PMC6192079_01
(a-c) Preoperative facial images showed a well-positioned maxilla and favorable chin projection associated with a deep labiomental sulcus.
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Federal University of Parana as she complained regarding her aesthetics and malocclusion. Facial analysis showed a well-positioned maxilla despite a hypodivergent face pattern, with a reduction of tooth exposure upon smiling, and favorable chin projection associated with accentuated and deep labiomental fold due to retrusion of the inferior alveolar segment (Figures 1 and 2).
(a, b) Preoperative intraoral images showing a deep bite and retrusion of the inferior alveolar segment.
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Federal University of Parana as she complained regarding her aesthetics and malocclusion. Facial analysis showed a well-positioned maxilla despite a hypodivergent face pattern, with a reduction of tooth exposure upon smiling, and favorable chin projection associated with accentuated and deep labiomental fold due to retrusion of the inferior alveolar segment (Figures 1 and 2).
(a) Preoperative panoramic radiography with subapical osteotomy simulation. (b). Digital cephalometric tracing of preoperative lateral radiograph using Dolphin Imaging Software.
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The chin (pogonion) was well positioned (Figure 3).
Surgical technique. (a) A "V" incision was conducted from the right to left retromolar region, and a mucoperiosteal flap was carefully detached to maintain the mental nerve integrity. (b) A ring of cortical bone was removed around the mental foramen, aiming to create a space around it. A gradual and careful removal of the buccal cortical bone with a drill exposed the inferior alveolar neurovascular bundle and let it free in all of its extension from the foramen to the retromolar region. (c) Once the inferior alveolar neurovascular bundle was viewed in its entirety, it was carefully removed from the inferior dental canal and repositioned either inferiorly or superiorly to it. (d) After nerve repositioning, a reciprocate saw was carefully used to conduct an osteotomy from the mental foramen to the retromolar region, to divide the lingual cortical bone from the basal bone, careful to avoid damage to the posterior teeth's apices. (e) After the dentoalveolar segment containing the entire lower dentition was mobilized, it was repositioned to the desired site and stabilized with miniplates and screws of the system 2.0.
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After a local bupivacaine 0.5% infiltration, a "V" incision was conducted from the right to the left retromolar region, and a mucoperiosteal flap was carefully detached to maintain the mental nerve integrity (Figure 4(a)). A gradual and careful removal of the buccal cortical bone with a drill, exposing the inferior alveolar neurovascular bundle and letting it free in all of its extension from the foramen to retromolar region, was done (Figure 4(b)), different from the original technique. After the repositioning, a reciprocate saw was carefully used to conduct an osteotomy from the mental foramen to the retromolar region to divide the lingual cortical bone from the basal bone, taking care to avoid damage to the posterior teeth's apices (Figure 4(c)). It is crucial to avoid as much possible damage to the lingual mucosa when cutting the lingual cortical bone due to the fact that it is the main pedicle supplying nutrition to the dentoalveolar segment after the osteotomy is completed (Figure 4(d)). The conducted incision was closed with absorbable sutures (Figure 4(e)).
(a) Postoperative panoramic radiograph. (b) Digital cephalometric tracing of postoperative lateral radiograph using Dolphin Imaging Software.
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Panoramic radiograph and cephalometric radiograph showed occlusal stability as well as the condyle in the right position after surgery (Figure 5).
Correction of deep bite and dental retrusion associated with occlusal stability (6-year follow-up).
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The resolution of the main aesthetic complaint of the patient, which was a deep labiomental sulcus, was achieved through the TMAO (Figures 6, 7, and 8).
Occlusal stability associated with aesthetic face (6-year follow-up).
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The resolution of the main aesthetic complaint of the patient, which was a deep labiomental sulcus, was achieved through the TMAO (Figures 6, 7, and 8).
Reconstructed computerized tomography images showing bone deposition and stability of the osteotomized segments (6-year follow-up).
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The resolution of the main aesthetic complaint of the patient, which was a deep labiomental sulcus, was achieved through the TMAO (Figures 6, 7, and 8).