Course of a dysgnathia treatment by Groisman & Laube

You are well taken care of by your specialists of oral, maxillofacial and facial surgery in Frankfurt

The classic malocclusion treatment will be divided into four segments: for our first appointment we are planning primarily an extensive consultation (Beratungsgespräch). For preparing a combined orthodontic-maxillosurgical treatment strategy, current X-ray images (orthopantomogram, FRS), gypsum models and a cephalometric evaluation (survey of am FRS X-ray image) are very useful.

If necessary, these diagnostic aids can be made by us, too. In addition, we are going to perform a clinical analysis of the functioning of the temporomandibular joints and cause a temporomandibuilar joint function MRT to be taken, if needed. For you we are going to work out a schedule that will help you to observe the course of the treatment.

Step 1: Preliminary orthodontic treatment

It is the goal of the orthodontic treatment to fix malpositionings of teeth, gaps and crowding of teeth so that shape and size of the maxillar arch will match those of the mandibular arch.

In this treatment the crooked teeth are moved by a multibanded appliance, i.e. fixed braces. At the same time, the teeth will be moved so that the relation between them and the jawbone becomes regular.

If there is not enough space in the jaw, a surgically aided widening of the maxilla and/or mandible may be indicated (vide: treatment of crossbite) in order to achieve a result that will remain stable in the long term. During this treatment section there may be a temporary enlargement of progenie or disto-occlusion.

Nowadays there are many possibilities for designing a multibanded appliance and attaching it to the teeth (visible and invisible). Your orthodontist will give you detailed advice.

Step 2: Surgical translocation of the jaws

During the second treatment segment the orthodontically pre-treated malocclusion is completely corrected by surgical adjustment of the jaws. The tooth movements are finished some four to six weeks before the operation and so-called rigid archs are inserted that maintain the tooth positions achieved.

In preparation, we perform an accurate computer-aided planning of the surgery including the use of 3-D X-ray images (DVT), photo and model analysis as well as functional analysis of the temporomandibular joints. Afterwards the overall planning is attuned with the individual esthetic facial profile.

Our surgical methods

The operation will be performed exclusively  through the  mouth so that skin cuts in the face are avoided and the facial skin remains unharmed. There is no risk of developing ugly scars in the facial skin region. We apply modern, tissue-saving methods where cuts in mucous membranes are made by radio frequency surgery and sensitive areas such as regions containing nerves are treated with the ultrasound scalpel. Most of all we are foregoing transbuccal access and utilize exclusively miniature titanium platelets that are temporarily inserted so that the mouth can be opened at any time after surgery. This means that oral hygiene (brushing of teeth), talking and eating (soft food) can begin immediately after surgery.

Operating on one jaw (monomaxillar dislocation osteotomy)

In monomaxillar dislocation osteotomy we distinguish between translocating the maxilla forward or to the rear by Le-Fort-I osteotomy (systematic bone cut above the dental roots while saving the neighboring structures) and translocating the mandible forward or to the rear by sagittal osteotomy behind the last tooth in the lower jaw (systematic bone cut in the region of the wisdom tooth/mandibular angle while saving the neighboring structures.

If only one jaw gets translocated, relation is always established to the jaw that is not being translocated or to the appertaining row of teeth, respectively. This means that the targeted position is determined by the opposing jaw. We can achieve exact fits by means of segment osteotomies (multiple separation of a jaw).

Operating on two jaws (bimaxillar dislocation osteotomy)

Certain malocclusions require simultaneous dislocation of the upper and the lower jaw. This means that translocation distances can be distributed among both jaws and be reduced altogether. This method enables optimized functional and esthetic results and is frequently used for jaw and/or facial asymmetries that cannot be corrected satisfactorily by operating only on one jaw. Bimaxillar dislocation osteotomy accomplishes three-dimensional correction of a malpositioning of both jaws.

Closing bone gaps

As a rule, short translocation distances, especially in the mandible, do not cause any relevant bone gaps. But in cases of long translocation distances it may be necessary to bridge bone gaps with so-called osteoplasties, i.e. bone supplement and/or bone transplants in order to guarantee proper healing of the bone.

Jaw in a new position

Once the jaws have been moved to the targeted position they are attached straight to the bone, underneath the mucous membrane, by miniature titanium platelets and/or micro platelet osteo- syntheses of a thickness of only 1.5-2mm. With those you will be able to open your mouth, talk, drink, eat soft foods and, of course, brush your teeth after surgery while the bones are healing. Only elastic bands are loosely attached that you can remove and reinsert on your own.

Long dislocation distance

In cases of very long dislocation distances the procedure of distraction osteogenesis is used. For this procedure miniaturized distractors, tiny appliances with a tuning mechanism are inserted under the mucous membrane after an appropriate osteotomy in the upper and/or lower jaw. They are not visible for others. The turning causes the jaw to be moved very slowly to the desired position while the principle of guided bone generation by a continuous growth stimulation by tractive power (callus distraction) is applied. The very slow, pain-free movement of 0.5 to 1 mm per day stimulates skin, gums and muscle tissue to grow also.

In cases of complex malocclusions it may be necessary to translocate the jaws in several parts in order to achieve regular positions of all teeth and pleasant esthetic results.

Postoperative course

Once the operation is finished, anesthesia is phased out and Hilotherm® therapy, a physical treatment with a cooling mask, is started immediately. This treatment will be continued without interruption for the first three days. You will spend your hospital stay in a modern room with a pleasant atmosphere and sophisticated comfort at Bethanien Hospital directly adjacent to our surgery. During your hospital stay of three to five days you will receive not only antibiotics and painkillers but also any medication required to limit facial swellings to an absolute minimum. During the whole duration of your treatment we are going to be your immediate contacts during our daily rounds and the professional nursing staff will be there for you at all other times. Prior to your release we shall make appointments with you for all future check-ups.

During the 3 to 5 days of your stay you are going to receive not only antibiotics and painkillers but also any medication necessary for keeping the swelling of your face down to a minimum. During the whole duration of your treatment, only the nursing staff and ourselves, during our daily rounds, will be your immediate contact persons. Before you are released, we shall establish an appointment schedule for all check-ups.

Step 3: Orthodontic fine tuning

During the third segment of your treatment your orthodontist is going to take care of the orthodontic fine tuning of the positions of your teeth. As a rule, this takes between three and six months. During this treatment segment the time for removal of the braces and the beginning of the retainer treatment will be determined.

As a rule we recommend a planned removal of the 3-D mini platelets to our patients since their function becomes obsolete once the bone is healed. If the recommended timespan is observed, removal can be handled without any tissue damage.

Step 4: Removal of the 3-D titanium platelets and fine adjustments

After approximately 12 months the 3-D titanium platelets will be removed. At that time additional fine adjustments can be made, such as a chin or nose correction, insertion of implants or a wrinkle treatment, always after a thorough check-up and taking into account your own wishes.