Diagnosis and treatment planning in dentofacial deformities: Are we justified?

To understand the viewpoint of the patients who already underwent corrective jaw surgery in order to ascertain whether the clinicians are justified pertaining to their diagnosis and treatment planning of patients with dentofacial deformities.

In order to conduct this study, a predetermined questionnaire was designed to comprehend the thought process of patients who were already subjected to corrective jaw surgery in various surgical centers belonging to various states of south India. One hundred and thirty-six patients were enrolled in the survey. Demographic information, educational qualification, primary reason for undergoing corrective jaw surgery, whether they were convinced with the surgical treatment plan offered to them by the clinician following thorough evaluation, whether they were willing to proceed with a staged surgical treatment plan if offered, and whether they prefer a simple chair-side facial analysis which is time-consuming yet effective or advanced and sophisticated technology that can predict the surgical outcome were evaluated.

It was observed that among the patients who underwent corrective jaw surgery, nearly 62% had both esthetic and functional concerns, while 27% had esthetic concerns and only 11% had functional concerns. The patients with esthetic concerns primarily had apprehensions pertaining to their lips and chin region followed by the jaws, while the functional concerns were primarily with regard to difficulty in chewing. It was observed that 77% of the patients with dentofacial deformity were willing for a staged surgical treatment plan for an optimal clinical outcome. Only 58% of patients felt that the investigations performed on them were sufficient to provide a proper treatment plan and an optimal clinical outcome, while 36% were unaware. It was noticed that 68% of the patients preferred a simple chair-side facial analysis over an advanced and sophisticated technology that can predict the clinical outcome.

On the basis of the inferences obtained from this study, it is wise to recommend that all the esthetic units of the face need to be taken into account while assessing the esthetics of a human face and not merely the relationships of the jaws. It can now be concluded based on the results obtained from this study that when one accomplishes a corrective jaw surgery purely constructed on the norms of the cephalometric analysis and data obtained from three-dimensional (3D) software solutions, it can inevitably fail to address few imperfections of the face. Therefore, for the diagnosis and planning treatment of dentofacial deformity patients, cephalometric analysis and 3D software solutions can only be used as an adjunctive diagnostic tools and clinical judgment needs to be given greater emphasis.