Dento-alveolar Segmentation Techniques in Craniofacial Malformation Surgery

Most craniofacial malformations present with whole jaw deformations, but some of them impose sole alterations of dento-alveolar structures. Maxillary and mandibular surgery on bone segments is one option to treat such deformations as such surgeries enable segment movements in all planes, thereby correcting malformations that are primarily based on the dento-alveolar and not the jaw level. Typical sites for interdental segment osteotomies are between laterals and canines, premolars and molars, but all osteotomy sites are possible. Additionally, osteotomies can be bilateral, unilateral or asymmetric. Segment osteotomies can be done in combination with tooth extractions to allow push-back movements. The ability to control intercanine width, buccolingual angulation of incisors, correct Bolton discrepancy or treat bi-alveolar protrusion are some of the advantages of segmentation techniques. Special attention must be done to the three-dimensional configuration of dental roots and alveolar nerves to avoid unfavorable complications. Most segment corrections must be incorporated into an orthodontic treatment concept. Even large dislocations can be performed in special situations. Segment osteotomies are an important part of the armentarium of malformation surgery.