Orthognathic surgery, also known as corrective jaw surgery, is a specialized field in dentistry that aims to correct and improve the alignment and function of the jaw and facial structures. This intricate procedure requires the use of various dental materials to achieve optimal outcomes. In this article, we will explore the different types of dental materials used in orthognathic surgery, their properties, and their applications.

1. Titanium Implants

Titanium implants are a common choice in orthognathic surgery due to their biocompatibility and mechanical strength. These implants are typically used to stabilize and fixate the jawbones in their corrected positions after surgical repositioning. Titanium’s ability to integrate with bone tissue (osseointegration) makes it an excellent choice for long-term stability and support.

The implants are available in different shapes and sizes to accommodate various anatomical considerations. They are surgically placed into the jawbones and provide a stable foundation for the healing process. The use of titanium implants ensures proper alignment during the healing phase, allowing for functional and aesthetic improvements.

2. Resorbable Plates and Screws

In some cases, resorbable plates and screws are used instead of titanium implants. These dental materials offer several advantages, particularly when the patient is in the growth phase or requires additional orthodontic treatment.

Resorbable plates and screws are made from materials such as polylactic acid (PLA) or polyglycolic acid (PGA), which gradually break down and are absorbed by the body over time. These materials eliminate the need for a second surgery to remove the implants, reducing patient discomfort and potential complications.

These resorbable materials provide initial stability during the healing process, and as the bone regenerates and gains strength, the implants slowly degrade. This approach is especially beneficial for younger patients who are still growing and may require further orthodontic adjustments.

3. Bone Grafting Materials

Bone grafting plays a crucial role in orthognathic surgery, especially when the patient has insufficient bone volume or irregularities in the jawbone structure. Bone grafting materials are used to promote bone regeneration, support new bone growth, and enhance the stability of the corrected jawbones.

There are several types of bone grafting materials available, including:

a) Autogenous Bone Grafts

Autogenous bone grafts involve harvesting bone from the patient’s own body, usually from the hip or chin region. These grafts offer excellent biological compatibility, as they contain live cells and growth factors that aid in the healing process. Autogenous bone grafts provide a reliable source of bone material and have a high success rate.

b) Allografts

Allografts are bone grafting materials derived from human donors. These materials undergo rigorous processing to remove any potential infectious agents while retaining their structural integrity. Allografts serve as an alternative to autogenous bone grafts and are suitable for patients who cannot or do not wish to use their own bone.

c) Xenografts

Xenografts are bone grafting materials sourced from animal donors, typically bovine or porcine sources. These materials undergo extensive processing to remove any organic components, leaving behind the mineralized matrix. Xenografts provide a framework for new bone growth and are gradually replaced by the patient’s natural bone over time.

d) Synthetic Bone Grafts

Synthetic bone grafts are made from various materials, such as calcium phosphate ceramics or biocompatible polymers. These grafting materials mimic the structure and composition of natural bone, providing a scaffold for new bone formation. Synthetic bone grafts offer predictable outcomes and eliminate the need for additional surgical procedures to harvest bone from other sites.

4. Temporary Anchorage Devices (TADs)

Temporary anchorage devices, or TADs, are miniaturized orthodontic implants used in conjunction with orthognathic surgery. These devices provide temporary anchorage points to facilitate tooth movement and orthodontic adjustments during the treatment process.

TADs are typically made of titanium and are inserted into specific locations in the jawbone. They act as stable anchor points for orthodontic forces, allowing for controlled and precise tooth movements. TADs provide orthodontists with greater control and flexibility in aligning the teeth, leading to improved treatment outcomes.

5. Orthodontic Archwires and Brackets

Orthodontic archwires and brackets are integral components in orthognathic surgery. These dental materials work in tandem to guide tooth movement and ensure proper alignment during the pre- and post-surgical phases.

Archwires are thin, flexible wires that apply gentle forces to the teeth, gradually moving them into their desired positions. They are available in various materials, including stainless steel and nickel-titanium alloys, with different levels of stiffness and flexibility.

Brackets, on the other hand, are small attachments bonded to the teeth, serving as anchor points for the archwires. These brackets can be made of metal or ceramic, providing stability and support during tooth movement.

The combination of orthodontic archwires and brackets plays a vital role in coordinating the alignment of the teeth with the repositioned jawbones, achieving optimal occlusion and facial aesthetics.

6. Injectable Bone Grafting Materials

In some cases, injectable bone grafting materials may be used in orthognathic surgery. These materials offer the advantage of easy delivery and placement into specific areas, such as voids or defects in the jawbone. Injectable bone grafts can be used to promote bone regeneration, fill gaps, and enhance the stability of the jawbones.

These grafting materials are typically composed of a combination of bone graft particles and a carrier substance, such as a biocompatible gel or a synthetic polymer. The carrier substance provides a moldable and cohesive consistency, allowing the grafting material to be easily injected into the desired site.

Once injected, the bone graft particles act as a scaffold for new bone formation, promoting the migration and proliferation of bone cells. Over time, the grafting material is gradually replaced by the patient’s own bone, resulting in a natural and integrated bone structure.

Injectable bone grafting materials are especially useful in cases where there are complex defects or areas that are difficult to access through traditional grafting techniques. They offer a minimally invasive approach and can significantly contribute to the success of orthognathic surgery.

7. Biocompatible Adhesives

Biocompatible adhesives are essential dental materials used during orthognathic surgery for various purposes. These adhesives provide bonding and sealing properties, facilitating the secure fixation of bone fragments or other dental components.

One common type of biocompatible adhesive used in orthognathic surgery is cyanoacrylate-based adhesive. This adhesive is known for its quick-setting properties and strong bond strength. It is often used to secure small bone fragments or to stabilize delicate structures during surgery.

Another type of adhesive commonly employed is resin-based adhesive. This adhesive is particularly useful for bonding dental brackets or other orthodontic components to the teeth. It offers excellent adhesion and durability, ensuring the stability of the brackets throughout the treatment process.

Biocompatible adhesives not only provide mechanical support but also help create a sterile environment by sealing off potential gaps or spaces. This prevents the accumulation of bacteria and promotes the proper healing of the surgical site.

8. Hemostatic Agents

Hemostatic agents are dental materials used to control bleeding during orthognathic surgery. These agents help achieve hemostasis, which is crucial for maintaining a clear surgical field and preventing excessive blood loss.

One commonly used hemostatic agent is oxidized cellulose. This material promotes clotting by absorbing blood and forming a gelatinous matrix that seals off bleeding vessels. Oxidized cellulose can be easily placed in the surgical site and provides effective hemostasis.

Another type of hemostatic agent is gelatin sponge. These sponges are made from purified porcine or bovine gelatin and are available in various sizes and shapes. When placed on a bleeding site, the sponge expands and absorbs blood, promoting clot formation and stopping the bleeding.

Hemostatic agents are an integral part of orthognathic surgery, as they aid in maintaining a clear surgical field, reducing the risk of complications, and ensuring the smooth progress of the procedure.

9. Antibacterial Coatings and Membranes

In certain cases, the use of antibacterial coatings or membranes may be beneficial during orthognathic surgery. These dental materials help prevent the colonization of bacteria and reduce the risk of infection at the surgical site.

Antibacterial coatings can be applied to dental implants or other surgical hardware to inhibit the growth of bacteria. These coatings are typically composed of antimicrobial substances, such as silver nanoparticles or chlorhexidine. By incorporating these coatings, the risk of post-surgical infections can be significantly minimized.

Membranes, on the other hand, are thin sheets or barriers placed between the surgical site and surrounding tissues to promote proper healing and prevent bacterial infiltration. These membranes can be made from various materials, including synthetic polymers or collagen-based materials. They act as a physical barrier, allowing for undisturbed tissue regeneration while preventing the passage of bacteria.

The use of antibacterial coatings and membranes adds an extra layer of protection during orthognathic surgery, promoting successful outcomes and reducing the potential for complications.

10. Digital Technologies in Orthognathic Surgery

In recent years, the integration of digital technologies has revolutionized various aspects of dentistry, including orthognathic surgery. These technologies provide enhanced accuracy, efficiency, and predictability in treatment planning and execution. Let’s explore some of the digital tools and materials used in orthognathic surgery:

a) Cone Beam Computed Tomography (CBCT)

CBCT imaging has become an essential tool in orthognathic surgery. Unlike traditional 2D radiographs, CBCT provides a detailed 3D image of the facial structures, allowing for precise evaluation of the jawbones, teeth, and surrounding tissues. This technology aids in accurate diagnosis, treatment planning, and virtual surgical simulations.

CBCT scans enable dental professionals to assess bone density, evaluate the relationship between the jaws, and identify any abnormalities or irregularities. This information helps in determining the optimal surgical approach and aids in the fabrication of custom-made surgical guides and appliances.

b) Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM)

CAD/CAM technology plays a significant role in the fabrication of dental appliances, including surgical guides, orthodontic appliances, and dental prosthetics. Using digital scans obtained from CBCT or intraoral scanners, computer software allows for precise planning and customization of these appliances.

For orthognathic surgery, CAD/CAM is employed in the creation of surgical guides. These guides serve as templates during surgery, providing guidance for accurate osteotomy and the placement of fixation devices. CAD/CAM technology ensures precise fit and alignment of these guides, facilitating a more streamlined surgical process.

c) 3D Printing

3D printing has revolutionized the field of dentistry by enabling the fabrication of complex and patient-specific dental appliances. In orthognathic surgery, 3D printing is used to create surgical guides, anatomical models, and orthodontic appliances.

Surgical guides produced through 3D printing offer unparalleled accuracy and efficiency during surgery. These guides are designed based on digital treatment plans and provide precise guidance for bone repositioning, implant placement, and fixation device positioning. With the aid of 3D printing, these guides can be rapidly fabricated, reducing surgical time and improving surgical outcomes.

d) Virtual Surgical Planning (VSP)

Virtual Surgical Planning (VSP) involves the use of advanced computer software to simulate and plan surgical procedures digitally. With the integration of CBCT scans and digital models, VSP allows for precise virtual manipulation of the jaws, enabling dental professionals to accurately plan the surgical movements.

VSP software provides the ability to visualize the predicted surgical outcomes, assess the occlusion, and optimize the treatment plan before the actual surgery takes place. This technology enhances communication between the surgical team, orthodontists, and patients, ensuring a comprehensive and collaborative approach.

e) Augmented Reality (AR) and Virtual Reality (VR)

Augmented Reality (AR) and Virtual Reality (VR) technologies are emerging tools in the field of orthognathic surgery. These immersive technologies provide a realistic and interactive environment, allowing surgeons to visualize and practice complex surgical procedures before entering the operating room.

AR and VR can be used to create virtual 3D models of the patient’s facial structures, enabling surgeons to virtually manipulate the jaws and simulate the surgical movements. This technology enhances surgical precision, reduces intraoperative complications, and improves overall patient outcomes.

The integration of digital technologies in orthognathic surgery has transformed the treatment process, offering improved accuracy, efficiency, and patient satisfaction. By utilizing these digital tools and materials, dental professionals can optimize treatment planning, enhance surgical outcomes, and provide patients with a more predictable and comfortable experience.

Conclusion

Dental materials and digital technologies continue to advance the field of orthognathic surgery, allowing for improved outcomes and patient care. From cone beam computed tomography (CBCT) and computer-aided design (CAD) to 3D printing and virtual surgical planning (VSP), these tools and materials contribute to accurate diagnosis, precise treatment planning, and successful surgical execution.

Digital technologies such as augmented reality (AR) and virtual reality (VR) further enhance surgical precision and offer a dynamic platform for preoperative simulations and patient education. These advancements not only benefit dental professionals in their treatment approach but also provide patients with a clearer understanding of the procedure and its expected results.

It is crucial for dental professionals to stay updated with the latest advancements in dental materials and digital technologies, ensuring that they can provide the highest level of care to patients undergoing orthognathic surgery. By leveraging these innovative tools and materials, the field of orthognathic surgery continues to evolve, providing patients with improved functional and aesthetic outcomes.

Frequently Asked Questions (FAQs) on Dental Materials for Orthognathic Surgery:

Q1: What are dental materials used in orthognathic surgery? A1: Dental materials used in orthognathic surgery include titanium implants, resorbable plates and screws, bone grafting materials (such as autografts, allografts, xenografts, and synthetic grafts), temporary anchorage devices (TADs), orthodontic archwires and brackets, injectable bone grafting materials, biocompatible adhesives, hemostatic agents, and antibacterial coatings or membranes.

Q2: Why are titanium implants commonly used in orthognathic surgery? A2: Titanium implants are widely used in orthognathic surgery due to their biocompatibility and strength. They provide stability and support during bone repositioning, allowing for proper alignment and healing. Additionally, titanium implants have a high success rate and can integrate well with the surrounding bone tissue.

Q3: What is the purpose of bone grafting materials in orthognathic surgery? A3: Bone grafting materials serve several purposes in orthognathic surgery. They can be used to fill voids or defects in the jawbone, promote bone regeneration, enhance stability, and provide a scaffold for new bone growth. Bone grafting materials can be derived from the patient’s own bone (autografts), donated bone (allografts), animal sources (xenografts), or synthetic materials.

Q4: How do temporary anchorage devices (TADs) contribute to orthognathic surgery? A4: Temporary anchorage devices, or TADs, are miniaturized orthodontic implants that serve as temporary anchor points during orthognathic surgery. These devices allow for controlled tooth movement and orthodontic adjustments, enhancing the precision and effectiveness of the treatment. TADs are typically made of titanium and provide orthodontists with greater control and flexibility in aligning the teeth.

Q5: What are the benefits of using digital technologies in orthognathic surgery? A5: Digital technologies, such as cone beam computed tomography (CBCT), computer-aided design and manufacturing (CAD/CAM), 3D printing, virtual surgical planning (VSP), augmented reality (AR), and virtual reality (VR), offer numerous benefits in orthognathic surgery. They provide detailed imaging for accurate diagnosis and treatment planning, facilitate the creation of custom-made surgical guides and appliances, allow for virtual surgical simulations, enhance surgical precision, and improve patient communication and satisfaction.

Q6: How do biocompatible adhesives contribute to orthognathic surgery? A6: Biocompatible adhesives are used in orthognathic surgery to secure bone fragments and dental components. They provide bonding and sealing properties, ensuring the stability and proper healing of the surgical site. Biocompatible adhesives can be cyanoacrylate-based or resin-based, offering strong bond strength and durability.

Q7: What role do hemostatic agents play in orthognathic surgery? A7: Hemostatic agents are dental materials used to control bleeding during orthognathic surgery. They help achieve hemostasis, maintaining a clear surgical field and preventing excessive blood loss. Hemostatic agents, such as oxidized cellulose and gelatin sponge, promote clotting and stop bleeding, contributing to a successful surgical outcome.

Q8: Are antibacterial coatings and membranes commonly used in orthognathic surgery? A8: Antibacterial coatings and membranes can be used in orthognathic surgery to reduce the risk of infection. Antibacterial coatings applied to dental implants or surgical hardware inhibit bacterial growth, while membranes act as physical barriers, preventing bacterial infiltration and promoting undisturbed tissue regeneration. Their usage may vary depending on the specific case and the surgeon’s assessment of the patient’s needs.

Q9: How do digital technologies, such as 3D printing, benefit orthognathic surgery? A9: 3D printing technology allows for the fabrication of patient-specific surgical guides, anatomical models, and orthodontic appliances. Surgical guides aid in precise osteotomy and placement of fixation devices, while anatomical models provide a tactile representation of the patient’s facial structures for better treatment planning. 3D printing enhances accuracy, efficiency, and customization in orthognathic surgery.

Q10: How can I ensure the use of appropriate dental materials in my orthognathic surgery? A10: It is essential to consult with your dentist or oral surgeon who specializes in orthognathic surgery. They will assess your specific case, conduct thorough evaluations, and recommend the most suitable dental materials for your treatment. Trusting experienced professionals and following their guidance will ensure the optimal use of dental materials in your orthognathic surgery.