Three-dimensional prediction of mandibular movement in the treatment of prognathism

The three-dimensional movements of the mandible that might occur during surgical correction of mandibular prognathism were analyzed preoperatively in 40 patients. Direct measurements were made on the dental models used to predict postoperative occlusion, and the results were transferred to the cephalometric tracings using three-dimensional coordinate transformation. Menton, gonion, and two bony points on the posterior borders of the ascending rami were chosen on the frontal and lateral cephalograms for prediction of the antero-posterior, vertical, and lateral movements. In most cases a reasonable amount of movement without much lateral shift at the posterior border of the mandible was predicted to occur when the postoperative position of the mandible was established to provide a stable occlusion. However, there were five cases in which predicted lateral movement at one of the posterior borders exceeded 5 mm, and, in four of them, protrusion of the mandible was not accompanied by lateral deviation. It was concluded that careful preoperative planning and postoperative treatment are necessary in these cases because a large amount of lateral movement at the site of operation might lead to postoperative relapse following ramus osteotomy.