3D Anterior Segmental Osteotomy for Protruding Mouth: A Patient's 1-Year Review
- Dr. Park
- Nov 14, 2024
- 3 min read
By Dr. Park Jong-chul, Oral and Maxillofacial Surgeon
This case study presents the 1-year postoperative results of a patient who underwent a 3D-planned anterior segmental osteotomy (ASO) to correct a protruding mouth.
Preoperative Condition
A protruding mouth often presents with excessive gingival display when smiling, difficulty closing the lips, and the formation of a mental crease (chin wrinkles). This patient exhibited prominent maxilla, a thick lower lip, and a pronounced mental crease.
Treatment Options for Protruding Mouth
Two primary treatment options exist for correcting a protruding mouth:
Anterior segmental osteotomy (ASO)
Orthodontic treatment
While orthodontic treatment was traditionally limited to cases with normal jaw position and proclined teeth, recent advancements like skeletal anchorage systems have expanded its applicability. However, surgery and orthodontics each have their own advantages and disadvantages. Choosing the appropriate method depends on the patient's specific condition and goals.
What is 3D-Planned Anterior Segmental Osteotomy?
3D-planned ASO utilizes CAD software to create a three-dimensional simulation of the entire surgical process, allowing for more precise surgical planning.
Traditional surgical planning for ASO relied on dental models to predict postoperative occlusion and facial changes, making it difficult to accurately predict skeletal changes, particularly the movement of the A-point (maxillary anterior-posterior position).
In contrast, 3D planning employs CAD software to predict not only dental occlusion but also skeletal movement, accurately visualizing changes in the A-point and B-point. This simulation allows for adjustments to the A-point, ANB angle, and other parameters to establish an optimal surgical plan, and provides guides for accurate execution of the plan during surgery.
1-Year Postoperative Results of 3D-Planned ASO - CT Comparison
Red squares have been placed in the same location for easy comparison. Although the patient did not undergo a genioplasty, the effect of chin advancement is evident. The improvement in the protruding mouth is clearly visible in the 45-degree image.
Actual Facial Changes
Correction of the protruding mouth enables more natural lip closure. As seen in the images, the release of lip tension also eliminates the mental crease..
3D-Planned ASO vs. Orthodontic Treatment: Which is Right for Me?
3D-Planned ASO
Utilizes CAD software for accurate and predictable results.
Enables customized surgical planning.
Offers a shorter treatment period (2-3 months).
Requires general anesthesia.
Orthodontic Treatment
Corrects dental and skeletal discrepancies through orthodontic appliances.
Non-surgical.
Requires a longer treatment period (2+ years).
Carries potential side effects like root resorption and tooth discoloration.
Can cause discomfort due to prolonged appliance wear.
In summary:
For rapid correction of a protruding mouth: 3D-planned ASO is recommended.
For a non-surgical approach with more time: Orthodontic treatment is recommended.
Potential Adverse Effects of Protruding Mouth Treatment
Regardless of the chosen treatment, patients should be aware of potential adverse effects:
Increased philtrum length: The philtrum may appear longer after surgery.
"Dish-face" appearance: Thinning of the upper lip may result in a "dish-face" appearance with increased visibility of the lower teeth when speaking.
Lip wrinkles: Posterior movement of teeth and gums supporting the lips can reduce lip tension, leading to fine wrinkles.
Nasolabial folds: Protruding mouth treatment has minimal effect on improving nasolabial folds.
Choosing 3D-Planned ASO
If, after considering these factors, a patient chooses ASO, 3D surgical planning is recommended due to its accuracy, predictability, and customized planning capabilities. The shorter treatment time compared to orthodontics is another significant advantage. However, as a surgical procedure, it may not be suitable for patients apprehensive about surgery.
Patients considering treatment for a protruding mouth should consult with an oral and maxillofacial surgeon to determine the most appropriate treatment option based on their individual needs.
3D Anterior Segmental Osteotomy for Protruding Mouth: A Patient's 1-Year Review