Double Anterior Segmental Osteotomy Under Local Anesthesia for Correcting Adult Protrusion With Thin Alveolus and Ankylosed Tooth.

Backgrounds: This paper describes an additional benefit in double anterior segmental osteotomy to correct severe anterior protrusion in adult patients with extremely thin mandibular alveolus and ankylosed tooth. For the optimal anterior segmental retraction, an ankylosed posterior tooth needed surgical inclination reposition. During anterior segmental osteotomy surgery under local anesthesia, additional single tooth osteotomy was performed without challenge. Methods: For anterior segment retraction, osteotomy cuts were made by the surgeon to define a block of bone embedding 6 mandibular anterior teeth. First premolars were extracted during initial orthodontic treatment period. But the ankylosed lower left lateral incisor and lower right second premolar root which remains mesially with uprighted crown hindered further anterior segment retraction. The authors removed cortical bone around second premolar root and repositioned to be upright. Anterior segment was retracted to proper position utilizing the space gained. Result: Thin alveolar mandibular anterior segment retraction and the second premolar uprighting were managed effectively with additional single tooth segmental osteotomy during anterior segmental osteotomy. Conclusion: Double anterior segmental osteotomy can be an effective alternative to conventional orthognathic surgery in selected adult patients. (C) 2017 by Mutaz B. Habal, MD.

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