Influences on Stability Following Orthognathic Surgery

描述（由申请人提供）：患者寻求牙面畸形治疗，期望他们的口腔功能、美观和口腔健康将得到改善，他们的生活质量将因治疗而提高。通过定量记录各种正颌手术程序和固定方法用于治疗牙面不和谐的稳定性和临床可接受性，本项目的研究结果在治疗牙面不和谐方面取得了重大进展。然而，即使有了这些进展，1)临床上显著的不可接受的术后和治疗后形态学改变仍发生在5%至20%的患者中。手术后发生的髁突定位和局部骨骼适应以及这些适应的影响以及在治疗结束和治疗完成后呈现的临床特征，程序和/或人口统计学因素对骨骼结果的影响尚未被描述；2)几乎100%接受下颌截骨手术的患者在术后短期内都会经历神经感觉改变，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会经历一个漫长而不舒服的恢复期，而且很多患者无法负担治疗费用。在本项目期间，我们将继续使用系统的、基于协议的、前瞻性观察性研究设计，对conebeamct进行纵向定量三维分析。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、术前和术后髁形态和位置，以及骨骼建模的区域），这些因素是临床观察到的骨骼位置适应随时间变化的基础。特异性目的2旨在评估下颌形态和固定螺钉放置对术后感觉改变的影响。特异性目标3旨在评估一种新兴的治疗干预措施，临时骨骼锚固，它比单颚截骨术成本更低，需要更短的恢复时间，作为治疗特定牙面不和谐的替代方法。这三个具体目标的临床数据将通过改善正颌手术的临床决策和治疗计划，提高患者做出知情治疗选择的能力，促进我们提高牙面畸形患者治疗质量的最终目标。

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.