CHAPTER 55 Orthodontics for Orthognathic Surgery Larry M. Wolford, DMD Eber L. L. Stevao, DDS, PhD C. Moody Alexander, DDS, MS Joao Roberto Goncalves, DDS, PhD Moderate to severe occlusal discrepancies and dentofacial deformities in late adoles- cents and adults usually require combined orthodontic treatment and orthognathic surgery to obtain optimal, stable, func- tional, and esthetic results. The basic goals of orthodontics and orthognathic surgery are to (1) satisfy the patients’ concerns, (2) establish optimal functional outcomes, and (3) provide good esthetic results. To accomplish this the orthodontist and the oral and maxillofacial (OMF) surgeon must be able to correctly diagnose existing dental and skeletal deformities, establish an appropriate treatment plan, and prop- erly execute the recommended treatment. The orthodontist is limited, to a great extent, by growth, and although the ortho- dontist can move teeth and, to some degree, the alveolar bone, he or she does not have any appreciable effect on the basal bone of the jaws. The orthodontist’s role is to align the teeth relative to the maxillary and mandibular jaws. The OMF surgeon is responsible for surgically repositioning the jaw(s) and associated structures. It is very important to listen to and understand the patients concerns. Empa- thetic listening from the first appointment and throughout the treatment will build trust, improve communication, and help provide a quality end result for all parties involved. Comprehensive analysis of the patient and the complete orthodontic records (cephalograms, pantomograms, photographs, dental models) are impor- tant for diagnosis and development of the presurgical orthodontic goals. Although detailed analysis of the patient’s facial and jaw structures from a clinical and radi- ographic perspective are vitally important, the focus of this chapter will be the teeth and orthodontic considerations in prepa- ration for orthognathic surgery. Other important factors in diagnosis, treatment planning, and outcomes, such as patient concerns, psychosocial factors, masticato- ry dysfunction, airway problems, speech difficulties, temporomandibular joint (TMJ) pathologies, and comprehensive orthognathic surgery work-up are dis- cussed elsewhere in this book. The normal values provided in this chapter are not absolutes for every patient because of individual size, morphologic variances, and racial and ethnic differ- ences. They are provided as a guide to help the clinician evaluate his or her patient. Establishing an all-inclusive diagnosis is paramount to developing a comprehen- sive treatment plan. The orthodontist must determine the orthodontic goals based on the pretreatment findings and on the projected treatment outcome. This chapter will first present orthodontic diag- nostic information, followed by orthodon- tic treatment considerations. Clinical and Dental Model Diagnosis From an orthodontic standpoint, in eval- uating the occlusion and dental factors, the clinical and dental model analyses cor- related with the cephalometric analysis provide the most information for diagno- sis and treatment planning. There are 12 basic evaluations that are helpful for these determinations. 1. Arch length: This assessment corre- lates the mesiodistal widths of the teeth relative to the amount of alveo- lar bone available and aids in identify- ing the presence of crowding or