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Gearing Effect in Clockwise Rotational Orthognathic Surgery.

Soo Hyun Woo1, Young Chul Kim2, Jang Yeol Lee3

  • 1From the Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine.

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Summary

Clockwise jaw rotation using maxillary posterior impaction effectively corrects skeletal class III malocclusion in Asians. This approach, particularly the gearing effect, proves more beneficial for individuals with longer lower anterior facial height (LAFH).

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Area of Science:

  • Orthodontics and Dentofacial Orthopedics
  • Surgical Planning
  • Craniofacial Surgery

Background:

  • Standard treatment for skeletal class III malocclusion involves maxillary advancement and mandibular setback.
  • Clockwise jaw rotation is a recognized orthognathic surgery technique, but its precise mechanism requires further investigation.
  • This study explores a novel approach using maxillary posterior impaction with clockwise rotation to correct class III malocclusion in Asian patients without maxillary advancement.

Purpose of the Study:

  • To introduce and evaluate the "gearing effect" in correcting skeletal class III malocclusion in Asians.
  • To assess the efficacy of maxillary posterior impaction with clockwise rotation without maxillary advancement.
  • To investigate the relationship between lower anterior facial height (LAFH) and treatment outcomes.

Main Methods:

  • Retrospective analysis of 29 patients undergoing class III correction via clockwise rotation of the maxillomandibular complex, excluding those with genioplasty.
  • Utilized artificial intelligence-based cephalometric analysis to measure facial skeletal landmarks.
  • Quantified the gearing effect by comparing LAFH to the anterior nasal spine to posterior nasal spine length.

Main Results:

  • A statistically significant correlation was found between posterior nasal spine impaction and menton setback (P = 0.002) and between clockwise palatal angle rotation and menton setback (P = 0.007).
  • Patients with longer LAFH exhibited a greater menton setback per unit of posterior nasal spine impaction and palatal angle rotation.
  • Improved A point convexity was observed without significant changes in the sella-nasion-A point angle.

Conclusions:

  • Clockwise rotational orthognathic surgery, leveraging the gearing effect, offers a viable treatment option for skeletal class III malocclusion.
  • The mandibular setback component of this technique is more effective in patients presenting with a longer LAFH.
  • This method provides skeletal correction without altering the sella-nasion-A point angle, suggesting stable outcomes.