Splintli ve Splintsiz İntermaksiller Tespitin Semirijid Fiksasyon Yapılmış Mandibular Osteotomi Olgularında Uzun Dönem Sonuçlar Üzerinde Etkisi
Özet
Ortoghnatic surgery,along with ortodontic treatment, has played a very important role in treatment of malocclusion throughout history. Surgical interventions were applied after orthodontic evaluation considering dental occlusion, facial aesthetics and function. In orthognathic surgery follow-up relapses are evaluated with skeletal stability in the long term. The factors which affect relapse are type of osteotomy, fixation technique, amount of advancement and recession in the postoperative period. There are numeroous reports in the literature concerning relaps and stability of orthodontic and surgical interventions. OBJECTIVE: Occlussal splints which are planned and manifactured for every patient preoperatively are used for repositioning of the osteotomized maxilla and mandibula intraoperatively. Occlusal splints are also used to ensure the centric occlusion during postoperative intermaxillary fixation. Our clinical experience suggests that use of splints in the postoperative period is uncomfortable and the patient needs longer orthodontic treatment. The goal of our study, is to show positive effects of kinetic interaction between the teeth. The differences between early and late postoperative lateral cephalometric radiographs were evaluated statistically. METODS: This retrospective study was designed in 2 groups. All patients were operated with the same surgical technique. That is;Lefort I osteotomy fo maxilla and Sagittal Split Ramus Osteotomy for mandibule either advancement or retropositioning,In group 1 early and late results of 18 patients who used splint postoperatively were assesed In group 1 early and late results of 16 patients who did not use splint postoperatively were assessed . All data obtained from lateral sephalometric films were transfered into electronic data using 'Epsilon perfection' scanner.Afterward this data was standardized by Dolphin cephalometric analysis program. The difference between these measurements were assessed by Mann-Whitney test. RESULTS: 4 variables of a total of 10 measurements were significantly different in the statistical evaluation. In three of them , all variables ( maxillary length , mandibular length , maxillomandibular difference ( ANS- PNS / Go- Gn ) p-values were below 0:05 . Maxillomandibular difference (Gn / Co- ANS ) value was found to be 0.053 and the value of the p-value was considered significant . As a result, the relapse rate was found to be higher in patients in whom splint were used. CONCLUSION: This study showed that the use of postoperative splints in patients with semirigid fixation is important in terms of relapse. Repositioning of bone segments after postoperative splinting has increased maxillamandibular difference variable. The difference arising in the mandible and maxilla length is a result of long-term splint use. In order to make the results significantly reliable early postoperative and late postoperative cephalometric drawings were compared. Using different devices for assesment of the early and late postoperative cephalometric radiographs of patients was a serious problem. Standardization has been achieved by assuming 1 molar tooth length 10mm for the magnification scale.