Prospective longitudinal study on the periodontal health of the adjacent teeth in segmented-non-segmented maxillary osteotomies

Background

Orthognathic surgery is the field of maxillofacial surgery that concerns the correction of dento-cranial-maxillofacial deformities. The goal of orthognathic surgery would be the correct position of the jaw. There are several types of maxillary osteotomies. When the maxilla is divided in two or more segments, we talk about segmented maxillary osteotomies. The segmented LeFort I osteotomy is reserved for transverse malformations smaller than 7 mm associated with other sagittal or vertical problems

Aim/Hypothesis

The aim of this study was to compare the periodontal changes which occurs in the adjacent teeth in segmented and non-segmented maxillary osteotomies.

Material and Methods

A prospective evaluation of all patients who received a maxillary osteotomy were performed at Instituto Maxilofacial, Centro Mèdico Teknon, Barcelona, Spain. Patients were selected consecutively on the basis of the following inclusion criteria- non-growing status+ patients candidates of segmental LeFort I osteotomy+ stable periodontal situation and informed consent. The pre and postoperative periodontal evaluation consisted on a complete periodontal charting from 14 to 24. The following parameters were recorded at baseline and 1-month and 6-month after the surgery+ gingiva biotype, plaque index, probing pocket depth, gingival recession and bleeding on probing. All measurements were made at six sites per tooth- Mesio-vestibular, central-vestibular, distovestibular, mesiopalatal, central-palatal and distopalatal. Furthermore, three CBCT were performed at three time-points- preoperatively, 1- and 6-months follow-up in order to assess the bone quantity.

Results

A total of 40 patients were included in the study + 20 underwent segmented Le Fort I and 20 non-segmented. Statistical analysis at month revealed significant differences in patients who underwent segmented maxillary osteotomies with an increase of pocket probing depth and bone loss. Furthermore, the major changes occurred in patients with thin biotype with a tendency to develop recessions.

Conclusion and Clinical Implications

There were significant periodontal changes in segmented maxillary osteotomies. A longitudinal assessment is required (6 months, 1 year) to assess the long-term results.