Course Program

BSCOSO SUMMER COURSE: SATELLITE ‘16

Facial planning for orthognathic surgery and principles of perioperative orthodontics

30 June, 2016

PROGRAM

TOPICS (Orthognathic surgery techniques)

1. Patient preparation for surgery and general anesthesia
   1. Elective medical exams
   2. Immediate pre-op patient protocol
   3. Anesthesia protocol for orthognathic surgery, induction and recovery
   4. Do’s before leaving the OR
      .
2. Bilateral sagittal split osteotomy
   1. Surgical technique in detail. Tips and tricks.
   2. Video demonstration, do’s and don’ts
   3. How to avoid or manage complications:
      1. Bad and unfavorable splits
      2. IAN injury
      3. Condylar torque and TMD
      4. Immediate or late malocclusion/relapse

3. Le Fort I osteotomy (single piece and multi-segment)
   1. Surgical technique in detail. Tips and tricks.
   2. Video demonstration, do’s and don’ts
   3. How to avoid or manage complications:
      1. High fracture or tuberosity fracture
      2. Vascular and neurological complications
      3. Immediate or late relapse
      4. Non-union

4. Genioplasty
   1. Surgical technique in detail. Tips and tricks.
   2. Video demonstration, do’s and don’ts
   3. How to avoid or manage complications:
      1. Asymmetry
      2. Mental nerve injury
      3. Vascular complications

5. Mandibular midline split for distraction or bending
   1. Surgical technique in detail. Tips and tricks.
   2. How to avoid or manage complications:
      1. Orthodontic tips and tricks
      2. Distractor design: bone-borne vs. tooth-borne
      3. Fixation techniques

6. Early post-surgical management
   1. General considerations
   2. Intensive care and immediate postop care: monitoring, medications, applications
   3. Discharge from the hospital
   4. Patient care at home, outpatient follow up protocol 14 days after surgery
   5. Patient care and follow-up protocol 14-60 days after surgery
      .
7.  Condylectomy (low and high)
   1. Surgical technique in detail. Tips and tricks.
   2. Video demonstration, do’s and don’ts
   3. How to avoid or manage complications:
      1. Facial nerve injury
      2. Disk displacement
      3. Early fibrosis

TOPICS (Parallel session for orthodontists)

• Materials and additional tools
• Common sense prescription of brackets
• Selection of brackets according to surgical case needs
• Orthodontic wire selection and sequence
• Skeletal anchorage devices: bollard plates, C plates, TADs, mentoplates

Participants will be invited to share opinions and clinical experience during discussion
Presentation will be based on clinical cases and examples

1 July, 2016   |   BSCOSO course: Principles of facial planning for surgery and
orthodontic setup for Class II patients
(Course directors: Dr. Simonas Grybauskas and Dr. Dalia Latkauskienė)

PROGRAM

08:00 – 09:30 Principles of facial planning for surgery and orthodontic setup for Class II patients PART I
09:30 – 10:00 Coffee break
10:00 – 11:30 Principles of facial planning for surgery and orthodontic setup for Class II patients PART II
11:30 – 13:00 Lunch
13:00 – 14:30 Principles of facial planning for surgery and orthodontic setup for Class II patients PART III
14:30 – 15:00 Coffee break
15:00 – 16:30 Principles of facial planning for surgery and orthodontic setup for Class II patients PART IV
16:30 – 17:00 Discussion

19:00 – 19:30 Transfer for the Networking Event (meeting point: Comfort Hotel lobby)
19:30 – 23:00 Networking Event

TOPICS

1. Decision-driven classification of dentofacial deformities
   .
2. Functional and aesthetic indications for orthognathic surgery
   1. Orthognathic surgery vs. camouflage
   2. Skeletal malocclusion and sleep disorders
   3. Orthognathic surgery in Class I patients
      .
3. Communication between a surgeon and an orthodontist
   1. What is a good treatment plan?
   2. Aesthetic treatment planning and facial analysis
   3. Risk sharing and communication
   4. Risks and benefits of orthodontic decompensation- surgeon‘s perspective
   5. General guidlines to combined orthognathic treatment
      1. Principles of a good orthodontic setup
      2. Assessment of orthodontic setup
      3. Assessment of early postsurgical result
   6. Understanding orthodontic and surgical relapse:
      1. Forced orthodontics
      2. Inaccurate surgical technique
      3. Condylar resorption

3a. Case evaluation :

i.   Size and anatomy of the teeth
ii.  Shapes and sizes of the dental arches
iii. Shape fitting of mandibular and maxillary arches
iv. Gingiva and bone outline as the limit to move the teeth
v.  Plan on restoring integrity of dental arch
vi. Third molars: what to do?

3b. Matherial selection:

i.   Brackets
ii.  Wires
iii. Tubes or bands
iv. Bonding principles
v.  Additional anchorage devices: miniscrews, miniplates, mentoplates, palatal  constructions

4. Orthodontic setup for surgery: general guidlines for all malocclusions:
   1. Intrinsic characteristics of dental arches:
      1. Transversal: uprighting vs. expansion
      2. Sagittal: position of incisors- retroclination vs. proclination
      3. Vertical: correction of deep curves or vertical deformities
   2. Extrinsic characteristics of dental arches (dental arch to jaw base relationship):
      1. Transversal: regulation of upper dental arch width to skeletal base
      2. Sagittal: correction of dental arch projection – protraction vs retraction
      3. Vertical: adjustment of upper occlusal plane to palatal plane and lower occlusal plane to mandibular plane
   3. How to:
      1. Retrocline upper or lower incisors: extraction vs. non-extraction treatment
      2. Procline upper or lower incisors, management of excessive space
      3. Distalize or medialize full arches: anchorage?
      4. Vertically adjust dental arches: anchorage?
      5. Transversally adjust dental arches? Segmentation? When?

5. Management of Class II-1 patients:
   1. Camouflage vs. Orthognathic surgery
   2. Pre-surgical setup:
      1. Cook book for orthodontists for a typical Class II-1 case
      2. Mandibular advancement
      3. Double jaw surgery: segmental and non-segmental
   3. Management of Class II-2 patients:
      1. Camouflage vs. Orthognathic surgery
      2. Pre-surgical setup:
         • Cook book for orthodontists for a typical Class II-2
         • Mandibular advancement for deep bite patients
         • Double jaw surgery
      3. Sculpting of short faces
      4. Dentoalveolar distraction and advancement

2 July, 2016   |   BSCOSO course: Orthodontic setup for Class III, open bite
and asymmetric patients. Orthodontic finishing after surgery
(Course directors: Dr. Simonas Grybauskas and Dr. Dalia Latkauskienė)

PROGRAM

08:00 – 09:30 Orthodontic setup for Class III, open bite and asymmetric patients. Orthodontic finishing after surgery PART I
09:30 – 10:00 Coffee break
10:00 – 11:30 Orthodontic setup for Class III, open bite and asymmetric patients. Orthodontic finishing after surgery PART II
11:30 – 13:00 Lunch
13:00 – 14:30 Orthodontic setup for Class III, open bite and asymmetric patients. Orthodontic finishing after surgery PART III
14:30 – 15:00 Coffee break
15:00 – 16:30 Orthodontic setup for Class III, open bite and asymmetric patients. Orthodontic finishing after surgery  PART IV
16:30 – 17:00 Discussion, Closing remarks

TOPICS

7. Management of Class III patients:

1. Camouflage vs. Orthognathic surgery
2. Pre-surgical setup:
   1. Cook book for orthodontists for a typical Class III case
   2. Double jaw surgery
   3. Segmental double jaw surgery

8. Management of open bite patients:

1. Camouflage vs. Orthognathic surgery
2. Pre-surgical setup:
   1. Cook book for orthodontists for typical dual occlusal plane open bite case
   2. Single occlusal plane
   3. Double occlusal plane

9. Management of asymmetric patients:

1. Camouflage vs. Orthognathic surgery
2. Condylar hypoactivity vs. condylar hyperactivity
3. Understanding TMJ pathology. Treatment considerations in growing patient and adults.
4. Pre-surgical setup:
   1. Cook book for orthodontists for vertical asymmetry case
   2. Decompensation in three planes of space
   3. Indications for surgery first: benefits and pitfalls

10. Orthodontic finishing:

1. Postsurgical patient regimen
2. Reinitiation of orthodontic treatment in segmented and non-segmented maxillas
3. TMD patients: differences in management and planning
4. Retention and follow-up

11. Management of complications

The official language of the BSCOSO Summer Course is English.