Surgical options in deep-bite mandibular deficiency with prominent chin - aesthetic considerations

A deep-bite hypoplastic mandible associated with a strong chin poses an aesthetic challenge. Functional correction of the distal occlusion can bring the chin point beyond the ideal or normal profile line. The aim of the study was to outline the indications and drawbacks of four approaches that are currently used to deal with this problem.

A retrospective study was done using lateral cephalograms and pre- and postoperative pictures of 40 randomly selected patients, judged by a panel of four surgeons. The following parameters were studied apart from occlusion: A-P chin position, chin height, mentolabial and submental folds, cervicomental and gonial angles, antegonial notch, lower lip position, and anterior mandibular bowing.

Procedures that involve a setback of the chin are potentially prone to create or increase submental fullness, especially the mandibular advancement/chin setback osteotomy. Procedures involving advancement of the anterior dentoalveolar segment relative to the symphyseal prominence (e.g. mandibular advancement/chin setback osteotomy, dentoalveolar mandibular advancement osteotomy) are prone to flatten the mentolabial fold excessively. The position of the chin point after mandibular advancement-posterior rotation osteotomy is difficult to predict. Maxillomandibular posterior rotation has potentially the best aesthetic outcome, provided that the chin point is not set back.