Comparison of Orthodontic and Combined Surgical Treatment for Mandibular Asymmetry

Objective: To evaluate clinical effects of orthodontic treatment (extraction or nonextraction) and orthodontic-orthognathic surgery treatment in mandibular asymmetry. Methods: The clinical data were divided into four groups. The first group consisted of 15 children who were corrected by expansion of maxillary arch. The second group consisted of 10 teenagers who were corrected by nonextraction orthodontic therapy. The third group consisted of 10 teenagers who were treated by extraction. The fourth group consisted of 10 adults who had severe mandibular asymmetry were treated by pre-surgical orthodontic method and then orthognathic surgery (bilateral sagittal split osteotomy of the mandibular ramus and genioplasty). Clinical comparison above situations includes: facial photographs, posteroanterior radiographs and panoramic radiographs. Results: In the first group, the upper and lower dental arches obtain concordance by expansion of maxillary arch. Mandibular can gradually drift to symmetry by upper jaw asymmetric expansion, Class III and crossbite elastics. Some cases of upper molars were moved distally or medially to establish normal functional occlusion and achieve ideal occlusion. In the third group, the mandible asymmetry was corrected by orthodontic extraction for camouflage. However, skeletal deformity can not be completely eliminated, it can only decrease the degree of mandible asymmetry. If added genioplasty will improve the therapeutic effects. In the fourth group, a satisfactory dental relationship and facial esthetics can be achieved by pre-surgical orthodontic and orthognathic surgery treatment. Conclusion: Early treatment of mandibular asymmetry shows a good result from orthodontic treatment alone. The result of nonsurgical camouflage orthodontic treatment on skeletal patterns is limited. Skeletal deformity can not be well treated with orthodontics extraction or nonextraction therapies, it only partly resolves the mandibular asymmetry. Combined surgical and orthodontic treatment might have led to a satisfactory dental relationship and facial esthetics.