Effects of the multiple-piece maxillary osteotomy on the periodontium

Clinical indications exist for both the surgically assisted rapid maxillary expansion (SARME) and the multiple-piece maxillary osteotomy (MPMO). Recent trends, however, imply that the SARME combined with a subsequent 1-piece osteotomy can supplant the use of the MPMO. Those favoring the SARME frequently site morbidities associated with the MPMO. Major reported complications include loss of dentoalveolar segments, teeth, and oronasal or oroantral communication. Relapse, tooth devitalization, and damage to the periodontium, including bone loss and soft tissue alteration, comprise the minor morbidities. If these can be avoided or minimized, then the use of the MPMO for its inherent advantages over the SARME in certain clinical situations may be indicated The purpose of our study was to critically evaluate the periodontium following the use of the MPMO to ascertain if minor morbidities are inherent to the procedure, and to quantify them. Records of 24 MPMO patients were reviewed, ranging from 3 to 24 months after surgery. A specific surgical technique was utilized for all patients, including bone grafting. The vertical segmental osteotomy sites varied and were recorded for comparison. Periodontal probing depths at the segmental osteotomy sites were compared with the adjacent interproximal spaces of each patient. Independent dental examiners were used to review photographs and periapical radiographs to compare the papillae and alveolar bone height, respectively, at the osteotomy site versus the neighboring interproximal areas. A paired t test was used to compare probing depth measurements at the vertical osteotomy site and neighboring interproximal sites. The mean difference between these two sites was 0.01 mm with a standard deviation of 0.25 mm. This was not statistically significant. Statistical analyses were also performed to compare these probing depth differences at varying sites in the maxilla, and to compare probing depth differences to gender, total number of osteotomies performed on each patient, estimated blood loss, and length of procedure. These results were not statistically significant. Independent examiners found no difference in gingival architecture or alveolar bone levels when comparing vertical osteotomy sites to neighboring interproximal sites. This study showed that damage to the periodontium at vertical osteotomy sites was minimal, and not a reason to avoid use of the multiple-piece maxillary osteotomy.