Orthognathic surgery

After presurgical orthodontics,

For maxillary prognathism- extraction of
1
st
premolar and retro-position of maxilla is
carried out wunderer technique
For mandibular retrognathism-
1. Intra oral Inverted L osteotomy
2. Extraoral C osteotomy
3. BSSO
Wunderer technique
Inverted L
BSSO
CLASS II DIV II
management
Problem here is- due to
maxillary retroclined incisors
there is premature contact of upper and lower
teeth which guides mandible to remain posteriorly
Main goal is to correct deep bite and procline
maxillary and thus the mandibular teeth
During mixed dentn period-activator and bionator is
used if infraocclusion of molar is there.interocclusal
acrylic is trimmed gradually.
In permanent- 1
st
premolar extracted thus space for
correctn of crowding
After growth cessation- orthognathic surgery.
CLASS III Malocclusion
A malocclusion that is very easy to
identify but is often difficult to treat
because of poor retention after
treatment.
Many factors
need to
be considered
Before Planning
the treatment-

-Patients opinion

-severity of
skeletal pattern



-expected
pattern
of growth.
TREATMENT MODALITIES





1. Growth modification
2. Orthodontic correction
3. Surgery
The reasons for early treatment-
reducing the severity
of malocclusion
To correct the anterior
displacement of
maxilla before
eruption of canine and
premolar to guide
them in class I relation
To provide a normal
environment for
growth of maxilla by
elimination of ant.
crossbite
Psychological benefit-
improved facial n
dental appearance
Frankel III
Chin cup therapy
Anterior Facemask
3D Screws
Orthodontic correction
If adequate overbite If reduced overbite

Proclination of Retroclination of lower
Upper incisors incisors with or without
maxillary proclination
Mixed dentition period
When canines are unerupted removable or fixed appliance
can be used
Anterior cross bite
Posterior crossbite
EXTRACTIONS
In mild mandibular prognathism
And lower arch crowding

Lower 1
st
premolar extracted

Followed by fixed class III
Intermaxillary elastics
Both Arch length deficiencies

Extraction in both upper and lower
Arch can be done
Etiology and management
of
Class I
Class II DIV I
Class III DIV II

Submitted by-
student
FINAL BDS (Ist Term)