Oral and Maxillofacial Surgery/Orthodontics

Ovais H Malik

David T Waring, Richard Lloyd, Sangeeta Misra and Elizabeth Paice

An Overview of the Surgical

Correction of Dentofacial
Deformity
Abstract: The correction of severe dentofacial discrepancies involving a combination of orthodontic and surgical therapies (termed ‘orthognathic
treatment’) is commonplace. There is an abundance of evidence within this field but it is often inconsistent. This article is an evidence-based
overview of such treatments and is aimed at the general dental practitioner. It will cover: the timing of treatment; the indications and risks
associated with different surgical osteotomies; the magnitude of surgical movements that can be achieved with these procedures; and
the importance of mandibular autorotation when planning treatment. Orthognathic treatment is considered to be the gold standard for
comprehensive correction of severe dentofacial discrepancies. It is undertaken by a multidisciplinary team of clinicians involving, but not
exclusive to, consultants in orthodontics and oral and maxillofacial surgery in secondary and tertiary medical centres throughout the United
Kingdom.
CPD/Clinical Relevance: It is imperative that general dental practitioners have a good understanding of orthognathic treatment in order to
recognize when such treatments are indicated, to inform the patient of possible treatment modalities and to be able to discuss associated risks
in order to make appropriate referrals. Since treatment timing and magnitude of surgical movements have a profound effect on stability of the
treatment result, these must be carefully considered by all clinicians involved in patient care to minimize relapse potential.
Dent Update 2016; 43: 550–562

Orthognathic treatment is used worldwide The aim of this article is to give

Ovais H Malik, BDS, MSc(Orth), MFDS
RCS(Ed), MOrth RCS(Eng), MOrth RCS(Ed),
FDS(Orth) RCS(Eng), Consultant in
Orthodontics, University of Manchester
Dental Hospital and Salford Royal NHS
Foundation Trust, Stott Lane, Manchester,
M6 8HD (ovaismalik@yahoo.com), David T
Waring, BChD, MDentSci, MFDS RCS(Eng),
MOrth RCS(Ed), FDS(Orth) RCS(Ed),
Consultant in Orthodontics, University of
Manchester Dental Hospital, Richard Lloyd,
BDS, MB ChB, FDS RCS, FRCS, Consultant in
Oral and Maxillofacial Surgery, Salford Royal
NHS Foundation Trust, Sangeeta Misra, BDS,
MFDS RCS(Eng), MOrth RCS(Eng), FDS(Orth)
RCS(Ed), Consultant in Orthodontics, Barnsley
General Hospital and Elizabeth Paice,
BDS(Hons), MClinDent, MJDF RCS(Eng),
MOrth RCS(Eng), FTTA in Orthodontics,
University of Manchester Dental Hospital and
Salford Royal NHS Foundation Trust, Stott
Lane, Manchester, M6 8HD, UK.
550 DentalUpdate July/August 2016
to correct severe dentofacial anomalies
with the benefits and risks of these being
shown in Table 1. There are a multitude
of maxillary and mandibular osteotomies
and techniques for repositioning the jaws
in three planes of space (Table 2). Some
are more commonly indicated than others,
some have been modified and refined over
time, yet no standardized techniques are
practised internationally on any one given
procedure. Consequently, one could ask
which techniques constitute current ‘best
practice’. Much of the available evidence is
based on the studies undertaken in the mid
1990s1,2,3 when routine clinical practices,
such as intermaxillary fixation (IMF) were
rudimentary and research techniques were
often flawed by today’s standards. Studies
tended to lack sample size calculations,
randomization processes, homogeneity of
the test groups or had retrospective or no
control groups.
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the general dental practitioner an evidence-
based overview of the surgical procedures
involved in orthognathic treatment using
classical and contemporary literature.
Timing of treatment
Most osteotomies in healthy,
non-syndromic individuals are planned
following cessation of active facial
growth,1,2,3 which is generally accepted to
be at approximately 19 years of age in boys
and 17 years in girls, although individual
variation does occur. The timing of surgical
correction also depends upon the type
of malocclusion, particularly for Class III
skeletal patterns where surgery is deferred
until 18−20 years in girls and boys to
minimize the likelihood of unfavourable late
mandibular growth.3 Assessing a patient
after cessation of active growth has the
following advantages:1
 The full extent of skeletal discrepancy

Benefits No improvement
Aesthetic improvement TMJ
Masticatory improvement Speech
Improvement in airway
patency
Table 1. Benefits and risks of osteotomies.
Type of Osteotomy
BSSO Mandibular (Md) advancement
BSSO Md setback
Md differential setback and advancement + rotation
Table 2. Indications for mandibular osteotomies.
can be identified;
 Treatment planning can be undertaken
to minimize potential for surgical and
orthodontic relapse;
 The patient is more mature and thus
capable of giving valid consent for
treatment.
Le Fort I osteotomies
Indications
Le Fort I maxillary advancement
This is mainly indicated for the
treatment of maxillary hypoplasia (Table
3, Figure 1), most commonly associated
with Class III skeletal bases. The magnitude
of the advancement is determined by the
need to place the upper incisors in the
relationship to the rest of the face and the
upper lip. This is generally the extent of
negative overjet plus the desired positive
overjet of 2−3 mm after single jaw surgical
correction of the maxilla alone. This corrects
the incisal relationship and builds in a small
amount of relapse correction (Figure 2 a−h).
The Le Fort I procedure can also be used
for minor midline (1−2 mm) discrepancies
by rotating the maxilla sagittally after the
down fracture.1
The extent of maxillary
July/August 2016 DentalUpdate 551
Oral and Maxillofacial Surgery/Orthodontics
a
Risks
GA (Mortality and Morbidity)
Nerve damage
Undesirable soft and hard tissue
changes
Wound infection
Relapse
Speech deterioration in cleft cases
Indication
Mandibular hypoplasia b
Mandibular hyperplasia
Mandibular asymmetry
advancement depends upon the following:
 The extent of skeletal anterio-posterior
discrepancy;
 Whether the surgical correction is
desired in the maxilla alone or in both
the jaws;
 The limit of correction that can be
obtained surgically;
 The likelihood of adverse effects upon
nasal morphology. Figure 1. (a) Le Fort I maxillary osteotomy. (b) Le
The scope of stable maxillary Le Fort I maxillary advancement.
Fort I advancement remains a contentious
issue as the published data has various
drawbacks,4,5,6 such as grouping of samples months of surgery.6
with different osteotomy procedures A second approach that may be
(Le Fort I maxillary advancement − with used to address a severe AP discrepancy
or without a simultaneous mandibular between the maxilla and mandible is a
procedure), heterogeneous samples (mixing bimaxillary osteotomy.4,5 Depending on
of cleft and non-cleft osteotomy cases), the severity and nature of the discrepancy,
pooling of data irrespective of direction of this will involve a combination of maxillary
maxillary movement following the Le Fort and mandibular advancement or setback.
I osteotomy (forward alone, forward and (Figure 3 a−h).
downward or forward with impaction) or
type of fixation (intermaxillary fixation ‘IMF’
Le Fort I maxillary setback
or rigid internal fixation ‘RIF’).
This can be achieved by
The range of surgical
removing a triangular wedge of tuberosity
anteroposterior (AP) advancement of
sectioned through the third molar region.7
maxilla has been reported from 2−10 mm
The third molar, if present, may have to
with a mean movement of 4.9 mm.6 Most of
be removed prior to the tuberositectomy.7
the surgical relapse occurred in the first six
However, this procedure is rarely indicated.
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 Oral and Maxillofacial Surgery/Orthodontics

Type of Osteotomy Indication f

Le Fort I, II and III Maxillary (Mx) advancement Mx hypoplasia

Mx impaction Vertical Mx Excess (VME)

Mx differential impaction Skeletally caused AOB

Mx differential rotation Mx asymmetry

Mx expansion (SARPE) Transverse Mx hypoplasia

Table 3. Indications for maxillary osteotomies.

a
c

d
g

e h

Le Fort I maxillary impaction

This is indicated for the
correction of excessive gingival display (>3
mm) on smiling,8 which is seen with vertical
maxillary excess (VME) when the anterior +
posterior face height is increased7 (Figure
4), and for the surgical correction of anterior
open bite (AOB) of skeletal aetiology7
(Figure 5). The degree of impaction is
determined by the amount of gingival
show at rest and on smiling and the upper
lip length.7 There is no established limit of
maximum maxillary impaction, but up to
Figure 2. (a-d) Extra-oral and intra-oral views of a patient with maxillary deficiency. (e-h) Extra-oral 8 mm of posterior maxillary intrusion has
and intra-oral views of the patient in (a−d) after pre-surgical orthodontic treatment and a Le Fort I
been reported in the literature.8,9
osteotomy with maxillary advancement.
Maxillary impaction tends to
552 DentalUpdate July/August 2016
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 Oral and Maxillofacial Surgery/Orthodontics

shorten the upper lip length by up to 25%.7
Condylar resorption of 9−12% has been
reported with Le Fort 1 posterior maxillary
impaction and mandibular autorotation.10
Mandibular autorotation
The concept of mandibular
autorotation (MA) with maxillary surgical
anterior and/or superior repositioning is
a
based on the perception of neuromuscular
adaptation which takes place as a
compensatory phenomenon immediately
following surgery.11,12 It is essential
to establish the extent of MA as this
leads to greater anterior prominence
of the mandible in the aforementioned
circumstances.12 Assessment of the incisor
position of an autorotated mandible
determines if further adjustment of the AP
maxillary position is required in order to
establish a positive overjet and overbite.12
Research to determine the
centre of autorotation (CR) of the mandible
was controversial two decades ago.12 The
assumed CR is at the centre of the condyle,
which is replicated on articulators, mastoid
air cells and on lateral cephalograms.
Another hypothesis is that autorotation is
a combination of translation and rotation
of the mandible with no constant centre
of rotation in the condyle. Autorotation of
the mandible has been reported to cause
condylar resorption in 9−12% of cases.10
SARPE
Indications
Surgically Assisted Rapid
Palatal Expansion (SARPE) is used to treat
a maxillary transverse deficiency in a
skeletally mature patient where the mid-

c f

Figure 3. (a−d) Extra-oral and intra-oral views of a patient with maxillary deficiency and mandibular excess requiring bimaxillary osteotomy. (e−h) Extra-oral
and intra-oral views of the patient in (a−d) after a bimaxillary osteotomy involving maxillary advancement and mandibular setback.

July/August 2016 DentalUpdate 555

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 Oral and Maxillofacial Surgery/Orthodontics
palatine suture has closed.13,14 There
is lack of definitive guidance on the
appropriate age for its use,13,14,15 although
one study has recommended ages
according to gender4 (over 25 years of
age in males, 20 years in females). SARPE
is indicated:13,14
 To treat a transverse maxillary
deficiency of >5 mm in a skeletally
mature patient;
 To provide space for a crowded
maxillary dentition when extractions
are not indicated;
 To increase the maxillary arch
perimeter and correct posterior
crossbite (unilateral or bilateral);
 To widen a narrow, high-arched palate
often associated with oral clefts.
The osteotomy should
be 4−5 mm above the apices of the
maxillary teeth.14 The areas of resistance
to lateral expansion are anterior support
(piriform aperture pillars), lateral support
(zygomatic buttresses), posterior support
(pterygoid junction) and medial support
(midpalatine synostosed suture).14 Initial
appliance activation of 0.5−2 mm is
recommended intra-operatively to ensure
that the screw is stable and that there
is no resistance to its movement.14 A
latent period of up to 7 days has been
reported before post-operative activation
is started.14,15 Post-operative expansion
is typically 0.5 mm−1 mm per day for up
to 3 weeks, depending upon the type of
screw and extent of transverse expansion
desired.14 The achieved expansion is
maintained for 3−6 months while bony
infill occurs at the mid-palatine suture
using a transpalatal arch with arms
palatal to the premolars or a quad-helix
appliance.14,15
Patients should be warned
about the possible presentation of
features such as a midline diastema,
alongside further risks such as nose
bleeds, headaches, loosening of the
distractor and palatal ulcerations.13,14,15
Relapse depends upon variables such as
the post-expansion retention regimen,
the time-point when relapse was
assessed and the amount of skeletal and
dento-alveolar change achieved with
SARPE. The achieved skeletal change
(47%) is completely stable whereas the
dento-alveolar tipping (53%) immediately
after SARPE is prone to relapse.16
556 DentalUpdate July/August 2016
Le Fort II osteotomy
The indication for a Le Fort II
osteotomy and maxillary advancement is for
the treatment of nasomaxillary hypoplasia
where the deficiency is at the infra-orbital
margins. This osteotomy accentuates the
prominence of nasal bridge.7
Le Fort III (Kufner) osteotomy
This operation is specified for
mild to moderate zygomatico-maxillary
hypoplasia where the nose is normal.7
Figure 4. Extra-oral view of a patient with VME
Patients with severe hypo-development and excessive gingival show on smiling.
of the middle third of the face who exhibit
flattening of the suborbital area and a
cheekbones are the suitable candidates for
this osteotomy.7
Segmental Le Fort I osteotomy
This type of osteotomy is a
useful adjunct when managing transverse
and vertical maxillary discrepancies. The
main indications are:1 b
 One-stage correction of transverse
maxillary deficiency;
 Correction of anterior open bite where
there is an obvious discrepancy in the
occlusal planes of the labial and buccal
segments; and
 Correction of severe anterior vertical Figure 5. (a, b) Intra-oral view of a patient with
maxillary excess or deficiency. anterior open bite before and after orthodontic
Segmental osteotomy has treatment and a Le Fort I posterior differential
also been used to correct small anterio- maxillary impaction.
posterior maxillary discrepancies17 as a
solitary procedure or in conjunction with
mandibular setback or advancement
osteotomies.1 When undertaking a
segmental maxillary osteotomy, the
pre-surgical orthodontics must employ
segmental mechanics.17 Despite its
versatility, the level of evidence involving
this surgical procedure is low and consists
of case reports and audits.17,18 The
associated risks include intra-operative
bleeding, oronasal fistula, devitalization
of teeth and, on rare occasions, segmental
avasular necrosis.
Bilateral Sagittal Split
Osteotomy (BSSO) Figure 6. Bilateral sagittal split osteotomy with
This procedure, in combination mandibular advancement.
with an advancement procedure, is the
most common technique used to correct
a severe Class II skeletal pattern with is used to correct a moderate to severe
mandibular retrognathia (Figure 6) and, Class III skeletal pattern with mandibular
when coupled with a mandibular setback, prognathism (Figure 7).1 The extent of
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 Oral and Maxillofacial Surgery/Orthodontics

anteroposterior mandibular movement
depends upon:
 The extent of the skeletal discrepancy;
 The limit of correction that can be
obtained surgically; and
 Whether the surgical correction is
necessary in mandible alone or
both jaws.
a
The mean surgical threshold for
BSSO mandibular setback is 10 mm with
no range given.19 A stable result is more
likely after mandibular setback than after
mandibular advancement, because the
soft tissues are not extensively stretched
when the condyles are set correctly in the
fossae before rigid fixation.19 Relapse can be
expected if the condyles are not properly
located within the fossae at the time of
surgery. If stretched, the pterygomasseteric
sling reverts to normal function when
mandibular mobility resumes, which tends
to return the proximal segment to its
original position, again resulting in relapse.19
Moreover, the inter-condylar width tends
to decrease after BSSO mandibular setback.
This change in axial inclination involves
either medial or lateral rotation of condylar
axis, however, rigid internal fixation limits
this type of relapse.19 Finally, remaining
growth can contribute to relapse. Its effects
are more pronounced in males with more
anti-clockwise (anterior and downward)
growth rotation.20 In contrast, women show
more clockwise rotation.20

c f

b e

Figure 7. (a−d) Extra-oral and intra-oral views of a patient with mandibular hyperplasia requiring BSSO setback. (e–h) Extra-oral and intra-oral views of the
patient in (a−d) after the BSSO setback. Note this patient also had an AOB and therefore required a simultaneous Le Fort I posterior differential maxillary
impaction.

July/August 2016 DentalUpdate 557

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 Oral and Maxillofacial Surgery/Orthodontics
The widely accepted limit of
BSSO mandibular advancement is 10 mm21
(Figure 8). The risk of horizontal surgical
relapse increases when the mandible is
advanced beyond 7mm.21 The mandibular
plane angle also has an influence on the
horizontal and vertical relapse. High angle
cases tend to relapse in the horizontal
plane, whereas low angle cases have a
tendency for vertical relapse.21 There is no
gender predilection to surgical relapse
although it is more frequently seen in
female patients that have undergone BSSO
mandibular advancement procedures. This
is thought to be due to a greater proportion
of females than males seeking surgical
correction of their Class II profiles.21
Other factors that contribute
to relapse include the experience of the
surgeon and patient-related factors such as
growth and compliance with post-surgical
orthodontics during the healing process.
a c
b d
Figure 8. (a, b) Extra-oral and intra-oral views of a patient with Class II malocclusion on a Class II
skeletal base with mandibular hypoplasia. (c, d) Extra-oral and intra-oral views of the patient in (a, b)
after BSSO mandibular advancement.
558 DentalUpdate July/August 2016
Figure 8 demonstrates an example of a
BSSO with mandibular advancement for
the correction of mandibular retrognathia
associated with an increased overjet.
Condylar resorption associated
with BSSO mandibular advancement
has been reported, where one study has
suggested an incidence of 10%.10 The risk
increases with the extent of mandibular
advancement, the use of IMF, an increased
mandibular plane angle and a low facial
height ratio.10
The most common complication
of BSSO mandibular procedures is
neurosensory disturbance (NSD).22,23
Whether this iatrogenic effect occurs along
the mandibular canal or at the mental
foramen, the symptoms are usually varying
degrees of anaesthesia or paraesthesia
(numbness) to the lower lip and chin.22,23
There is a large variation in the reported
incidence of iatrogenic NSD with reports
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of 80−100%, although this tends to be
temporary rather than permanent.23 Ow
and Cheung22 reported, in a prospective
randomized clinical trial, that all 23
patients in the test group experienced
NSD during the six-week post-operative
period when assessed subjectively (using
a questionnaire based on visual analogue
scale) and objectively (with light touch,
2-point discrimination and pain detection
threshold). The prevalence of long lasting
NSD 1 year after surgery is found in 8−10%
of the cases.23 This large range of NSD
incidence exists due to the lack of standard
methods of neurosensory evaluation
and differences in follow-up periods.22,23
However, long-term satisfaction rates in the
patients undergoing orthognathic surgery
are high (87−100%) despite these reports
of NSD.23
Genioplasty
A genioplasty may be used to
correct abnormal chin prominence.21 It may
be undertaken in combination with other
surgical procedures or in isolation. If part
of an orthognathic treatment plan, the
genioplasty may be completed at the same
time as the other osteotomies or postponed
by six months and undertaken separately.24
This delay permits resolution of the facial
swelling and facilitates reassessment of the
facial profile following the primary surgery.
An abnormal chin prominence
can present as:24,25
 An anterio-posterior chin deficiency
(retrogenia);
 Pseudoretrogenia, as seen in Class II
mandibular retrognathia, where the chin
is normal;
 A large or small chin in all three planes of
space (macrogenia or microgenia);
 A midline asymmetry of chin.
The horizontal osteotomy
must run 4−5 mm below the apices of
the canines and 3 mm below the mentalis
nerve.24 An isolated genioplasty is effective
for managing mild anterio-posterior
mandibular deficiency of <5 mm.25
The chin can be moved in
all three planes of space using various
procedures:24,25
 Sliding/advancement genioplasty which is
used for correction of retrogenia without
any vertical change in the height of the
chin;

 Two-tier/stepladder genioplasty which is
used for large AP correction as the lower
segment is advanced sagittally over an
already advanced proximal segment;
 Vertical lengthening genioplasty with
interpositional bone graft to increase the
vertical height of the chin;
 Vertical reduction/wedge genioplasty
where a segment of bone is removed
to reduce the height of the lower facial
third; and
 Centring/cuneiform genioplasty and
hemigenioplasty which are used
to correct vertical and horizontal
asymmetries. Depending upon the
extent and location of the asymmetry,
bone can be resected on the affected
side.
A pressure dressing is applied to
the chin for the support of the soft tissues,
lower lip and elimination of empty spaces
to reduce swelling and achieve definition of
labiomental fold.24
Distraction osteogenesis
Distraction Osteogenesis (DO)
is a bone-lengthening process by gradual
mechanical separation of iatrogenically
separated bony fragments. This procedure
is indicated for the correction of extremely
severe maxillary and mandibular
deficiencies when >10 mm advancements
are necessary, but which are likely to be
unstable using conventional surgical
procedures.24
Distraction osteogenesis may
be used in the surgical correction of
craniofacial anomalies, such as hemifacial
microsomia, severe bilateral mandibular
deficiency, maxillary deficiency associated
cleft lip and palate, bimaxillary facial
deficiency associated with Crouzon
syndrome, midfacial hypoplasia and
transpalatal deficiency26,27 and maxillary
or mandibular vertical alveolar ridge
deficiencies following failed graft
procedures.28 There is lack of evidence
regarding protocols for DO, maximum
augmentation distance and long-term
success or relapse rate.26,27,28
The distraction phase of
treatment is the period in which traction
is applied to the transport bone fragment
and the formation of new immature woven
and parallel-fibred bone commences.24
The rate of distraction on average is 1 mm/
July/August 2016 DentalUpdate 561
Oral and Maxillofacial Surgery/Orthodontics
day.26,28 The distractor is usually activated
by 1 mm at the time of placement followed
by a latent period which is 7 ± 2 days
between surgical placement of a distractor
and commencement of distraction.26,28
The rhythm of distraction ranges between
1−4 times/day.28 The average distraction
achieved in mandible and midface are
16−17 mm and 14 mm, respectively,27
whereas that for alveolar distraction
osteogenesis was 6.8 ± 2.5 mm (range 3−15
mm).28 Some overcorrection is undertaken
to compensate for probable relapse
(3 mm).27
The distraction device is left
in situ after the active distraction period
for 6−12 weeks to allow the consolidation
phase to occur.26,27,28 This is the period
during which maturation and corticalization
of the callus occurs.28 Complications
associated with DO are soft tissue
dehiscence, transient paraesthesia, inferior
dental and facial nerve injuries, haematoma,
deviation of direction of distractor, fracture
or instability of the distractor, fibrous non-
union and poor quality new-bone formation
and relapse.26,27,28
Summary
This article was written as a
brief summary of orthognathic surgical
procedures, incorporating some of the
relevant literature and aimed at general
dental practitioners, to raise awareness
of the more common types of treatments
available for the correction of severe
dentofacial deformities. A comprehensive
guide and literature review is outside the
scope of this article.
References
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N. A comparison of outcomes of
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Schols JGJH. A systematic review of the
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rapid maxillary expansion. J Cranio-
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18. Ho M, Boyle M, Cooper J, Dodd M,
Richardson D. Surgical complications of
segmental Le Fort I osteotomy. Br J Oral
Maxillofacial Surg 2011; 49: 562−566.
19. Joss CU, Vassalli IM. Stability after
bilateral sagittal split osteotomy
setback surgery with rigid internal
fixation: a systematic review. J Oral
Maxillofacial Surg 2008; 66: 1634−1643.
20. Behrents RG. Growth in the aging
craniofacial skeleton. In: Monograph 17:
Craniofacial Growth Series. McNamara
Book Review
Glass-Ionomers in Dentistry. Dr Sharanbir
Sidhu (ed). Switzerland: Springer International
Publishing, 2016 (151pp, £86.00 h/b) ISBN:
978-3-319-22623-5.
Glass-ionomer materials, first
introduced in the 1970s, play an important
role in restorative dentistry today, in a wide
variety of applications. In order to provide an
in-depth review of this subject, the editor of
this book, Dr Sharanbir Sidhu, has brought
together eight experts in the field from across
the world.
The book follows a logical order,
starting with the history of glass-ionomer
materials and their development at the
Laboratory of the Government Chemist in
London as part of work on the setting of
dental silicate cements.
Chapter 2, by Michael Burrow
from Melbourne, provides details of the
physical properties of glass-ionomer materials
before moving on to the clinically-relevant
aspect of restoration longevity. This chapter
includes a large table on the performance of
glass-ionomers in non-carious cervical lesions
(perhaps their most common use in the UK?),
with the data indicating annual loss rates of
2.7% in a 13-year study and 2.4% in a 10-year
562 DentalUpdate July/August 2016
JA, ed. Ann Arbor, MI: University of
Michigan, 1985; 17: 1.
21. Joss CU, Vassalli IM. Stability after
bilateral sagittal split osteotomy
advancement surgery with rigid
internal fixation: a systematic review.
J Oral Maxillofacial Surg 2009; 67:
301−313.
22. Ow A, Cheung LK. Skeletal stability
and complications of bilateral sagittal
split osteotomies and mandibular
distraction osteogenesis: an evidence
based review. J Oral Maxillofacial Surg
2009; 67: 2344−2353.
23. Wijbenga JG, Verlinden CRA, Jansma
J, Becking AG, Stegenga B. Long-
lasting neurosensory disturbance
following advancement of the
retrognathic mandible: distraction
osteogenesis versus bilateral sagittal
split osteotomy. Int J Oral Maxillofacial
Surg 2009; 38: 719−725.
24. Ronchi P. Orthodontic-Surgical
Treatment of Dentofacial Anomalies.
evaluation.
Geoffrey Knight, again from
Australia, provides chapter 3 and gives
readers a beautifully illustrated look at
contemporary uses of glass-ionomer
materials, including interproximal slot and
tunnel restorations (although this reviewer
had considered the latter as being history!)
and the co-cure method of bonding
auto-cure glass-ionomer cements to resin
composite.
Our very own Avi Banerjee has
written an interesting chapter on the use
of glass-ionomer materials in minimum
intervention (MI) caries management and
ART, central to this being the potential for
remineralization of demineralized carious
dentine and the associated role of these
cements in MI management of deep caries.
Chapter 5, written by Josette
Camilleri from Malta, deals with the uses
of glass-ionomer materials in endodontics,
perhaps not something that these materials
are famed for. Examples are given of root-
end fillings and perforation repairs using
glass-ionomer, although the chapter ends
somewhat negatively in a statement that
research has indicated that ‘they have been
outperformed by other materials that have been
developed over the years’…
Glass-ionomer materials have
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 144.082.238.225 on December 30, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.
An Integrated Esthetic-Functional
Approach. London: Quintessence
Books, 2005.
25. Ward JL, Garri JI, Wolfe A. The osseous
genioplasty. Clin Plastic Surg 2007; 34:
485−500.
26. Nada RM, Sugar AW, Wijdeveld
MGMM, Borstlap WA, Clauser L,
Hoffmeister B, Kuijpers-Jagtman
AM. Current practice of distraction
osteogenesis for craniofacial
anomalies in Europe: a web based
survey. J Cranio-Maxillo-Facial Surg
2010; 38: 83−89.
27. Mofid MM, Manson PN, Robertson
BC, Tufaro AB, Elias JJ, Vander Kolk CA.
Craniofacial distraction osteogenesis;
a review of 3278 cases. Plast Reconstr
Surg 2001; 108: 1103−1114.
28. Saulacic N, Lizuka T, Martin MS,
Garcia AG. Alveolar distraction
osteogenesis: a systematic review.
Int J Oral Maxillofacial Surg 2008; 37:
1−7.
been considered to be highly suitable
for use in children, so chapter 6 by David
Manton from Melbourne and Katie Bach
from Auckland is highly relevant, with a
well-worded warning – ‘due to the apparent
simplicity of the use of these materials, they
are also prone to misuse’! The final chapter,
by Joshua Cheetham of Bayswater, Australia,
gives the reader a glimpse toward the future
of glass-ionomer materials, with details of the
possible methods which might be employed
in order to improve their physical properties
– such as spherical particles and/or glass
fibre reinforcement, and discusses possible
avenues for improvement in properties
such as wear resistance. Surprisingly, there
appears to be no mention of the idea of heat
curing glass-ionomers, a concept designed
to improve the physical properties of glass-
ionomers and which seems to be the subject
of increasing research.
There is no question that the
book fulfils the objective of the author,
namely to describe the continuing and new
roles of glass-ionomer cements in restorative
dentistry. It provides a useful and detailed
evaluation of the current status of these
materials and will be of value to academics
and practitioners alike.
F J Trevor Burke
Editorial Director, Dental Update