Borderline surgical cases

In some cases with mandibular excess, the diagnosis will suggest that mandibular surgery may be needed. It is helpful to delay orthodontic treatment for such cases, if possible. T his will allow assessment of growth patterns, using regular cephalometric radiographs, so that a more informed surgical/non-surgical decision can be reached.

Class III surgical cases rn

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Some cases are clearly Class III surgical cases from the outset, and should not be treated until all growth has ceased. Timing will be agreed with the surgeon, and may be beyond the age of 20 vears in males and a little earlier in females.

Fig. 8.4 The Arnef: analysis uses a true vertical line.

Surgical Cases

Fig. 8.5 The Arnett analysis became available in September 1999. It offers new levels of sophistication as an aid in diagnosis and treatment planning for orthodontists and surgeons. It emphasizes soft tissue facial measurement, and the numerical printouts are color coded.

The analysis is related to the true vertical line (TVL) and has separate norms for males and females. The treated patient shown here, by permission of Dr Arnett, had bi-maxillary surgery to advance the maxilla and set back the mandible. There was also hydroxyapetite grafting of orbital rims.

within 1 SD within 2 SD within 3 SD more than 3 SD

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