Clinical experience of using occlusocorrectors as an operational positioner

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INTRODUCTION

Accurate planning and prediction of hardware-surgical treatment results are essential for achieving optimal esthetic and functional outcomes in correcting dentomaxillofacial anomalies (DMFA) [1, 2]. The increasing use of computer-aided surgical planning in orthognathic surgery has advantages over traditional methods [3, 4]. However, treatment success depends on factors such as the surgical technique, the degree of DMFA decompensation in the preoperative period, and a proper comparison of control and diagnostic models of the jaws in constructive dentition [1, 5–7]. Postoperative recurrence of DMFA may result from unstable bone fragment fixation, mandibular head displacement, and inaccurate mandible positioning due to insufficiently tight occlusal contacts of teeth [5–7]. During surgery, plastic positioning splints are commonly used to stabilize occlusion. These splints are affixed to a jaw and have clear impressions of antagonist teeth. However, despite precise surgical jaw positioning, such devices have several disadvantages. To ensure sufficient rigidity, splints must have the minimum required thickness, which may contribute to overbite. Additionally, their removal from the oral cavity in some cases may lead to a syndrome associated with forced mandibular position, necessitating correction by an orthodontist. This increases the risk of extended treatment time [8]. In cases with multiple occlusal contacts during the postoperative period, such as insufficient DMFA decompensation before surgery or partial tooth loss, particularly in end-defect cases, using such devices can significantly worsen oral hygiene. Therefore, composite onlays — occlusal correctors — manufactured by laboratory methods and fixed on the patient’s teeth with liquid-flow composite material or glass ionomer cement are optimal for surgical mandible positioning and postoperative stabilization.

PRACTICAL APPLICATIONS

A clinical example is presented to illustrate the application of occlusal correctors in facilitating surgical positioning of the mandible during osteotomy.

A 23-year-old patient (referred to as Kh.) undergoing orthodontic treatment for distal tooth row ratio, lower micrognathia, and retrognathia (Fig. 1) received a combined hardware-surgical plan to correct the DMFA through orthognathic surgery involving forward displacement of the mandible by oblique sagittal osteotomy (Fig. 2). Plaster models of the jaws aligned well in the constructive occlusion (Fig. 3), eliminating the need for an operative positioner, which would have required an overbite to ensure rigidity. Instead, the laboratory method was employed to fabricate and adhesively fix occlusal correctors with clear impressions of antagonist teeth on teeth 3.7, 3.6, 4.6, and 4.7 using a composite material, thereby preventing inaccuracies in positioning the mandible during surgery (Fig. 4). The use of occlusal correctors enabled precise positioning and stabilization of the mandible, followed by sequential grinding and the introduction of teeth in contact, resulting in optimal morphofunctional occlusion at the end of treatment (Figs. 5 and 6).

 

Fig. 1. Dental rows of patient H. before treatment in lateral (a, b), straight (c) projections

Рис. 1. Зубные ряды пациентки Х. до лечения в боковых (а, b), прямой (c), проекциях

 

Fig. 2. Dental rows of patient H. in lateral (a, b), straight (c) projections at the stage of decompensation of the maxillary anomaly in order to prepare for osteotomy of the mandible

Рис. 2. Зубные ряды пациентки Х. в боковых (а, b), прямой (c) проекциях на этапе декомпенсация ЗЧЛА с целью подготовки к остеотомии нижней челюсти

 

Fig. 3. Plaster models of the jaws of patient H. in the constructive bite in the lateral (a, b), straight (c) projections

Рис. 3. Гипсовые модели челюстей пациентки Х. в конструктивном прикусе в боковых (а, b), прямой (c) проекциях

 

Fig. 4. Dental rows of patient H. with occlusal correctors fixed on teeth 3.7, 3.6, 4.6, 4.7, in the postoperative period in lateral (a, b), direct (c), occlusal (d) projections

Рис. 4. Зубные ряды пациентки Х. с фиксированными на зубы 3.7, 3.6, 4.6, 4.7 окклюзокорректорами, в послеоперационном периоде в боковых (а, b), прямой (c), окклюзионной (d) проекциях

 

Fig. 5. Dental rows of patient H. in the postoperative period in the lateral (a, b), direct (c) projections: the stage of creating multiple occlusal contacts by grinding the overlays and using interdigital elastic ligature rings

Рис. 5. Зубные ряды пациентки Х. в послеоперационном периоде в боковых (а, b), прямой (c) проекциях: этап создания множественных окклюзионных контактов путем сошлифовывания накладок и применения межчелюстных эластических лигатурных колец

 

Fig. 6. Dental rows of patient H. at the end of orthodontic treatment in lateral (a, b), straight (c) projections

Рис. 6. Зубные ряды пациентки Х. по окончании ортодонтического лечения в боковых (а, b), прямой (c), проекциях

 

FINDINGS

1. When implementing the hardware-surgical plan to correct dental midline facial esthetics using orthognathic surgery, the greatest impact is achieved when significant decompensation occurs in the preoperative period.
2. The alignment of plaster models of the jaws in constructive dentition before surgery is a crucial factor in minimizing the recurrence of DMFA.
3. Composite occlusal correctors can serve to stabilize and position the jaw accurately during osteotomy surgery, thereby preventing inaccuracies.

CONCLUSIONS

The utilization of composite occlusal correctors as surgical positioners can stabilize the mandibular position, preserve oral hygiene, and prevent the occurrence of forced mandibular position syndrome.

ADDITIONAL INFORMATION

Authors’ contribution. All the authors made a significant contribution to the preparation of the article, read and approved the final version before publication. Personal contribution of each author: R.A. Fadeev — collecting material, writing and editing the text of the manuscript; A.N. Lanina — collecting material, analyzing the data obtained, writing the text of the manuscript; N.V. Vishneva — collecting material, analyzing the data obtained, writing the text of the manuscript.

Funding source. The authors claim that there is no external funding when writing the article. Competing interests. The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article.

Ethics approval. The material of the article demonstrates the results of clinical observation, does not contain research materials.

Informed consent to publication. All participants voluntarily signed an informed consent form prior to the publication of the article.

About the authors

Roman A. Fadeev

North-Western State Medical University named after I.I. Mechnikov

Email: sobol.rf@yandex.ru
ORCID iD: 0000-0003-3467-4479
SPIN-code: 4556-5177
Scopus Author ID: 6503892124

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Anastasia N. Lanina

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: sadis57@mail.ru
ORCID iD: 0000-0002-4501-2166
SPIN-code: 4585-8331

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Natalia V. Vishnyova

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: hirstom_pspbgmu@mail.ru
ORCID iD: 0000-0001-9186-5277
SPIN-code: 9720-0502
Russian Federation, Saint Petersburg

References

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