Treatment plan is prepared after a thorough clinical examination of face, occlusion, radiographs and plaster dental models. This is one of the most important stages because once the treatment is started it is hardly possible to reverse it or suspend.
In the beginning information about patient’s general health state and previous diseases is evaluated. If there are no contraindications for the surgery and general anaesthesia, the following systems are evaluated one by one: teeth and dental arches, jaws’ size and interrelationship, jaw joints, airway size and facial aesthetics.
Teeth and dental arches. Teeth status, their position in dental arches, angulation and crowding is evaluated – these are the factors which help to define the mismatch between upper and lower dental arches. New teeth position is modelled in dental arches, i. e. it is determined which way the arches should be aligned and how much different teeth should be angulated, so that dental arches would fit each other best.
Jaw size and position. The information on jaw size, position and interrelationship is received from radiographs and facial measurements. Than new position of jaws is planned with the use of special software. The program allows to predict how the facial profile might look after surgery.
Jaw joint state. Lower jaw joints may suffer literally in every patient with malocclusion due to unfavourable load. A patient may start feeling clicking or popping, joint disks may get dislocated, joints may wear out faster. When functional disorders in the joints are noticed, special attention is paid to the treatment planning and additional medical treatment is prescribed during the entire treatment period.
Airway and sleep scale. If one or both jaws are insufficiently developed airway may be narrow and less oxygen is provided to the body. At night masticatory muscles relax and the lower jaw drops back further compressing the airway, then a person starts to snore. This is extremely important for middle age people with obesity who are more often diagnosed with obstructed sleep apnea. During the sleep breathing is interrupted numerous times, a person does not get enough oxygen and it negatively affects various systems and organs. OSA patients constantly feel sleepy throughout the daytime. When narrow airways and sleep apnea is diagnosed jaws are planned and positioned during surgery in a way that airways would benefit from maximal widening.
Facial aesthetics. Facial attractiveness is mostly determined by upper and lower jaws since lips and chin projection follow the position of the jaws and synthesize the harmony of the face. One should know the formulas of facial aesthetics while planning jaw position since they help to create beautiful features and facial profile. If surgery is perfectly performed but follows less than ideal treatment plan, the occlusion may become correct but the face will not rise in aesthetics. Contrary, if an ideal treatment plan is worked out but the surgery is underperformed, the occlusion may be not as good as the facial profile. Therefore, it is of utmost importance that the treatment plan, direction of treatment and conduction of surgery itself shall be performed by one person who understands facial aesthetics, masters surgery technique well and is not afraid of carrying responsibility for the entire treatment.