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This study hypotheses that using low medial cut osteotomy BSSO in mandibular setback can be an efficient and effective method to limit the bony segment interferences , decreasing muscles stripping during osteotomy ,decrease condylar torque and so securing preoperative condylar position during BSSO in comparison with using high medial cut BSSO.
Research question:
Description of research question:
P: Population: Patients with facial skeletal deformity and need for mandibular setback using bilateral sagittal split osteotomy (BSSRO) alone or combined with lefort osteotomy.
I: Intervention: Patients with facial skeletal deformity and need and for mandibular setback using low medial cut osteotomy as modification of bilateral sagittal split ramus osteotomy (BSSRO).
C: Comparator: Patients with facial skeletal deformity and need and for mandibular setback using traditional high medial cut osteotomy bilateral sagittal split ramus osteotomy (BSSRO).
O: Outcome: Comparing the post-operative condylar positions changes and TMJ functions of two osteotomies.
Research question:
Is using low medial cut osteotomy modification in BSSRO in mandibular setback will provide more control over proximal segment position than traditional high medial cut through:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| mandibular setback using low medial cut ostetomy | Experimental | mandibular setback using low medial cut ostetomy by keeping the cut ''low'' or close to the mandibular occlusal plane and ''short'' or terminating anterior to the lingula. |
|
| mandibular setback using high medial cut ostetomy | Active Comparator | mandibular setback by placement of the medial ramus osteotomy cut 'high', just a few millimeters above the lingula, superior and lateral to the entrance point of the inferior alveolar nerve (IAN) into the mandibular foramen , |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| mandibular setback using BSSRO | Other | mandibular setback using BSSRO |
|
| Measure | Description | Time Frame |
|---|---|---|
| 3D mandibular condylar position changes | assessment of condylar position changes in millimetre using C.T.(axial ,coronal and sagital cut. ).
perpendicular distance between the coronal plane and the most superior point of the condylar head | Preoperative- 1-month postoperative - 6 months post operative |
| Measure | Description | Time Frame |
|---|---|---|
| Assessment of changes in articular disc position | In order to trace the position of the TMJ disc, a line was drawn from the uppermost point of the articular fossa (UAF, marked as 10) to the lowermost point of the articular tubercle (LAT, marked as 0). This line was continued anteriorly and inferiorly. If the anterior border of the disc was anterior to this line, it was considered negative. These two points were chosen because they did not change with remodelling . Perpendicular lines to this line were drawn in the anterior and posterior borders of the disc. Finally, disc position was determined by averaging anterior (point A) and posterior (point P) disc limits. |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical assessment of maximum incisal opening (MIO) | assessment of changes(in millimetre) in Maximum incisal opening (MIO) | Preoperative - 1 months postoperative - 6 months postoperative |
| pain on TMJ |
Inclusion criteria:
Exclusion criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Fahmy Mobarak, professor | Cairo University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Dentistry Cairo University | Cairo | 11553 | Egypt |
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| ID | Term |
|---|---|
| D019767 | Maxillofacial Abnormalities |
| D008313 | Malocclusion, Angle Class III |
| ID | Term |
|---|---|
| D019465 | Craniofacial Abnormalities |
| D009139 | Musculoskeletal Abnormalities |
| D009140 | Musculoskeletal Diseases |
| D018640 | Stomatognathic System Abnormalities |
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| Preoperative , 6month postoperative |
assessment of changes in severity of pain over TMJ using (pain scale from 0 to 10)
| Preoperative - 1 months postoperative - 6 months postoperative |
| sounds on TMJ | assessment of resulted sounds during TMJ function (present or not present) | Preoperative - 1 months postoperative - 6 months postoperative |
| D009057 | Stomatognathic Diseases |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D008310 | Malocclusion |
| D014076 | Tooth Diseases |