Orthognathic surgery osseointegration and adult orthodontics : multidisciplinary synergy to correct dentofacial deformities

The need for interdisciplinary approach within the various areas of dentistry to collaborate in the complex rehabilitation become very important. Many specialists are guilty of treating from an unidisciplinary point of view, that can lead to incomplete diagnostics, improper treatment planning, and compromised results. A single specialist, often, develops treatment plans according to his own specialized capabilities, expertise and skills, rather than by what the patient actually needs and by the treatment options dentistry can provide. This approach can lead to secondary problems, from esthetical, functional, skeletal, neuromuscular, periodontal and stability stand points. Sometimes, also multidisciplinary treatment has several problems, when the team members do not understand the potential or limitations of the other disciplines therapies. So, to achieve optimal dentofacial results, the approach to patient care should be interdisciplinary. This permits the synergism of each different discipline’s specialized expertise and skills, into the comprehensive protocol of treatment. This presentation shows the importance which has interdisciplinary consultation, communication and collaboration between specialists in various branches of dentistry, in particular between implantology, periodontics, prosthetics, oral and maxillofacial surgery and orthodontics to obtain best results which include the teeth health and their support tissue, the occlusion and esthetic appearance. The therapeutical treatment of serious orofacial deformities must be neither orthodontic nor surgical only. The orthognathic surgery has scientific importance when is considered as part of the therapeutical method. A different therapeutical approach makes note of a wrong formulation of ideas that may introduce to a worse functionality as well as to the problem of a relapse. In some adult patients, orthodontic anchorage may be more difficult to achieve because of missing teeth and wide edentulous spaces. In these situations, the implants may be used initially as skeletal anchorage to facilitate tooth movement, and secondarily as abutments for fixed prostheses. Tooth movement that is difficult or impossible with conventional tooth-borne anchorage is also possible with mini-implants. Using the fixtures as skeletal anchorage there are some problems because of severity of surgery, the discomfort of initial healing, a longer period of treatment time and they could only be inserted in retromolar, tuber and edentulous areas, evidencing limitations for the direction of force application. The use of mini-implants as anchorage produces a satisfactory result in a short period of time with two minimal surgical procedures, and enables to insert an appliance in any aimed position and carries out easily the tooth movement. This is very important for preventing dental, periodontal, esthetical and psychological problems during orthodontic treatment.