Tridimensional planning for surgical/orthodontic treatment of mandibular excess

The dentofacial deformity of mandibular excess is frequently complicated by significant discrepancies in the anteroposterior position of the maxilla and mandible. Disproportionality of facial height as a result of increased or decreased vertical growth of the jaws, labiomental contour, transverse arch relationships, and/or asymmetries also complicate this deformity. Planning treatment for mandibular prognathism must entail diagnostic consideration of all three dimensions of space if maximum results are to be obtained with contemporary surgical techniques. In this article some of these diagnostic considerations, pre- and postsurgical orthodontic objectives, surgical techniques, orthodontic sequencing, timing of treatment, and clinical results are delineated to acquaint the orthodontist with contemporary treatment planning for this deformity in order to obtain optimum function, esthetics, and relative stability. Tridimensional facial proportionality, occlusal balance, and good dental and skeletal stability were achieved in five patients (average age, 17.5 years) with relative or absolute mandibular prognathism. These patients, who were observed for an average postoperative follow-up period of 24 months, were treated by multiple maxillomandibular surgical procedures in concert with orthodontic treatment.