Long-term evaluation of patients with progressive condylar resorption following orthognathic surgery

The aim of this retrospective study was to evaluate the long-term treatment results of 26 patients who developed progressive condylar resorption (PCR) following a bilateral sagittal split advancement osteotomy (n=19) or a bim axillary osteotomy (n=7). PCR was diagnosed clinically and from a compariso n of pre- and postoperative cephalometric and orthopantomographic radiograp hs. The preoperative condylar configuration and resorption pattern were ass essed distinguishing between 'deep bite' and 'open bite'. Patients with 'de ep bites' tended to have more resorption on the superior site of the condyl e, while 'anterior open bites' often had resorption on the superior and ant erior sites of the condyle. The patients were divided into 2 groups, one re ceiving nonsurgical treatment that included splints, orthodontics with or w ithout extractions and restorative dentistry. The second group underwent re peated surgery to treat skeletal relapse. Thirteen patients who underwent n on-surgical treatment after orthognathic surgery had satisfactory results f rom orthodontic dental compensation, although only 3/13 had Class I occlusi on. Another 13 patients had unacceptable occlusal and/or esthetic results a nd, therefore, underwent a second surgery. Following surgery, 7 patients ha d satisfactory occlusal and esthetic results and were skeletally stable. Fo ur patients had 40-80% relapse, but with a stable occlusion. Two patients h ad 120% and 100% relapse, respectively and needed a third surgical interven tion. The first patient had a stable occlusal and esthetic result with appr oximately 30% relapse at pogonion, but the second patient still had an unst able malocclusion with again 100% relapse. It appeared that, without surgic al intervention after PCR, further resorption ceased after approximately tw o years. Second surgery appeared to produce variable results, but, in this series, the majority had significant improvement.