doi:10.1016/j.ijom.2005.06.018 
Copyright © 2005 International Association of Oral and Maxillofacial Surgeons Published by Elsevier Ltd.
Clinical Paper
Orthognathic Surgery
Anterior mandibular apical base augmentation in the surgical orthodontic treatment of mandibular retrusion
1Department of Maxillo-Facial Surgery, S. Paolo Hospital Milan, University of Milan Italy, Via A. di Rudinì 8, 20142 Milan, Italy
2Department of Maxillo-Facial Surgery, Istituto Galeazzi Milan, University of Milan Italy, Italy
Accepted 29 June 2005.
Available online 27 October 2005.
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Abstract
The authors describe a surgical technique alternative to traditional pre-surgical orthodontics in order to increase the apical base in mandibular retrusion (class II, division I). This subapical osteotomy, optimizing inferior incisal axis without dental extractions and a long orthodontic treatment, associated to genioplasty permits to obtain an ideal labio-dento-mental morphology. This procedure avoids in some cases the need of a mandibular advancement and, if necessary, it reduces his entity with obvious advantages.
Key words: mandibular apical base; dento-alveolar osteotomy
Figs. 1 and 2. To correct the proinclination of lower incisors the traditional pre-surgical orthodontics performs incisors retraction after premolars extraction.
Fig. 3. The increase of apical base and correction of lower incisal axis without premolar extraction can be obtained by advancement of the dento-alveolar osteotomized fragment; advancement genioplasty completes the operation.
Fig. 4. Preoperative facial appearence showing vertical maxillary excess with slight protrusion.
Fig. 5. Preoperative dental occlusion.
Fig. 6. Preoperative tele Rx shows lower incisal axis largely exceeding 90° and skeletal class II consequent to mandibular rotation.
Fig. 7. Intraoperative view: lower anterior dento-alveolar osteotomy with advancement and overlapping of its apical base (fixed with a microscrew).
Fig. 8. Intraoperative view: advancement of the chin and gaps bone grafting with maxillary and vomer bone.
Fig. 9. Postoperative tele Rx shows the new incisal axis and a wide increase of apical base.
Fig. 10. Facial appearance at the end of treatment.
Fig. 11. Final dental occlusion (after surgery the patient refused any orthodontic refinement).
Fig. 12. Panoramic X at 6 months shows a good healing of osteotomy sites.
Abstract
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