Influences on Stability Following Orthognathic Surgery

描述（由申请人提供）：患者寻求治疗牙面畸形，期望通过治疗改善其口腔功能、美学和口腔健康，并提高其生活质量。该项目的研究结果通过定量记录用于治疗牙面不协调的各种正颌外科手术和固定方法的稳定性和临床可接受性，导致了牙面不协调治疗的重大进展。然而，即使有这些进展，1）临床上显著的不可接受的术后和治疗后形态学变化发生在5%至20%的患者中。术后发生的髁状突和局部骨骼适应性改变的定位以及这些适应性改变的影响，以及治疗结束时和治疗完成后的临床特征、手术和/或人口统计学因素对骨骼结果的影响尚未得到表征; 2）几乎100%的下颌骨截骨术患者在术后短期内经历神经感觉改变，平均而言，神经感觉评估的定量测量在两年内不会恢复到基线值。虽然“手术创伤”通常被认为是原因，但下颌骨形态和/或固定螺钉放置也可能是重要的影响因素; 3）患者在正颌手术后仍然经历漫长而不舒服的恢复期，并且成本使许多患者无法接受治疗。在本项目期间，我们将继续使用系统性、基于方案的前瞻性观察性研究设计，使用ConeBeamCT的纵向定量三维分析。具体目标1旨在评估潜在的预测因素（人口统计学、临床特征、手术类型、术前和术后髁突形态和位置以及骨骼建模的局部区域），这些因素是临床观察到的位置骨骼适应随时间变化的基础。特定目标2旨在评估下颌骨形态和固定螺钉放置对术后感觉改变的影响。具体目标3旨在评估一种新兴的治疗干预措施，临时骨骼锚定，与单颌截骨术相比，其成本更低，恢复时间更短，是治疗特定牙面不协调的替代方法。这三个具体目标的临床数据将推进我们的最终目标，即通过改善正颌外科的临床决策和治疗计划，并通过提高患者做出知情治疗选择的能力，提高牙颌面畸形患者的治疗质量。 公共卫生相关性：该提案的结果将大大增强对面部骨骼手术后骨骼适应的理解，并确定有助于骨骼反应（特定目标1）和神经恢复（特定目标2）变化的特定形态和/或特定区域。具体目标3代表，据我们所知，第一次前瞻性纵向比较的有效性和恢复模式的临时骨骼支抗正畸治疗与正颌手术。该项目的成功完成将提供额外的知识，以促进手术技术和治疗结果的改善。该项目代表了实现我们的总体目标的下一步，即通过开发循证治疗，结合诊断，程序和骨骼反应信息，改善寻求治疗牙面不和谐患者的结局和治疗方案。

DESCRIPTION (provided by applicant): Patients seek treatment for dentofacial deformity with the expectation that their oral function, esthetics, and oral health will be improved and that their quality of life will be enhanced as a result of treatment. Findings from this project have led to significant progress in the treatment of dentofacial disharmony by quantitatively documenting the stability and clinical acceptability of various orthognathic surgery procedures and fixation methods used to treat dentofacial disharmonies. However, even with these advances, 1) clinically significant unacceptable post-surgery and post-treatment morphological changes occur in 5 to 20 percent of patients. The localization of the condylar and regional skeletal adaptations that occur after surgery and the effect of these adaptations and presenting clinical characteristics, procedural and/or demographic factors on the skeletal results at the end of treatment and after treatment is complete have not yet been characterized; 2) virtually 100% of patients who have a mandibular osteotomy experience a neurosensory alteration in the short-term after surgery and, on average, quantitative measures of neurosensory assessment will not have returned to baseline values by two years. Although "surgical trauma" is generally cited as the cause, mandibular morphology and/or fixation screw placement may also be significant contributing factors; and 3) patients still experience a lengthy and uncomfortable recovery period following orthognathic surgery and the cost puts treatment out of reach for many patients. During this project period we will continue our use of the systematic, protocol-based, prospective observational study design using longitudinal quantitative three dimensional analyses of ConeBeamCTs. Specific Aim 1 is intended to assess the potential predictors (demographic, presenting clinical characteristics, type of surgery, pre and post-surgery condylar morphology and position, and regional areas of skeletal modeling) that underlie the clinically observed variation in positional skeletal adaptation over time. Specific Aim 2 is intended to assess the effect of mandibular morphology and fixation screw placement on post-surgical sensory alteration. Specific Aim 3 is intended to assess an emerging treatment intervention, Temporary Skeletal Anchorage, that is less costly and requires less recovery time than single jaw osteotomy as an alternative approach to treatment for specific dentofacial disharmonies. The clinical data from these three specific aims will advance our ultimate goal of improving the quality of treatment for patients with dentofacial deformities by improving clinical decision making and treatment planning for orthognathic surgery and by enhancing the ability of patients to make informed treatment choices. PUBLIC HEALTH RELEVANCE: The results from this proposal will greatly enhance the understanding of the skeletal adaptations following facial skeletal surgery and identify specific morphology and/or specific regions that contribute to the variability in the skeletal response (Specific Aim 1) and nerve recovery (Specific Aim 2). Specific Aim 3 represents, to the best of our knowledge, the first prospective longitudinal comparison of the effectiveness and recovery pattern of temporary skeletal anchorage during orthodontic treatment versus orthognathic surgery. The successful completion of this project will provide additional knowledge to facilitate improvement of procedural techniques and treatment outcomes. This project represents the next step in achieving our overall goal of improving the outcomes and treatment options of patients seeking treatment for dentofacial disharmony by developing evidence-based treatments, incorporating diagnostic, procedural, and skeletal response information.