Surgical inferior repositioning of the maxilla: treatment considerations and comprehensive management

Surgical inferior repositioning of the hypoplastic or vertically deficient maxilla is discussed with respect to various relevant treatment considerations, and a specific regimen for comprehensive management is recommended. Treatment considerations for persons with true vertical maxillary deficiency include esthetic, functional, and neuromuscular factors. Primary among these factors are the relationship between the maxillary incisor and the upper lip, the physiologic interocclusal space, and the masticatory bite force. A regimen for the comprehensive management of these factors is recommended to ensure skeletal stability. These measures include a careful surgical technique, transplantation of viable autogenous bone, critical evaluation of the physiologic interocclusal space, and elimination of destructive masticatory forces to the maxilla during healing of the graft by an intraoral skeletal fixation appliance. Adherence to these fundamental biologic principles ensures predictability to the inferiorly repositioned maxilla.