Mandibular repositioning in adult patients — an alternative to surgery? A two-year follow-up

Background

Adult patients presenting with skeletal discrepancies may refuse surgical intervention.

Materials and methods

Thirty-two patients who declined orthognathic correction of their maxillo-mandibular dysplasia and who were without signs of temporomandibular dysfunction (TMD) were offered mandibular repositioning as a non-invasive alternative. Simulating a skeletal correction, it was explained that the approach was based on results described in case reports.

Before commencing treatment, initial records, lateral and frontal head films, study casts and photos were obtained (T0) and the mandible was repositioned to camouflage a retrognathic skeletal discrepancy or a mandibular transverse asymmetry by means of an occlusal build-up using Triad™ gel.

Results

Three months later (T1), 23 patients had adapted to the new occlusion reflected by an absence of functional disturbance and without fracture of the composite occlusal build-up. Mandibular position in these patients was maintained by additional orthodontic treatment and an adjustment of the occlusion to the built-up postured position (T1). The skeletal changes occurring during repositioning were assessed on sagittal and frontal head films while intra-articular changes occurring during a two-year follow-up period (T2) were evaluated on images constructed from CBCT scans. No significant change, either in the direction of relapse or in the direction of further normalisation of condylar position, were observed during the two-year observation period.

Conclusion

Mandibular repositioning is a non-invasive intervention that may be considered a valid alternative to surgery in selected patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indicators regarding the predictability of the adaptation. A CBCT scan at T0 might have contributed to the identification of the patients who would likely accept the repositioning.