Radiographic evaluation of condylar positioning in patients undergoing orthognathic surgery (original) (raw)
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Vojnosanitetski pregled, 2015
Background/Aim. Postoperative condylar position is a substantial concern in surgical correction of mandibular prognathism. Orthognathic surgery may change condylar position and this is considered a contributing factor for early skeletal relapse and the induction of temporomandibular disorders. The purpose of this study was to evaluate changes in condylar position, and to correlate angular skeletal measurements following bimaxillary surgery. Methods. On profile teleradiographs of 21 patients with mandibular angular and linear parametres, the changes in condylar position, were measured during preoperative orthodontic treatment and 6 months after the surgical treatment. Results. A statistically significant difference in values between the groups was found. The most distal point on the head of condyle point (DI) moved backward for 1.38 mm (p = 0.02), and the point of center of collum mandibulae point (DC) moved backward for 1.52 mm (p = 0.007). The amount of upward movement of the point...
Maxillofacial Plastic and Reconstructive Surgery, 2018
Background: We evaluated change in the mandibular condyle after orthognathic surgery using cone-beam computed tomography (CBCT) in patients with facial asymmetry. Methods: Thirty patients with skeletal class III malocclusion and mandibular prognathism or facial asymmetry were classified into two groups according to the amount of menton deviation (MD) from the facial midline on anteroposterior (AP) cephalogram: group A (asymmetry, MD ≥ 4 mm; n = 15) and group B (symmetry, MD < 4 mm; n = 15). Position and angle of condylar heads on the axial, sagittal, and coronal views were measured within 1 month preoperatively (T0) and postoperatively (T1) and 6 months (T2) postoperatively. Results: On axial view, both groups showed inward rotation of condylar heads at T1, but at T2, the change was gradually removed and the condylar head returned to its original position. At T1, both groups showed no AP condylar head changes on sagittal view, although downward movement of the condylar heads occurred. Then, at T2, the condylar heads tended to return to their original position. The change in distance between the two condylar heads showed that they had moved outward in both groups, causing an increase in the width between the two heads postoperatively. Analysis of all three-dimensional changes of the condylar head positions demonstrated statistically significant changes in the three different CBCT views in group B and no statistically significant changes in group A. Conclusions: There was no significant difference between the two groups in condylar head position. Because sagittal split ramus osteotomy can be performed without significant change in symmetrical and asymmetrical cases, it can be regarded as an effective method to stabilize the condylar head position in patients with skeletal class III malocclusion and mandibular prognathism or facial asymmetry.
Journal of Craniofacial Surgery, 2020
The study includes 21 adult patients with skeletal class III malocclusion who underwent orthognathic surgery and had computed tomography images records presurgery (T0) up to 6 months after the surgery (T1). The computed tomography images were analyzed three-dimensionally using the Proplan CMF 3.0 software. Different skeletal and dental parameters were used in analyzing the cephalometric analysis of the patients. The change in the condylar axis angle was evaluated on 3 planes: axial, coronal, and sagittal. The anteroposterior position of the condyle in relation to the glenoid fossa was evaluated in the sagittal plane. ffSNB, ffANB, ffLeft Y-axis, ffRight Y-axis were statistically significant (P < 0.01). Significant differences on the condylar axis angle were found between the groups on the sagittal plane (P < 0.05) whereas no significant differences were noted on the axial and the coronal plane. In the anteroposterior condylar position related to the glenoid fossa, the condyle exhibited different displacement on different condyles. The right condyle exhibited more of the posterior displacement whereas the left condyle exhibited more of anterior displacement of the condyle in relation to the glenoid fossa. Numerous studies have done regarding the changes after postsurgery using the two-dimensional cephalometric analysis. Using the 3D techniques helps us to identify the cephalometric point more accurately which thus enhances the accuracy in the cephalometric analysis. However, care should be taken not to change the axis of rotation of the condyle to prevent from the treatment relapse and to avoid temporo-mandibular disorders.
Dentomaxillofacial Radiology, 2013
Objectives: To evaluate the morphological condylar changes following orthognathic surgery by using a rapid and reliable computational method on panoramic radiographs. Methods: Digital panoramic radiographs of 45 patients who underwent bilateral sagittal split osteotomy (alone or associated with a Le Fort I osteotomy) between 2007 and 2010 were analysed. Calculation of the area, perimeter and height of 90 condyles was performed by using a specific computational method. Measurements were taken before surgery (m 1), 1 day after surgery (m 2) and 1 year after surgery (m 3). The evolution of each index was analysed using paired t-tests between measures before and 1 day after surgery (m 1 2 m 2) and measures before and 1 year after surgery (m 1 2 m 3). The changes in the condylar area, perimeter and height were examined using the Bland and Altman plotting method. Results: There were no statistically significant changes in the mean condylar area, perimeter or height between m 1 and m 2 or between m 1 and m 3. The Bland and Altman plots for each index showed that a very limited number of condyles increased or decreased in area, perimeter and/or height outside the boundaries of the measurement error. Given the impossibility for a condyle to increase in size, these results are considered to represent the limits of the computational method used. Conclusions: This study demonstrated that there were no significant morphological condylar changes at the 1-year follow-up following surgery and that the range of normality in condylar changes could be influenced by the methodology used.
A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review
Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, 2012
It is very important to clarify the relationship between a dentofacial structure and a temporomandibular joint (TMJ) structure in orthognathic surgery. Recently, it was reported that the skeletal and occlusal patterns were associated with the TMJ morphology including the disc position. In orthognathic surgery, some surgeons state that alterations in the condylar position from surgery can lead to malocclusion associated with the risk of early relapse, and also favor the development of temporomandibular disorders (TMD). For these reasons, several positioning devices have been proposed and applied, but now there is no scientific evidence to support the use of condylar positioning devices. There are some reasons why scientific evidence cannot be obtained, however, it also includes the question whether the preoperative position of the condyle is the desired postoperative position. The purpose of this study was to verify the desired condylar position in orthognathic surgery, based on literature on the postoperative condylar position in orthognathic surgery. From the studies reviewed, it was suggested that the preoperative position of the condyle was not the desired postoperative position in orthognathic surgery.
2019
Aim: The aim of the study was to compare two radiographic techniques, orthopantomograph (OPG), and cone-beam computed tomography (CBCT) in determining the sagittal condylar guidance (SCG) and to find out if CBCT can serve as an alternative aid to program semi-adjustable and fully adjustable articulators. Materials and Methods: Following the inclusion and exclusion criteria, 40 individuals (20 males and 20 females) aged between 20 and 40 years were selected. An OPG and a CBCT radiograph were obtained for each individual. Using appropriate software, the SCG was measured for both the sides, for both the radiographic methods. The values for each individual were obtained by two investigators for both the methods using the respective software and the average value was taken. After performing the Shapiro–Wilk test, paired t-test was used to compare the mean difference pairwise (for both right and left side) while t-test was used to compare the mean difference between two groups. Results: R...
Three-dimensional assessment of condylar surface changes and remodeling after orthognathic surgery
Imaging science in dentistry, 2016
This study was performed to evaluate condylar surface changes and remodeling after orthognathic surgery using three-dimensional computed tomography (3D CT) imaging, including comparisons between the right and left sides and between the sexes. Forty patients (20 males and 20 females) who underwent multi-detector CT examinations before and after surgery were selected. Three-dimensional images comprising thousands of points on the condylar surface were obtained before and after surgery. For the quantitative assessment of condylar surface changes, point-to-point (preoperative-to-postoperative) distances were calculated using D processing software. These point-to-point distances were converted to a color map. In order to evaluate the types of condylar remodeling, the condylar head was divided into six areas (anteromedial, anteromiddle, anterolateral, posteromedial, posteromiddle, and posterolateral areas) and each area was classified into three types of condylar remodeling (bone formatio...
International Journal of Dentistry Research, 2017
Aim: Changes of the mandibular condyle are unwanted and unpredictable complications of orthognathic surgery. This pilot study investigated the prevalence and severity of mandibular condylar changes after orthognathic surgery. Materials and Method: In this prospective study 20 patients with class II and III malocclusion who needed orthognathic surgery were evaluated. Ramus height, condylar width, joint pain, overjet and overbite, angular changes on lateral cephalogram, maximal mouth opening, maxillary and mandibular movements before and 6 months after surgery were assessed. Results: In this study condylar atrophy was radiographically evident on panoramic radiographs of 6 (30%) of the patients; one patient was treated for class II malocclusion and the other 5 were treated for class III malocclusion. Conclusion: This study showed radiographically evident condylar atrophy in 30% after surgery; however none had any related clinical signs or symptoms. None of the cases that developed condylar atrophy postsurgery correlated significantly with the variables assessed in this short term pilot study. Further studies and longer follow-up is needed to validate the results.