PMC4816591_01
- Lateral and frontal extraoral photographs before orthodontic treatment. Patient at 14 years of age.
2176-9451-dpjo-21-01-00089-gf01.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf01.jpg
f01
Extraoral and intraoral initial status, previous to orthodontic treatment, can be seen in Figures 1 and 2, respectively.
- Intraoral photographs before orthodontic treatment. Patient at 14 years of age.
2176-9451-dpjo-21-01-00089-gf02.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf02.jpg
f02
Extraoral and intraoral initial status, previous to orthodontic treatment, can be seen in Figures 1 and 2, respectively.
- Intraoral photographs after preoperative orthodontic treatment.
2176-9451-dpjo-21-01-00089-gf03.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf03.jpg
f03
SS archwires) and extraction of mandibular first premolars for correction of dental compensations, enabling the occlusal coordination of both dental arches (Fig 3). Surgical treatment objectives were maxillary advancement of 3 mm, anterior impaction of 6 mm, impaction of 8 mm at the level of the right canine and 4 mm at the level of the left canine, with Le Fort I osteotomy and anterior and counterclockwise mandibular repositioning with bilateral sagittal split osteotomy (BSSO).
- 3D image of the skull fused with surface scans of the upper and lower plaster dental casts.
2176-9451-dpjo-21-01-00089-gf04.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf04.jpg
f04
Upper and lower dental plaster casts were scanned using a surface laser scanner and incorporated in the 3D image by means of a semi-automatic procedure (Fig 4).
- 3D image of the preoperative situation (A) and the postoperative virtual simulation of the predicted results on hard tissues after repositioning the mobilized bone structures (B).
2176-9451-dpjo-21-01-00089-gf05.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf05.jpg
f05
A 3D simulation of postoperative results on hard tissue was produced (Figs 5A, 5B).
- 3D planned intermediate (A) and final (B) situation with the virtual splint set between the dental arches. Intermediate (C) and final (D) CAD/CAM surgical splints milled on PMMA.
2176-9451-dpjo-21-01-00089-gf06.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf06.jpg
f06
- Intraoperative situation of the conventional initial splint (A), intermediate CAD/CAM splint (B) and final CAD/CAM splint (C) fitting the dental arches.
2176-9451-dpjo-21-01-00089-gf07.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf07.jpg
f07
I and BSSO osteotomies. Intraoperative registration of the correct condylar position within the glenoid fossa was performed using the initial splint (acrylic splint generated by the conventional method), and the reposition of the osteotomized maxilla and mandible was guided by the CAD/CAM surgical splints using fixation plates and screws (Figs 7A-C).
- Intraoral photographs of the unfinished postoperative orthodontic treatment, 10 months after orthognathic surgery.
2176-9451-dpjo-21-01-00089-gf08.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf08.jpg
f08
Treatment continued with the postoperative orthodontic phase for final occlusal detailing (Fig 8).
- Frontal facial photographs at rest, before (A) and after orthognathic surgery, comissuroplasty and jugal lipofilling (B).
2176-9451-dpjo-21-01-00089-gf09.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf09.jpg
f09
Six months after orthognathic surgery, left comissuroplasty and jugal lipofilling with Coleman's technique were performed using an autologous abdominal fat graft (Figs 9A, 9B and 10A, 10B).
- Frontal facial photographs at smiling, before (A) and after orthognathic surgery, comissuroplasty and jugal lipofilling (B).
2176-9451-dpjo-21-01-00089-gf10.jpg
PMC4816591_01_2176-9451-dpjo-21-01-00089-gf10.jpg
f10
Six months after orthognathic surgery, left comissuroplasty and jugal lipofilling with Coleman's technique were performed using an autologous abdominal fat graft (Figs 9A, 9B and 10A, 10B).