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Combined mandibular distraction osteogenesis and surgical-assisted maxillary rapid expansion to treat patients with severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral idiopathic condylar resorption
XUE Xiao-chen, LI Biao, SUN Hao, LIU Zhi-xu, ZHU Min, WANG Xu-dong
2017, 15 (2):
153-156.
doi: 10.19438/j.cjoms.2017.02.011
PURPOSE : To introduce a treatment approach for severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral idiopathic condylar resorption. METHODS : Six cases with severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral ICR were included in this study, and they were treated with mandibular distraction osteogenesis and surgery-assisted rapid maxillary expansion. The path and magnitude of distraction were simulated using computer-aided surgical simulation technique. The outcome of distraction, the necessity of secondary surgery and stability were evaluated through 4 aspects: profile, occlusion, temporomandibular joint (TMJ) condition and sleep respiratory function at T0, T1, T2 and T3. CT, TMJ questionnaire, MRI of TMJ and PSG were acquired at this 4 time points. RESULTS : Three cases finished all treatments. The distraction magnitudes were 13.0mm, 6.7mm and 8.1mm, respectively. Chin advanced in genioplasity for 7.2 mm, 0 and 11 mm, respectively. Maxillary dental arch widened 5.3mm, 7.3 mm and 4.9 mm, respectively. Polysomnography data revealed that severe obstructive sleep apnea hypopnea syndrome was cured. Skeletal malocclusion was effectively corrected in all 3 cases and there was no obvious relapse during remodeling phase. TMJ condition remained stable. CONCLUSION S: Mandibular DO and SARME approach can effectively correct severe skeletal Class II malocclusion and narrow maxillary dental arch secondary to bilateral ICR. Using CASS technology to simulate the magnitude and path of distraction, the outcomes are more stable and predictable.
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