PMC4942733_01
A,B,C:Preoperative Occlusion. D,E,F:Occlusion in 3D virtual planning. G,H,I:Postoperative occlusion after 30 days.
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The patient was a healthy 24-year-old woman with an anterior open bite (3 mm overbite, 4 mm overjet, 2 mm Angle class II anterior occlusion, and 2 mm Angle class III posterior occlusion) who had been undergoing orthodontic treatment for 2 years (Fig. 1A-C). Based on these factors, monomaxillary surgery with Le Fort I osteotomy was chosen for 2 mm advancement of the posterior maxilla and a V-shaped segmental maxillary osteotomy between teeth UR3/4 and UL3/4 for 8  clockwise rotation and 5-mm down repositioning of the premaxilla, thereby modifying occlusion to Angle class I and closing the anterior open bite (Fig. 1D-F). The overbite improved from -3 mm to 2 mm and overjet from 4 mm to 2 mm, ensuring closure of the anterior open bite and maintaining coordination between the posterior and anterior segments of dental occlusion at Angle class I (Fig. 1G-I) Repeat CBCT performed 6 months after surgery revealed bone formation with density greater than that of the tissue surrounding the segmental maxillary osteotomy, providing stable occlusion (Fig. 4).
Virtual planning. A:Axial view - V-shaped segmental maxillary osteotomy showing a 4.1 mm surgical gap between UR3/4 and UL3/4, and a 4.8 mm surgical gap on the floor of the nasal fossa (red arrows). B,C,D:Lateral and frontal view.
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Reconstructions of the segmented osteotomies showed a gap of approximately 4.1 mm in the area between teeth UR3/4 and UL3/4 and approximately 4.8 mm on the floor of the nasal fossa (Fig. 2).
Surgical procedure A:Gap between the sections of the maxilla. B:Framework filled with Bio-oss  granules. C:Collagen membrane placed over the grafted area. D:Rigid internal fixation with L-shaped microplates stabilizing the collagen membranes.
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