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Stability after mandibular setback: mandible-only versus 2-jaw surgery.

William R Proffit1, Ceib Phillips, Timothy A Turvey

  • 1Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA. William_Proffit@dentistry.unc.edu

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
|February 28, 2012
PubMed
Summary

Mandibular setback surgery alone shows less ramus stability than two-jaw surgery. While chin position changes similarly, two-jaw surgery offers better control of ramus position post-orthognathic surgery.

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Area of Science:

  • Orthognathic surgery
  • Craniofacial surgery
  • Dental and skeletal cephalometrics

Background:

  • Rigid internal fixation has advanced mandibular setback techniques.
  • Class III malocclusion correction often involves mandibular setback surgery.
  • Postoperative stability remains a key concern in orthognathic surgery.

Purpose of the Study:

  • To evaluate if improved mandibular setback techniques enhance postoperative stability.
  • To compare stability between mandibular setback alone and two-jaw surgery for Class III correction.

Main Methods:

  • Cephalometric analysis of skeletal and dental changes.
  • Comparison of 17 patients (mandibular setback alone) and 83 patients (two-jaw surgery).
  • Analysis of gonion movement, ramus inclination, and pogonion changes.

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Main Results:

  • Mandibular setback alone showed significant gonion posterior movement (47%) and ramus inclination changes.
  • Two-jaw surgery demonstrated better control of ramus position (1%).
  • Both groups exhibited similar mean chin (pogonion) forward movement (2.8 mm) postoperatively.
  • Chin movement in mandible-only cases was mainly due to ramus inclination recovery; in two-jaw cases, it involved gonion movement and maxillary rotation.

Conclusions:

  • Postoperative stability in mandibular setback surgery has improved but still requires attention.
  • Two-jaw surgery provides superior control over ramus position compared to mandibular setback alone.
  • Understanding the mechanisms of chin position change is crucial for predicting stability.