Liu JY, Li GF, Tang Y, Yan FH, Tan BC. Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification: A case report. World J Clin Cases 2022; 10(25): 8980-8989 [PMID: 36157638 DOI: 10.12998/wjcc.v10.i25.8980]
Corresponding Author of This Article
Bao-Chun Tan, MS, Doctor, Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhongyang Road, Nanjing 210008, Jiangsu Province, China. tanbaochun2002@163.com
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 6, 2022; 10(25): 8980-8989 Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8980
Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification: A case report
Jia-Ying Liu, Gui-Feng Li, Ya Tang, Fu-Hua Yan, Bao-Chun Tan
Jia-Ying Liu, Fu-Hua Yan, Bao-Chun Tan, Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
Gui-Feng Li, Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
Ya Tang, Department of Preventive Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Tan BC was responsible for conceptualization and supervision; Liu JY was responsible for writing the original draft, reviewing, and editing; Li GF, Tang Y, and Yan FH contributed to investigation and data curation; all the authors approved the final version for submission. Liu LY and Li GF contributed equally to this work.
Supported byNanjing Clinical Research Center for Oral Diseases, No. 2019060009; and the Nanjing Medical Science and Technology Development Program, No. YKK17139.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bao-Chun Tan, MS, Doctor, Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhongyang Road, Nanjing 210008, Jiangsu Province, China. tanbaochun2002@163.com
Received: March 29, 2022 Peer-review started: March 29, 2022 First decision: June 16, 2022 Revised: June 22, 2022 Accepted: July 21, 2022 Article in press: July 21, 2022 Published online: September 6, 2022 Processing time: 150 Days and 6.1 Hours
Abstract
BACKGROUND
Maxillofacial deformities are skeletal discrepancies that cause occlusal, functional, and esthetic problems, and are managed by multi-disciplinary treatment, including careful orthodontic, surgical, and periodontal evaluations. However, thin periodontal phenotype is often overlooked although it affects the therapeutic outcome. Gingival augmentation and periodontal accelerated osteogenic orthodontics (PAOO) can effectively modify the periodontal phenotype and improve treatment outcome. We describe the multi-disciplinary approaches used to manage a case of skeletal Class III malocclusion and facial asymmetry, with thin periodontal phenotype limiting the correction of deformity.
CASE SUMMARY
A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage, but the treatment outcome was not satisfactory. After examination, gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement. After orthodontic decompensation, double-jaw surgery was performed to reposition the maxilla-mandibular complex. Finally, implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile. The appearance and function were significantly improved, and the periodontal tissue remained healthy and stable.
CONCLUSION
In patients with dentofacial deformities and a thin periodontal phenotype, multi-disciplinary treatment that includes PAOO could be effective, and could improve both the quality and safety of orthodontic-orthognathic therapy.
Core Tip: This report describes the comprehensive management of a patient with skeletal Class III malocclusion and facial asymmetry. For such cases, it is critical to evaluate the patient’s chief complaints, skeletal as well as soft tissue problems. This case highlighted the importance and benefits of periodontal phenotype modification, which can prevent complications such as attachment loss of anterior teeth that compromise the treatment outcome. Corticotomy combined bone augmentation with or without gingiva augmentation, can not only increase the safety of treatment, but also stretch the limits of deformity correction.
