Korean J Orthod.  2020 May;50(3):157-169. 10.4041/kjod.2020.50.3.157.

Assessment of bone density changes following two-jaw surgery using multidetector computed tomography: A pilot study

• Lee Y
• Park JH
• Chang NY
• Lee MY
• Kim BC
• Seo HY
• Mangal U
• Chae JM

• KMID: 2502625
• DOI: http://doi.org/10.4041/kjod.2020.50.3.157

Abstract

Objective
The aim of this retrospective study was to evaluate the pre- and postsurgical bone densities at alveolar and extra-alveolar sites following twojaw orthognathic surgery.
Methods
The sample consisted of 10 patients (mean age, 23.2 years; range, 18.0–27.8 years; 8 males, 2 females) who underwent two-jaw orthognathic surgery. A three-dimensional imaging program (Invivo 5) was used with multidetector computed tomography images taken preand postoperatively (obtained 32.3 ± 6.0 days before surgery and 5.8 ± 2.6 days after surgery, respectively) for the measurement of bone densities at the following sites: (1) alveolar bone in the maxilla and mandible, (2) extra-alveolar sites, such as the top of the head, menton (Me), condyle, and the fourth cervical vertebrae (C4).
Results
When pre- and postsurgical bone densities were compared, an overall tendency of decrease in bone density was noted. Statistically significant reductions were observed in the densities of cancellous bone at several areas of the maxillary alveolar bone; cortical and cancellous bone in most areas of the mandibular alveolar bone; cortical bone in Me; and cancellous bone in C4. There was no statistically significant difference in bone density in relation to the depth of the alveolar bone. In a comparison of the bone densities between groups with and without genioplasty, there was almost no statistically significant difference.
Conclusions
Accelerated tooth movement following orthognathic surgery may be confirmed with reduced bone density. In addition, this study could offer insights into bone metabolism changes following orthognathic surgery, providing direction for further investigations in this field.

Keyword

Bone density; Orthognathic surgery; Multidetector computed tomography; Regional and systemic acceleratory phenomena

Figure

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  Figure 1 Frankfurt horizontal (FH) plane orientation of computed tomography images. All images were reoriented to the FH plane using both porions and the right orbitale on the red line. A, Right lateral view. B, Frontal view. C, Left lateral view.

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  Figure 2 Reorientation and measurement of alveolar bone density in the sagittal views. A, B, Computed tomography images were reoriented to align the axis of the left maxillary and mandibular central incisors perpendicular to the horizontal plane. C, Posterior occlusal plane was aligned so it was parallel to the horizontal plane. D–F, Bone densities were measured at the alveolar crest (AC, yellow line) and at each depth (dotted lines; 5, 10, 15 mm from AC).

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  Figure 3 Measurement sites in the alveolar bone. A, B, Measurement sites in the maxilla and mandible. 1, 5: Between central and lateral incisors. 2, 6: Between the first and second premolars or between canines and remaining premolars when premolar extraction was performed. 3, 7: Between the second and first molars. 4: Maxillary tuberosity. 8: Retromolar pad. All measurements were acquired from the left side of the arch. Measurement areas of cortical and cancellous bone are shown as red dots and a yellow line, respectively.

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  Figure 4 Bone density measurement at the top point of the head. A, The most superior point was selected in the midsagittal view. B, Magnified view of the measurement site.

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  Figure 5 Bone density measurement at menton (Me). A, Presurgical image, the blue line represents the vertical slice drawn over Me (yellow arrow). B, Presurgical sagittal slice at Me (red dot). C, Postsurgical image. D, Postsurgical sagittal slice at Me (red dot).

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  Figure 6 Bone density measurement at the condyle. A, The axial slice with the largest mediolateral diameter of the mandibular condyle was selected. B, The condyle was re-oriented as the most medial and lateral points aligned in a horizontal line. C, Cortical bone densities at the medial and lateral points were measured (red dots), and cancellous bone density was measured in the middle 5 mm upon the line connecting the medial and lateral points.

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  Figure 7 Bone density measurements for the fourth cervical vertebrae (C4). A, Orientation of computed tomography images for C4. B, Measurement sites for C4 (yellow arrow). C, Magnified view of C4. Cortical bone densities were measured at the most anterosuperior and posteroinferior red points and cancellous bone density was measured in the middle 5 mm of the line (yellow) connecting the two red points.

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