Types of Segmental Alveolar Osteotomies in the Mandible

Class II division I malocclusions are the most common dentofacial deformities seen in clinical practice. Combined orthodontic and surgical treatment in cases of severe class II dentofacial deformities (class II division I malocclusion/class II division II malocclusion) is a routine procedure in these orthodontic patients (Bell et al., American Journal of Orthodontics. 85:1–20, 1984). Some indications for segment osteotomies in combination with correction of class II deformities are as follows: Excess vertical growth in the anterior dentoalveolar process of the mandible, some types of mandibular vertical alveolar deficiency and anterior open bite, relapse after BSSO, cases of condylar agenesis and hypoplasia, lateral open bite, mandibular dental arch asymmetry, and negative curve of Spee (Köle. Oral Surgery, Oral Medicine, and Oral Pathology 12(3):277–288, 1959; MacIntosh RB Journal of Maxillofacial Surgery. 2:210-218, 1974). However, the aim will always be to avoid segmental osteotomies by means of suitable orthodontic pretreatment, since the techniques of relocating the entire mandible are safer and involve fewer risks. Nevertheless, there are situations in which the performance of a segmental osteotomy is indicated, either in combination with a BSSO or as a stand-alone procedure. Segmental osteotomies can be performed in the anterior mandibular region, but also laterally.