Anterior Decompensation Using Segmental Osteotomy for Patients With Mandibular Asymmetry

To obtain sufficient correction of facial asymmetry by orthognathic surgery, precise and sufficient dental decompensation during preoperative orthodontic treatment is needed. Facial asymmetry often includes complicated 3-dimensional dental compensation in the anterior alveolar region, which can limit the treatment options and lengthen the treatment time. As an alternative, anterior decompensation using segmental osteotomy (ADSO) with the patient under local anesthesia could be a reasonable approach, as it represents an effective, selective, and relatively safe method for correcting lower anterior disharmony during preoperative treatment. Furthermore, ADSO can quickly eliminate anterior compensation and move the teeth to their proper positions such that the basal bone supports them beyond the anatomic limits. Precise evaluation and diagnosis using data obtained from 3-dimensional computed tomography should be performed for accurate ADSO. The present report describes the versatile use of ADSO for 2 patients with different types of severe facial asymmetry. In the first case, ADSO was performed to correct the anterior dentoalveolar yaw and in the second, to change the vertical positioning and inclination of the anterior teeth. In both cases, sufficient elimination of anterior compensation using ADSO guaranteed successful improvement of the facial asymmetry and stabilization of occlusion after orthognathic surgery. The use of ADSO during preoperative treatment can quickly and effectively correct lower anterior disharmony and facilitate surgical correction of facial asymmetry.