Occlusal plane alteration and its implications for the facial profile of patients submitted to bimaxillar orthognathic surgery – A literature review and report of two clinical cases





Orthognathic surgery; Occlusal plane; Counterclockwise rotation; Clockwise rotation.


The aim of the present study was to examine and highlight the effects of orthognathic surgery associated with alteration of the occlusal plane through the correlation of two case reports and a literature review. Through the use of electronic databases, a literature search was carried out, surveying the published studies, that was ilustrated through two case reports. Using surgical approaches, was possible to, basically, promote mandibular advancement and counterclockwise rotation of the occlusal plane in class II patients, even as the mandibular recoil movement with occlusal plane clockwise rotation in the case of a class III patient. All surgical management was carried out in order to create a stable and functional occlusal relationship for patients at a level that could not be reached only by conventional technique. In addition, the study is also applied as implications of this orthosurgical conduct in the tissue changes and facial profile of class II and class III patients, both with vertical excess of the maxilla. It was observed this type of orthosurgical treatment increases postoperative occlusal stability and produces satisfactory aesthetic results.


Arnett, G. W. & Gunson, M. J. (2004). Facial planning for orthodontists and oral surgeons. Am. J. Orthod. Dentofacial Orthop., 126(3), 290-5.

Bang, S. M., Kwon, Y. D., Kim, S. J. Lee, B. S., Choi, B. J., Ohe, J. Y. & Suh, J. H. (2012). Postoperative Stability of 2-jaw surgery with clockwise rotation of the occlusal plane. J. Craniofacial Surgery. 23(8), 486-3.

Bell, W. H., Proffitt, W. B. & White, R. P. (1980) Surgical Correction of Dentofacial Deformities. W.B. Saunders Co., Philadelphia, 115-8.

Brandtner, C. et al. (2015). Long-term skeletal and dental stability after orthognathic surgery of the maxillomandibular complex in Class II patients with transverse discrepancies. J. Craniomaxillofac. Surg. 43(8), 1516-5.

Carlotti, A. E. Aschaffenburg, P. H. & Schendel, S. A. (1986). Facial changes associated with surgical advancement of the lip and maxilla. J. Oral Maxillofac. Surg. 44, 593-3.

Casteigt, J., & Dereudre, B. (1984). Surgical approach of a vertical problem: the long face syndrome. Rev. Stomatol. Chir. Maxillofac., 85(3), 214-9.

Chemello, P. D. et al. (1994). Occlusal plane alteration in orthognathic surgery-part II: Long-term stability of results. Am. J. Orthod. Dentofacial Orthop. 106, 434-6.

Cottrell, D. A, & Wolford, L. M. (1994). Altered orthognathic surgical sequencing and a modified approach to model surgery. J. Oral Maxillofac. Surg. 52(10), 1010-10.

Dela Coleta, K. E. D. et al. (2009). Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses. Int. J. Oral Maxillofac. Surg. 38, 126–12.

Ellis III, E., Reynolds, S., & Carlson, D. S. (1988). Stability of the mandible following advancement: a comparison of three postsurgical fixation techniques. Am. J. Orthod. Dentofacial Orthop. 42(1), 38-11.

Epker, B. N., & Fish, L. C. (1986). Dentofacial deformities: integrated orthodontics and surgical correction. Mosby, 400-6.

Gottsauner-Wolf, S., Laimer, J., & Bruckmoser, E. (2018). Posterior airway changes following orthognathic surgery in obstructive sleep apnea. J. Oral Maxillofac. Surg., 76(5), 1093.e1-1093.e21.

Hack, G. A., Oterloo, J. J. M. V., & Nanda, R. (1993). Long-term stability and prediction of soft tissue changes after Le Fort I surgery. Am. J. Orthod. Dentofacial Orthop. 104(6), 544-11.

Holty, J. E. C., & Guilleminaut, C. (2010). Maxillomandibular advancement for the treatment of obstructive sleep apnea: a metanalysis. Sleep Med. Rev. 14, 287-10.

Iizuka T. et al. (2004). Analysis of soft tissue profile changes after mandibular advancement surgery. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 98(1), 17-4.

Kim, Y. I. et al. (2010). The assessment of the short and long-term changes in the condylar position following sagittal split ramus osteotomy (SSRO) with rigid fixation. J. Oral Rehabil. 37, 262-8.

Mansour, S., Burstone, C., & Legan, H. (1983). An evaluation of soft-tissue changes resulting from Le Fort I maxillary surgery. Am. J. Orthod., 84(1), 37-10.

Margoni-Neto, O. (2007). Stability of maxillo-mandibular counterclockwise rotation and mandibular advancement with tmj concepts total joint prosthesis. Oral abstract A. A. O. M. S., 6(38 49).

Mccollum, A. G., Reyneke, J. P., & Wolford, L. M. (1989). An alternative for the correction of the Class II low mandibular plane angle. Oral Surg. Oral Med. Oral Pathol. 67(3), 231-10.

Okazaki, L. K. (1999). Quando indicar uma cirurgia ortognática. In: Araujo, A. Cirurgia ortognática. Santos, p. 7-10.

Olate, S. et al. (2018). Complications in orthognathic surgery. J. Craniofac. Surg. 29(2), 158-3.

Pereira Filho, V. A. et al. (2007). Cephalometric evaluation of posterior airspace in patients with Class II occlusion undergoing orthognathic surgery. Rev. Dent. Press Orthodon. Ortoped. Facial. 12(5), 119-4.

Pinho, T., & Figueiredo, A. (2011). Orthodontic-orthognathic surgical treatment in a patient with Class II subdivision malocclusion: occlusal plane alteration. Am. J. Orthod. Dentofacial Orthop. 140, 703-9.

Pizzol, K. E. D. C., Barbeiro, R. H., & Coleta, R. D (2006). Avaliação da alteração do plano oclusal em cirurgias ortognáticas combinadas com utilização de fixação interna rígida em pacientes com padrão facial de Classe II. Rev. Dent. Press Ortodon. Ortop. Facial, 11, 104-13.

Posnick, J. C., Fantuzzo, J. J., & Orchin, J. D. (2006). Deliberate operative rotation of the maxillomandibular complex to the alteration of the A-point to B-point relationship for enhanced facial esthetics. J. Oral Maxillofac. Surg. 64, 1687-8.

Radney, L., & Jacobs, J. D. (1981). Soft-tissue changes associated with surgical total maxillary intrusion. Am. J. Orthod. 80(1), 191-22.

Reyneke, J. P. et al. (2007). Postoperative skeletal stability following clockwise and counter-clockwise rotation of the maxillomandibular complex compared to conventional orthognathic treatment. Br. J. Oral Maxillofac. Surg. 45, 56–8.

Reyneke, J. P. Rotation of the maxillomandibular complex. (2003). In: REYNEKE, J. P. Essentials of orthognathic surgery. Chicago: Quintessence. cap. 4, 201-44.

Reyneke, J. P., & Evans, W.G. (1990). Surgical manipulation of the occlusal plane. Int. J. Adult Orthodon. Orthognath. Surg. 5(2), 99-11.

Sambataro, S., Lorusso, P., Caprioglio, A., Franchi, L. Cicciu, M., & Fastuca, R. (2020). Changes of occlusal plane in growing patients with increased vertical dimension during class ii correction by using cervical headgear. The Journal of Craniofacial Surgery, 31(1), 172-3.

Santo, L. M. D. (2001). Alterações nos tecidos moles faciais após osteotomias Le Fort I. Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista, Araraquara. Monografia (Especialização) - p. 34

Schendel, S. A. et al. (1976). Superior repositioning of the maxilla: Stability and soft tissue osseous relations. Am. J. Orthod., 70(1), 663-11.

Sonego, C. L., Bobrowski, A. N., Chagas Junior, O. L., & Torriani, M. A. (2014). Aesthetic and functional implications following rotation of the maxillomandibular complex in orthognathic surgery. Int. J. Oral Maxillofac. Surg. 43, 40–5.

Turvey, T. A. et al. (1988). Simultaneous superior repositioning of the maxilla and mandibular advancement. Am. J. Orthod. Dentofacial Orthop. 94(5), 372-9.

Wolford, L. M., Chemello, P. D. & Hilliard, F. W. (1994). Occlusal plane alteration in orthognathic surgery. J. Oral Maxillofac. Surg. 51, 730-10.



How to Cite

FERREIRA, G. R. .; FONSECA, Ítalo R. M. .; LIMA NETO, T. J. de .; SILVA, W. P. P. da .; TRINDADE, P. A. K. .; FAVERANI, L. P. . Occlusal plane alteration and its implications for the facial profile of patients submitted to bimaxillar orthognathic surgery – A literature review and report of two clinical cases. Research, Society and Development, [S. l.], v. 10, n. 4, p. e44810412386, 2021. DOI: 10.33448/rsd-v10i4.12386. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/12386. Acesso em: 8 may. 2021.



Health Sciences