Comparative Analysis of Sagittal Maxillary Positioning Reference in Orthognathic Surgical Design of Skeletal Class Ⅲ Malocclusion

doi:10.13701/j.cnki.kqyxyj.2025.09.012

Abstract

Abstract: Objective: To compare the correlation between sagittal position reference of the maxilla and midfacial soft tissues in surgical design for skeletal Class Ⅲ malocclusion patients. Methods: Eighty-two patients of skeletal Class Ⅲ malocclusion were included in this study. They were treated at the Department of Oral and Maxillofacial Trauma Orthognathic Plastic Surgery, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University from March 2022 to December 2024. The spiral computed tomography (SCT) were taken before and 6 months after surgery. The Mimics and ProPlan CMF were applied to perform three-dimensional reconstruction. Twenty-eight parameters of craniofacial bones and soft tissues, including horizontal/sagittal linear distances, angular measurements, and nasal-related indices were measured. The statistical analysis was performed between twenty-eight facial parameters and Sella-Nasion-A point angle (SNA), A-point-Nasion vert distance (A-N) and Goal Anterior Limit Line (GALL) by the GraphPad Prism. Results: In two SNA groups (SNA< 80° and SNA≥80° ), there were statistical differences in four indexes (superior nasolabial angle, bilateral ∠1, and left ∠3) (P<0.05). There were statistical differences in nine indexes (tip height, superior nasolabial angle, left cheek convexity, subnasal depth, bilateral nasal alar depth, right ∠1, bilateral ∠2) in two A-N groups (A-N<0 and A-N≥0) (P<0.05). The three indexes (bilateral cheek convexity, right ∠1) had statistical differences in two GALL groups (upper incisor point to GALL <-2 and upper incisor point to GALL ≥-2) (P<0.05). Compared with the SNA angle (10 parameters) and GALL (9 parameters), the amount and intensity of correlation between A-N and the midfacial soft tissue parameters were best (P <0.05). Furthermore, the nineteen postoperative patients which the A-N was in the normal range (0±2) mm were included and divided into two groups according SNA (80°≤SNA≤85°, n=11; SNA>85° or <80°, n=8). The results showed that there was no significant statistical difference in the midface soft tissue measurement between the two groups. Conclusion: Compared with SNA and GALL, the A-N had higher correlation with most midface soft tissue parameters, and could more sensitively reflect the profile changes of midface soft tissue.

Key words: orthognathic surgical procedures, skeletal Class Ⅲ malocclusion, maxillary sagittal parameters, esthetics

LI Jingyi, WAN Shujun, LV Xin, ZHANG Qian, WANG Yuxin. Comparative Analysis of Sagittal Maxillary Positioning Reference in Orthognathic Surgical Design of Skeletal Class Ⅲ Malocclusion[J]. Journal of Oral Science Research, 2025, 41(9): 806-813.

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