Surgical Orthodontic Approach to the Treatment of Jaw Deformities

The results of surgical orthodontic approach to jaw deformities and bone grafting of alveolar clefts were reported. After preoperative orthodontic treatment to align the dental arch to obtain the best occlusion at surgery, the mandible was set back by sagittal split osteotomies of the ascending rami for the treatment of mandibular prognathism. Le Fort I type osteotomy of the maxilla was also used in severe cases. Occlusion and facial appearance greatly improved postoperatively and 90 % of the patients were satisfied with regard to their chief complaints. Postoperative mandibular movement was also improved, but masticatory efficiency was below the normal level. In addition to orthodontic or surgical orthodontic treatment, bone grafting to the alveolar cleft using autogenous iliac bone is mandatory to recover normal oral appearance and function in cleft patients. Radiographically, adequate bone bridging was attained in 95 % of patients with unerupted canine, whereas the value for patients with erupted canine was 70 %. The volume of bone formation at 3 and 12 months postoperatively were 109 % and 100 % of that of the preoperative defect, respectively. Lateral incisors and/or canines erupted to the grafted alveolus in 2～3 years. Tooth autotransplantation was also used to restore normal occlusion. The importance of recovery of oral function was stressed