A Guide to Orthodontic Devices for Craniofacial Plastic Surgeons
Alisa Girard, MBS1,2; Jonlin Chen, BS1; Sabrina Dorfmann, DMD1; Ilana Ickow, DMD MS1; Robin Yang, DDS MD1.
1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States; 2Division of Plastic Surgery, Rutgers – Robert Wood Johnson Medical School, Piscataway, New Jersey, United States
BACKGROUND: The goal of orthodontics is to improve oral function while enhancing a patient’s facial esthetics, self-esteem, and psychosocial concerns. However, for over 1.2 million Americans, orthodontic management is required both pre-operatively and post-operatively to facilitate complex craniofacial procedures such as monobloc advancement, lefort III adv, lefort II advancement, and orthognathic surgery. This combination treatment is used to address a variety of conditions ranging from jaw size/positioning discrepancies to syndromic craniofacial anomalies. Furthermore, the literature demonstrates that proper orthodontic care has a significant impact on orthognathic surgery outcomes and patient quality of life. Despite the interplay between orthodontics and orthognathic surgery, craniofacial plastic surgeons and residents do not receive formal orthodontic training. Providing a basic understanding of orthodontics would help surgeons better understand the role of orthodontic treatment in achieving enhanced dental occlusion and alignment and help optimize surgical decision making. The purpose of this study is to provide plastic surgeons with a description of the types of orthodontic treatment that are utilized in conjunction with skeletal surgery (preventive, interceptive, and corrective), the basics of orthodontics and associated hardware, and an overview of the most commonly used orthodontic devices.
Methods: A review of recent literature was conducted to consolidate current practices for the use of orthodontic devices commonly used in orthognathic surgical patients.
Results: Orthodontic treatments are divided into three broad categories: preventive, interceptive, and corrective care. Braces and clear aligners are popular devices used to correct tooth positioning via three orders of control: first order (‘in-out’ and rotation), second order (mesio-distal angulation or ‘tip’), and third order (inclination or torque). Further, various treatments exist for skeletal and dental malocclusions, which may occur in transverse and/or sagittal planes. For the treatment of crossbites or narrow arches, palatal expanders such as the Hyrax or Haas can be used. With older patients, expanders need the aid of miniscrews (MARPE) or surgery (SARPE) to widen the palate. Appliances for sagittal corrections typically take advantage of patient’s remaining growth and include a variety of headgear types (cervical, high-pull, occipital, reverse-pull), functional appliances (fixed or removable), or simply the use of interdental elastics.Conclusions: Orthodontic care is critical to orthognathic surgery outcomes. As patients are increasingly seeking orthodontic care in conjunction with surgery, it is important for plastic surgery trainees to develop a strong understanding of the various orthodontic devices used.
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