Facial asymmetries : how to avoid maxillary osteotomy using mini-screws and bite planes? A case series

The cant of the occlusal plane in the frontal plane reflects facial asymmetry. Its treatment requires close collaboration between the orthodontist and the maxillofacial surgeon. In case of mild cant, treatment consists in coordination of dental arches followed by mandibular osteotomy. For more severe asymmetries, mandibular and maxillar surgery may be necessary to straighten the occlusal plane. However, this procedure can be disproportionate when the cant is moderate. The objective of our case series is to describe an orthodontic-surgical protocol straightening the occlusion plane using bite planes and miniscrews, without surgery of the maxilla.

The protocol is based on the creation, the day before the mandibular surgery, of bite planes with asymmetric thicknesses, allowing the surgeon to fix the mandible horizontally in frontal plane. Bite planes are removed a few weeks after surgery. Elastic tractions supported by miniscrews placed on the lower arch allow maxillary teeth extrusions.

Through the four clinical cases presented, we observed a straightening of the occlusal plane and a facial harmonization.

This orthodontic-surgical protocol may be interesting for mild to moderate occlusal cant, avoiding a Le Fort I osteotomy.