Orthodontic objectives in orthognathic surgery: state of the art today

In treating jaw discrepancies, camouflage and surgery have different treatment modalities, often involving opposite orthodontic mechanics and different extraction decisions. Pretreatment identification of surgical patients is therefore essential. Esthetics, function, stability, and treatment time have to be considered and patients provided the information they need to be part of the decision-making process. The goal of presurgical orthodontics is to position the teeth, allowing an optimal skeletal correction at surgery. While intra-arch alignment is similar to conventional orthodontics, leveling is not carried out automatically in surgical patients. In open-bite cases, steps within the arches are an indication for segmental surgery. Orthodontic leveling will be limited to the segments, and segments will be leveled with differential intrusion at surgery. In deep-bite/short-face cases, leveling a severe curve of Spee should be done after the occlusion is unlocked by surgery. Anteroposteriorly, dental compensations are removed by ideally positioning the teeth relative to their apical bases. This will make the malocclusion look worse presurgically, but it will unravel the true magnitude of the skeletal problem, thus allowing an optimal correction at surgery. It is important to recognize if a transverse problem is skeletal or dental in nature and if the correction should be done orthodontically, by segmental surgery, or by surgically assisted palatal expansion. No orthodontic expansion should be done presurgically in a patient who will have surgical expansion. Any tooth movement with relapse potential should be avoided presurgically. Postsurgical orthodontics will bring teeth into position and proper intercuspation within a reasonable time period.