MAXILLA
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Right first premolar has been extracted. Subperiosteal tunnel is dissected across the hard palate between the bilateral extraction sites Le Fort I Osteotomy + Anterior Segmental Osteotomy
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The gingivoperiosteal flap is left intact and retracted inferiorly while the right vertical maxillary osteotomy lines are marked “Maxilla Necrosis only occur when vascularization of surrounding soft tissue pedicle are damaged” Fonseca, 2016 Both LeFort I and anterior segmental osteotomies are completed
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The LeFort I posterior segment is split bilaterally in the paramedian fashion Final fixation of both segments
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MANDIBLE
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(A) Configuration of osteotomy lines (B) Full detachment of the pterygomasseteric muscle sling (C, D) Ostectomy of the pterygoid protuberance facilitates concomitant angle contouring and is a good source of bone grafts if needed BSSO
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Markings for (A) the right vertical, (B) horizontal, and (C) left vertical components of the osteotomy Lower Anterior Subapical Osteotomy Arrows designate the canine roots. Note that the gingival bridges remain intact and are retracted
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The osteotomized segment is mobilized, and any bony interference preventing proper seating of the segment into the splint is burred Configuration of the fixation hardware.
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Genioplasty is a versatile surgical procedure that allows sagittal, vertical and transverse changes to be made to the chin without affecting the dental occlusion
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COMPLICATIONS
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Injury to adjacent structures Adjacent teeth root Adequate bone level between subapical and genioplasty osteotomy Prevent fracture and space for plating Incorrect osteotomy All ostetomies must be marked with surgical marker or pencil. Osteotomy position Avoid devascularization of osteotomized segments subperiosteal soft tissue elevation should be performed only as required leave adequate palatal attachment for each maxillary segment Segmental Necrosis All patients should be warned preoperatively of the possibility an aged appearance More apparent nasolabial folds, a more obtuse nasolabial angle lowering of the lip vermillion decreasing gingival display during smile Reduce incisor show at rest Surgical planning Careful planning and construction of wafer We must burr any areas of bony interference between segments Malocclusion
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Thank You…