Presurgical &

postsurgical
orthodontics
Presented by:–
Neelima Singh
 CONTENTS
• Introduction
• Presurgical orthodontics
o Stability
o Esthetics
o slot size
o Bonding and banding
• Objectives of presurgical orthodontics
• Postsurgical orthodontics
o Working arch wires
o Intermaxillary elastics
o Retention protocol
• Conclusion
• References
 INTRODUCTION

Asjad Nizar, Sheethal Jayachandran, Jibin Joy, K Nillan Shetty and Harshitha Kotian; Pre and post surgical orthodontics: A
literature review; International Journal of Applied Dental Sciences 2022; 8(1): 173-175
 Thetreatmentmaybedividedintofourstages:

Treatment planning

Presurgical orthodontics

Surgical procedure

Postsurgical orthodontics

Asjad Nizar, Sheethal Jayachandran, Jibin Joy, K Nillan Shetty and Harshitha Kotian; Pre and post surgical orthodontics: A
literature review; International Journal of Applied Dental Sciences 2022; 8(1): 173-175
 Presurgical Orthodontics

Presurgical Orthodontics Goals

• Align and level teeth without concern for dental occlusion.
• Establish proper anterior-post. and vertical position of the incisors.

If the patient is not properly prepared: -

• Surgery cannot be carried out effectively,
• Quality of the result is diminished
• Postsurgical orthodontic treatment time increases

Asjad Nizar, Sheethal Jayachandran, Jibin Joy, K Nillan Shetty and Harshitha Kotian; Pre and post surgical orthodontics: A
literature review; International Journal of Applied Dental Sciences 2022; 8(1): 173-175
 Selection of the appliance
1. Stability
2. Esthetics
3. Slot Size
4. Bonding vs Banding

Singh, N., Kaur, S., & Sharma, V. K. (2021). Pre and post operative orthodontics in orthognathic surgery: A review.
International Journal of Health Sciences, 5(S2), 156²168.
 STABILITY

Use of a preadjusted appliance due to the stability by

rectangular wire in a rectangular slot.

Proffit does not recommend Begg

ESTHETICS
appliance for surgical patients, as
the stability provided by a
Hugo et al. (2000) reported the use of a
round wire is much
maxillary
less.
lingual and mandibular labial appliance in
orthognathic
patients. But they too mentioned the use of labial appliances
Asjad Nizar, Sheethal Jayachandran, Jibin Joy,
just before theKsurgery
Nillan Shetty
andandthereafter
Harshitha Kotian;
untilPre andend
the post of
surgical
the orthodontics: A
literature review; International Journal of Applied Dental Sciences 2022; 8(1): 173-175
 Slot Size

Either slot size – 18 or 22

Bonding vs banding

Bond anteriors, and band posteriors

Singh, N., Kaur, S., & Sharma, V. K. (2021). Pre and post operative orthodontics in orthognathic surgery: A review.
International Journal of Health Sciences, 5(S2), 156²168.
 Objectives of preoperative orthodontics
• Alignment
• Levelling
• Decompensation
• Incisor inclination preparation
• Arch coordination
• Elimination of occlusal interferences.

Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for Orthognathic Surgical Treatment Planning;
International Journal of Science and Research; Volume 10 Issue 3, March 2021
 PRESURGICAL LEVELING IN DEEPBITE CASES

• If incisors intruded presurically – unstable

• If incisors not intruded presurgically – opening mandibular rotation – stable
• In case of LAFH is short – incisor edge to chin distance normal – extrusion
of posteriors

Asjad Nizar, Sheethal Jayachandran, Jibin Joy, K Nillan Shetty and Harshitha Kotian; Pre and post surgical orthodontics: A
literature review; International Journal of Applied Dental Sciences 2022; 8(1): 173-175
 PRESURGICAL LEVELING IN CASES WITH VME

• VME with anterior open bite – leveling of anteriors is higher than

posteriors
• No attempt – to close the anterior open bite pre-surgically.
• Avoid intrusion in posteriors and any extrusion in the anterior region
(relapse tendencies).
• Reversed curve of Spee – segmental orthodontics.

Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for Orthognathic Surgical Treatment Planning;
International Journal of Science and Research; Volume 10 Issue 3, March 2021
 DECOMPENSATION

• Normally teeth erupt in soft tissue equilibrium – in presence of sagittal

& traverse discrepancy – alternation in inclination
• Re- establishment of correct position wrt skeletal bases.
 Total decompensating
 Partial decompensation
• Unmask / unveil true extent of underlying skeletal defect.

Singh, N., Kaur, S., & Sharma, V. K. (2021). Pre and post operative orthodontics in orthognathic surgery: A review.
International Journal of Health Sciences, 5(S2), 156²168.
 Objectives of preoperative orthodontics
• Alignment
• Levelling
• Decompensation
• Incisor inclination preparation
• Arch coordination
• Elimination of occlusal interferences.

Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for Orthognathic Surgical Treatment Planning;
International Journal of Science and Research; Volume 10 Issue 3, March 2021
Final surgical Planning
• 2 weeks before surgery:
• OPG.
• Lateral ceph.
• Casts.
• Photos – intra and extra-oral.
• PA ceph – if there is facial
asymmetry.
• IOPA and occlusal view if needed.
• Face bow transfer onto an
articulator if needed

Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for Orthognathic Surgical Treatment Planning;
International Journal of Science and Research; Volume 10 Issue 3, March 2021
Model Surgery
1) To verify that the planned
movements are possible.
2) To relate the mandibular and
maxillary dentitions in the position
where the surgical splint will be
made.

Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for Orthognathic Surgical Treatment Planning;
International Journal of Science and Research; Volume 10 Issue 3, March 2021
2 jaw model surgery

1. Impression and was bite

2. Mounting of maxillary 1st and mandibular cast with wax bite
3. During mounting 5 mm acrylic spacer
4. Grooves created in plaster & petroleum jelly applied
5. Covered with blue colour plaster
6. First – maxillary procedure is done
7. After impaction – pink plaster to stabilize maxilla in position
8. Maxillary mounting loosen – maxilla is dropped ( autorotation on maxilla)
9. In this position immediate splint is made
10. Blue plaster removed from mandibular cast & mandibular repositioning is
done
11. Final splint is made – used in IMF
Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for Orthognathic Surgical Treatment Planning;
Requirements of the splint
• Fit the teeth accurately
• Minimum thickness – not more
than 2 mm
• Excess acrylic should be
trimmed off the buccal aspect.

Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for Orthognathic Surgical Treatment Planning;
International Journal of Science and Research; Volume 10 Issue 3, March 2021
POSTSURGICAL ORTHODONTICS
 Working arch wires

• Braided (multistrand) stainless steel 0.017, or 0.018 or 0.019 × 0.025-

inch.
• TMA (titanium-molybdenum alloy) 0.017, or 0.018 or 0.019 × 0.025-
inch.
• Nickel-titanium (NiTi) 0.017, or 0.018 or 0.019 × 0.025-inch.

Nielsen, Ib Leth (2022) "Important Orthodontic Considerations in Preparation of Orthognathic Surgical Cases," Taiwanese
Journal of Orthodontics: Vol. 34: Iss. 2, Article 1.
 Intermaxillary working elastics

Retention protocol

Nielsen, Ib Leth (2022) "Important Orthodontic Considerations in Preparation of Orthognathic Surgical Cases," Taiwanese
Journal of Orthodontics: Vol. 34: Iss. 2, Article 1.
CONCLUSION
 REFERENCES

• Asjad Nizar, Sheethal Jayachandran, Jibin Joy, K Nillan Shetty and Harshitha
Kotian; Pre and post surgical orthodontics: A literature review; International
Journal of Applied Dental Sciences 2022; 8(1): 173-175
• Singh, N., Kaur, S., & Sharma, V. K. (2021). Pre and post operative
orthodontics in orthognathic surgery: A review. International Journal of Health
Sciences, 5(S2), 156²168.
• Kumar A.; Presurgical Orthodontic Preparation: A Newer Trend for
Orthognathic Surgical Treatment Planning; International Journal of Science
and Research; Volume 10 Issue 3, March 2021
• Nielsen, Ib Leth (2022) "Important Orthodontic Considerations in Preparation
of Orthognathic Surgical Cases," Taiwanese Journal of Orthodontics: Vol. 34:
Iss. 2, Article 1