3D aesthetic planning in orthognatic surgery

Doc. MUDr. et MUDr. René Foltán, Ph.D., FEBOMFS   

Keynote Lecture - Friday, September 19, 2014

The present day demands on aesthetics are tremendous. Every day our patients and us are confronted with perfect human beings from commercials which foist their aesthetic views on us and shift the “normality” to extremes. But in fact the planning of not only the combined orthodontic-surgical treatment, but also the orthodontic treatment alone typically continues to be based on lateral cephalogram. This way we plan only the resulting profile to be achieved by the therapy. Apart from other things it is also because we have sufficient amount of valid information in the form of mean cephalometric values.

The "en face" treatment plan is therefore developed only based on linear craniometry, if anything. There are, however, only a very few supporting craniometric data, at least with respect to our Slavic population. Thus we have to often rely on our subjective opinion on the resulting aesthetics which can substantially differ from the perception of beauty by the patient himself.

The introduction of CBCT, facial and intraoral scanners opens up to us unprecedented possibilities not only in making the diagnosis, but also in planning the resulting aesthetic effect and they facilitate the direct involvement of the patient in the therapeutic decision-making process. The 2D projections, used by us until now and providing only a lateral image, undoubtedly had a certain reporting value for the patient. In most cases inadequate, though. We cannot see ourselves in profile. However, we can observe ourselves directly, or with maximum 2/3 of direct view.

In the presentation we will sum up our experience with the use of 3D technology in planning the combined orthodontic-surgical treatment. Apart from profile characteristics, we shall also focus on planning the transversal changes and we would also like to zero in on basic 3D cephalometric differences that we observe in our predominantly Slavic population of patients and that on some occasions positively while on other occasions adversely influence the development of the final treatment plan.

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