Surgical Segmentation in Face of a New Orthodontics. When, Where and How

by Melhem Elias Fernando

Along with diagnostic and therapeutic innovations, contemporary orthodontics has become faster and much more effective. Dental movements that used to take too long or even seemed to be impractical not so long ago are now incorporated into routine clinical practice. Techniques using self-ligating brackets, temporary anchorage devices and clear aligners are being associated with shorter and less invasive treatments, even reducing the need of surgical interventions. In face of the improvements of a relatively new Orthodontics, surgical segmentation of the maxilla or mandible is being reassessed in many cases of orthognathic surgery, due to the concept that leveling the curve of Spee and full decompensation can be almost always achieved in the pre-surgical phase. But what are the limits for this practice? How to identify the situations where orthodontic movements alone, without any surgical segmentation, may lead to unaesthetical results or even to relapse. In this presentation, it will be discussed when surgical segmentation should be performed, in which regions and with what techniques, aiming for optimized outcomes in terms of aesthetics, function and stability.

Learning Objectives

After this lecture, you will be able to recognize the indications for surgical segmentation and the situations when orthodontic movements alone should be avoided
After this lecture, you will be able to define the best locations for surgical segmentation, and the consequences of this choice in orthodontic preparation and finalization
After this lecture, you will be able to evaluate whether segmentation can be performed in a single surgical time, together with the major procedure, or whether it will require a first isolated surgery