Two middle-aged cases of deep overbite without molar support treated by orthognathic surgery.

INTRODUCTION: Patients with severe overbite in middle age often undergo prosthetic treatment without a diagnosis of dentofacial deformity, but soft tissue trauma can occur in such patients due to the lack of inter-occlusal space. Comprehensive surgical orthodontic treatment and prosthetic treatment are indicated to correct the overbite and soft tissue injury for such patients. PRESENTATION OF CASE: We report the cases of two middle-aged patients with dentofacial deformity and severe overbite without molar support. In both cases, prosthetic treatment had been performed for many years without any improvement of the occlusion. Case 1: A 47-year-old Japanese man had a maxillary incisor protrusion and reduced lower anterior facial height profile with the left mandibular molars lost due to periodontal disease. After preoperative orthodontic treatment and occlusal elevation in the molar teeth using an implant prosthesis, a sagittal split ramus osteotomy (SSRO) was performed. Case 2: A 57-year-old Japanese woman had mandibular retrognathia with maxilla and mandibular-arch length discrepancy. The left mandibular molars needed to be extracted due to periodontal disease. After preoperative orthodontic treatment and reconstruction of the molar occlusion using an implant prosthesis, three-segment Le Fort I osteotomy and SSRO were performed. DISCUSSION: Malocclusion with dentofacial deformity is a risk factor for severe deep overbite or other occlusion collapse. CONCLUSION: In middle-aged patients with deep overbite with missing molar teeth, we should consider both prosthodontic treatment and comprehensive dental therapy, including orthognathic surgery.

The stability of an alar cinch suture after Le Fort I and mandibular osteotomies in Japanese patients with Class III malocclusions.

We previously reported a modified technique for the placement of symmetrical cinch sutures after switching from a nasal to an oral endotracheal tube. We undertook a study to assess the effectiveness of our technique and the stability of changes in the nasolabial morphology after bimaxillary surgery. The study group comprised 30 patients aged 17-36 years who had skeletal Class III malocclusion. All patients had bimaxillary surgery with an alar base cinch suture and V-Y closure. The nasal region was measured directly or on cephalograms before, and 1 week and 1 year after operation. The suture did not alter the width of the alar base, but the nasolabial angle and projection of the tip increased significantly. The length of the upper lip did not change significantly.