Abstract
Recently, there has been an apparent increase in elderly patients seeking orthognathic surgery. In such cases, it is necessary to consider systemic diseases, multiple tooth defects, periodontal diseases, etc. Comprehensive treatment is important. We report the case of a senior adult with skeletal mandibular protrusion with multiple missing teeth treated with comprehensive treatment. The patient was a female aged 65 years at the first visit with the chief complaint of mandibular protrusion. She had a concave facial profile. ∠ANB, ∠SNA, ∠SNB were −7.0°, 80.0°, 87.0°, respectively. The intraoral view showed multiple missing teeth. The canine relationship was Class Ⅲ. Lower incisors showed lingual inclination because of dental compensation. We used orthodontic anchor screws to improve the lower incisor angle and height during presurgical orthodontic treatment. For intermaxillary fixation during orthognathic surgery, brackets were attached to the maxillary dentition immediately before the operation. After 16 months of preoperative orthodontic treatment, sagittal split ramus osteotomy was performed. As a result, the mandibular incisors were inclined labially by 2.0° and intruded by 1.5mm. The mandible was set back by 9.0mm at the Pogonion. The concave facial profile was improved by the appropriate amount of mandibular set-back. Maxillary dentition and mandibular molars were improved by prosthetic treatment. The final prosthesis was worn during retention. At more than 2 years after surgery, the patient expressed satisfaction with the changes in facial appearance and stable occlusion remained.
The findings from this case suggest that although surgical orthodontic treatment for senior adult patients involves risks, it is possible to achieve functional, esthetic and quality of life （QOL） improvements.
