Skeletal balance, functional occlusion, and facial harmony are common goals in orthodontics and orthognathic surgery. However, the boundary line for the decision between orthodontic and surgical treatment remains very controversial in adult borderline patients. Up to 10% of orthodontically treated patients are borderline and may have been treated either way (both with camouflage and orthognathic surgery). It is suggested that orthodontic camouflage of skeletal malocclusions would have acceptable results if there were an average or short facial pattern, mild anteroposterior jaw discrepancy, dental crowding lower than 4–6 mm, normal soft tissue features (nose, lips, chin), and no transverse skeletal problems. Poor results would be expected with the following: a long vertical facial pattern, moderate or severe antero-posterior jaw discrepancy, dental crowding greater than 4–6 mm, exaggerated facial features, and a transverse skeletal discrepancy.
Article Selected | Sample Size | Mean Age (Years) | Surgery |
---|---|---|---|
Article Selected | Cephalometric Values (Pre-Treatment Characteristics of Subjects—Means) | Value Range | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Proffit et al., 1992 | 1 | 22 | Mandibular setback | ||||||||
Proffit et al., 1992 | Camouflage | Surgery | OVJ: 1–4 OVB: 1–4 ANB: 1–5 Mandibular Plane: 27–37 Maxillary Incisor (degrees): 16–28 Mandibular Incisor (degrees): 19–31 Soft tissue A’-B’ difference: −2 to 8 Buccal interdigitation (L): −2 to 2 Buccal interdigitation (R): −2 to 2 Crossbite: absent | ||||||||
Cassidy et al., 1993 | 53 | Not provided (adult patient specified) | Mandibular advacement | ||||||||
OVJ | 6.6 | 9 | Mihalik et al., 2003 | 74 | 26.8 | Not provided | |||||
ANB | 5.1 | 5.8 | Ruf et al., 2004 | 69 | 23.9 | Mandibular advancement with a retromolar sagittal split osteotomy without genioplasty | |||||
Mandibular plane angle | 34 | 32.2 | Kinzinger et al., 20 | 60 | 20.6 | ||||||
Cassidy et al., 1993 | Bilateral sagittal split osteotomy of the mandible without genioplasty | ||||||||||
Camouflage | Surgery | Not provided | Chaiyongsirisern et al., 2009 | 32 | 23 | Mandibular advancement with bilateral sagittal split osteotomy | |||||
Overjet | 7 | 8.3 | Raposo et al., 2018 | Specified in the primary study | Specified in the primary study | ||||||
Overbite | Specified in the primary study | ||||||||||
3.2 | 2.5 | Kerr et al., 1992 | 40 | 16.7 | Not provided | ||||||
Wits A/B | 3.5 | 5.2 | Stellzig-Eisenhauer et al., 2002 | 175 | Not provided (adult patient specified) | Not provided. | |||||
Molar relationship | −0.9 | −2.2 | Rabie et al., 2008 | 25 | 17.8 | Bimaxillary surgery, mandibular surgery only, and maxillary surgery only | |||||
L1-APog (mm) | 0.5 | 0.4 | Kochel et al., 2011 | 69 | 25.25 | Not provided. | |||||
PNS-A (mm) | 50.9 | 51.8 | Benyahia et al., 2011 | 57 | Not provided (adult patient specified) | ||||||
N-Me (mm) | Not provided | ||||||||||
121.2 | 121.8 | Martinez et al., 2017 | 156 | Not provided (age over 20 years specified) | maxillary advancement, mandibular setback, and bimaxillary surgery | ||||||
S-Go (mm) | 77.3 | 76 | Eslami et al., 2018 | 45 | 24.15 | Setback of the mandible, maxillary advancement, or bimaxillary surgery. | |||||
ANB | 5.5° | 6.7° | Troy et al., 2009 | 79 | Not provided (complete growth spurt specified) | Mandibular setback, maxillary advancement, or both | |||||
Y axis | 58.5° | 58.6° | Georgalis et al., 2015 | 67 | Not provided (adult patient specified) | maxillary advancement, and mandibular setback | |||||
GoGn-SN | |||||||||||
33° | |||||||||||
33.9° | |||||||||||
1/1 | |||||||||||
125.5° | |||||||||||
121.9° | |||||||||||
U1-SN | |||||||||||
103.6° | 106.2° | ||||||||||
IMPA | 97.8° | 98° | |||||||||
Mihalik et al., 2003 | Camouflage | Mandibular advancement | Not provided | ||||||||
Overjet (mm) | 5.82 | 7.9 | |||||||||
Overbite (mm) | 4.3 | 9.34 | |||||||||
MxInc-SN | 105.07° | 103.97° | |||||||||
MdInc to MP | 103.48 ° | 100.35° | |||||||||
ANB | 5.59° | 6.57° | |||||||||
Palatal plane | 6.66° | 8.54° | |||||||||
Mandibular plane | 33.96° | 34.20° | |||||||||
TFH | 116.20 mm | 120.51 mm | |||||||||
Ramus ht—Co-Go | 55.31 mm | 59.91 mm | |||||||||
Mand length—Co-Pg | 109.58 mm | 111.83 mm | |||||||||
Ruf et al., 2004 | Herbst | Surgery | Herbst | Surgery | |||||||
ANB | 5.18 | 6.04 | OVJ(mm) | −12.25 | −11.75 | ||||||
Wits (mm) | 2.55 | 4.72 | |||||||||
Overbite (mm) | 4.43 | 4.23 | OVB(mm) | −6.25 | −9.5 | ||||||
Spa-Gn × 100/N-Gn (index) | 54.55 | 54.84 | |||||||||
Spp-Go’ × 100/S-Go’ (index) | 41.4 | 46.89 | ANB(°) | −3 | −5.25 | ||||||
NAPg (°) | 172.08 | 170.87 | |||||||||
NS/Sn/PgS (°) | 159.68 | 158.12 | NAPg(°) | 4.75 | 12 | ||||||
NS/No/PgS (°) | 126.3 | 121.35 | |||||||||
Kinzinger et al., 2009 | Orthopedic | Extraction | Surgery | Not provided | |||||||
OVJ (mm) | 7.59 ± 2.57 | 3.95 ± 2.73 | 7.21 ± 3.06 | ||||||||
OVB (mm) | 2.70 ± 2.29 | 1.21 ± 2.16 | 4.05 ± 3.54 | ||||||||
SNA (°) | 81.32 ± 4.10 | 82.99 ± 3.38 | 82.53± 4.06 | ||||||||
SNB (°) | 74.80 ± 4.31 | 76.90 ± 3.57 | 75.22 ± 4.36 | ||||||||
Ar-Go-Me (°) | 119.30 ± 9.89 | 127.99 ± 6.19 | 121.73 ± 10.51 | ||||||||
UP1/SN | 105.59 ± 9.06 | 104.38 ± 6.69 | 103.39 ± 13.76 | ||||||||
L01/MP | 100.56 ± 7.05 | 92.79 ± 7.42 | 99.10 ± 9.51 | ||||||||
N-A-Pog | 171.34 ± 6.61 | 170.37 ± 6.00 | 170.49 ± 8.26 | ||||||||
N’-Pn-Pog’ | 123.63 ± 5.08 | 129.34 ± 4.86 | 122.76 ± 5.78 | ||||||||
N’-Sn-Pog’ | 153.30 ± 6.25 | 157.24 ± 4.38 | 154.14 ± 8.00 | ||||||||
Chaiyongsirisern et al., 2009 | Herbst | Surgery | Not provided | ||||||||
OVJ (mm) | 8 ± 2.07 | 9.9 ± 2.60 | |||||||||
OVB (mm) | 4.88 ± 0.47 | 4.94 ± 1.44 | |||||||||
ANB (°) | 5.06 ± 2.50 | 5.13 ± 1.54 | |||||||||
Wits (mm) | 2.13 ± 1.96 | 3.64 ± 2.65 | |||||||||
Spa-Gn × 100/N-Gn (index) | 53.29 ± 2.13 | 52.08 ± 2.52 | |||||||||
Spp-Go × 100/S-Go’ (index) | 48.63 ± 4.24 | 47.05 ± 4.26 | |||||||||
NAPg | 172.00 ± 7.25 | 170.81 ± 5.04 | |||||||||
NS/Sn/PgS | 160.75 ± 7.46 | 158.41 ± 5.12 | |||||||||
NS/No/Pgs | 135.13 ± 6.03 | 130.90 ± 4.25 | |||||||||
Raposo et al., 2018 | Not provided | Not provided | |||||||||
Kerr et al., 1992 | Surgery | Orthodontics | ANB Angle M/M ratio L1/Mand° Holdaway angle |
−4° 0.84 83° 3.5° |
|||||||
SNA (°) | 79.5 ± 4.0 | 81.2 ± 2.4 | |||||||||
SNB (°) | 86.4 ± 5.2 | 83.8 ± 3.3 | |||||||||
ANB (°) | 6.9 ± 2.9 | −2.6 ± 2.6 | |||||||||
M/M ratio | 0.78 ± 0.07 | 0.89 ± 0.08 | |||||||||
BaSN | 126.6 ± 6.1 | 126.3 ± 6.9 | |||||||||
Gonial angle | 133.3 ± 8.3 | 132.2 ± 5.5 | |||||||||
MMPA | 25.3 ± 7·8 | 29.0 ± 4.1 | |||||||||
Facial proportions | 55.9 ± 3.6 | 56.2 ± 2.3 | |||||||||
U1/max° | 115.4 ± 7.8 | 112.9 ± 7.3 | |||||||||
L1/mand° | 78.5 ± 9.9 | 85.4 ± 5.2 | |||||||||
Y-axis | 61.9 ± 4.5 | 64.0 ± 3.3 | |||||||||
Holdaway angle | 0.9 ± 4.4 | 6.1 ± 5.0 | |||||||||
Stellzig-Eisenhauer et al., 2002 | Nonsurgical | Surgical | Individual score = −1.805 + 0.209 × Wits + 0.044 × SN + 5.689 × M/M ratio − 0.056 × Golower); if: >−0.023 Camouflage <−0.023 Surgery |
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SN (mm) | 68.77 ± 4.33 | 67.41 ± 5.18 | |||||||||
Golower (°) | 75.46 ± 5.14 | 80.37 ± 6.56 | |||||||||
1-ML (°) | 86.15 ± 6.97 | 78.02 ± 9.19 | |||||||||
Wits (mm) | −4.61 ± 1.70 | −12.21 ± 4.25 | |||||||||
ANB (°) | −0.06 ± 2.09 | −4.22 ± 3.19 | |||||||||
M/M ratio | 0.92 ± 0.08 | 0.80 ± 0.07 | |||||||||
NAPog (°) | −0.90 ± 2.89 | −5.23 ± 3.64 | |||||||||
1/1 (°) | 133.09 ± 9.36 | 139.36 ± 10.83 | |||||||||
Rabie et al., 2008 | Orthodontic | Surgery | Holdaway >12° Holdaway <12° |
Camouflage Surgery | |||||||
ANB (°) | −1.46 ± 2.06 | −2.12 ± 2.51 | |||||||||
Wits (mm) | −8.46 ± 2.73 | −10.86 ± 5.61 | |||||||||
M/M ratio | 0.85 ± 0.07 | 0.83 ± 0.10 | |||||||||
NAPog (°) | −3.71 ± 5.09 | −3.61 ± 7.07 | |||||||||
Go lower (°) | 75.58 ± 4.77 | 78.49 ± 7.01 | |||||||||
Facial prop | 55.43 ± 2.71 | 56.28 ± 2.49 | |||||||||
U1-SN (°) | 111.76 ± 6.02 | 108.74 ± 11.07 | |||||||||
L1-ML (°) | 93.74 ± 7.30 | 86.91 ± 10.97 | |||||||||
U1-L1 (°) | 120.65 ± 7.89 | 128.71 ± 10.95 | |||||||||
Holdaway angle | 14.57 ± 4.07 | 10.14 ± 4.26 | |||||||||
Kochel et al., 2011 | Nonsurgical | Surgical | Individual score = −10.988 + 0.243 × Wits + 0.055 × M/M ratio + 0.068 × NSAr −0.589 × mand MLD; if: >0.251 Camouflage <0.251 Surgery |
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SN (mm) | 66.18 ± 1.21 | 68.70 ± 0.76 | |||||||||
Golower (°) | 75.40 ± 1.02 | 76.25 ± 1.17 | |||||||||
1-ML (°) | 89.90 ± 1.05 | 84.34 ± 1.19 | |||||||||
Wits (mm) | −4.56 ± 0.30 | −9.22 ± 0.49 | |||||||||
ANB (°) | 0.49 ± 0.44 | −3.68 + 0.53 | |||||||||
M/M ratio (%) | 92.71 ± 1.35 | 81.26 ± 1.20 | |||||||||
ANPog (°) | −0.51 ± 0.54 | −5.27 ± 0.62 | |||||||||
1/1 (°) | 132.64 ± 1.55 | 135.42 ± 1.48 | |||||||||
NSAr (°) | 127.06 ± 1.20 | 121.83 ± 0.78 | |||||||||
Mand MLD (mm) | 0.45 ± 0.11 | 1.35 ± 0.16 | |||||||||
Benyahia et al., 2011 | Surgery | Orthodontics | Holdaway angleIf >7.2°, camouflage If <7.2°, surgery |
||||||||
Goinf (°) | 78.01 ± 6.06 | 78.08 ± 4.66 | |||||||||
L1-ML (°) | 83.75 ± 9.91 | 91.00 ± 6.06 | |||||||||
U1-SN (°) | 108.27 ± 10.23 | 108.55 ± 6.70 | |||||||||
Ao-Bo (mm) | −10.44 ± 3.74 | −7.59 ± 1.95 | |||||||||
ANB (°) | −4.41 ± 3.13 | −1.01 + 2.01 | |||||||||
GoMe/SN | 1.143 ± 0.089 | 1.12 ± 0.07 | |||||||||
NaPog (°) | −5.49 ± 3.65 | −0.89 ± 2.48 | |||||||||
U1-L1 (°) | 134.62 ± 13.19 | 124.02 ± 8.98 | |||||||||
NSAr (°) | 122.64 ± 5.31 | 123.74 ± 6.17 | |||||||||
Axe Y | 54.57 ± 4.30 | 58.58 ± 3.24 | |||||||||
Holdaway angle | 3.04 ± 5.43 | 11.32 ± 3.46 | |||||||||
Martinez et al., 2017 | Camouflage | Surgery | Not provided | ||||||||
SNA (°) | 80 ± 4.2 | 80.9 ± 4 | |||||||||
SNB (°) | 82 ± 4 | 84.1 ± 4.2 | |||||||||
ANB (°) | −1.9 ± 2.3 | −3.2 ± 3.1 | |||||||||
Wits (mm) | −7 ± 1.9 | −11.2 ± 3.2 | |||||||||
FA (°) | 66.7 ± 3.9 | 66.4 ± 4.4 | |||||||||
MPA (°) | 33.4 ± 5.9 | 34.8 ± 6.6 | |||||||||
UII (°) | 114 ± 5.5 | 112.7 ± 5.5 | |||||||||
LII (°) | 86.2 ± 6 | 77.5 ± 8.7 | |||||||||
IA (°) | 133.3 ± 7.7 | 140 ± 10.4 | |||||||||
Eslami et al., 2018 | Camouflage | Surgery | Holdaway > 10.3° Camouflage Wits appraisal > −5.8 mm Holdaway < 10.3° Surgery Wits appraisal < −5.8 mm |
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ANB (°) | −1.1 ± 1.2 | −2.1 ± 1.2 | |||||||||
Wits Appraisal (mm) | −4.8 ± 1.8 | − 6.8 ± 1.7 | |||||||||
NAPog (°) | −3.6 ± 3.2 | −6.3 ± 3.9 | |||||||||
Go lower (°) | 77.4 ± 7 | 80.6 ± 4 | |||||||||
Y axis | 68.6 ± 8.6 | 68.1 ± 3.8 | |||||||||
U1-SN (°) | 107.8 ± 6.2 | 106.2 ± 8 | |||||||||
L1-ML (°) | 90 ± 9.2 | 85.9 ± 7.2 | |||||||||
U1-L1 (°) | 132.4 ± 10.3 | 132.8 ± 11.2 | |||||||||
Holdaway angle | 11.9 ± 2.8 | 8.7 ± 3.5 | |||||||||
Troy et al., 2009 | Surgery | Camouflage | Not provided | ||||||||
ANB (°) | −4.47 | −1.43 | |||||||||
Wits (mm) | −10.87 | −6.91 | |||||||||
SN-GoGn (°) | 29.78 | 30.01 | |||||||||
Lower anterior face height % | 55.84 | 55.13 | |||||||||
OVJ (mm) | −3.27 | −0.78 | |||||||||
U1-SN (°) | 108.87 | 104.96 | |||||||||
L1-GoGn (°) | 83.5 | 91.07 | |||||||||
Georgalis et al., 2015 | Surgery | Camouflage | Treatment change (T1-T3) for borderline surgery and camouflage groups | ||||||||
Surgery | Camouflage | ||||||||||
ANB | −3.8 ± 2.4 | −1.2 ± 2.0 | ANB | 4.3 * | 0.8 * | ||||||
Wits | −11.5 ± 3.6 | −7.2 ± 2.8 | Wits | 5.2 * | 2.1 * | ||||||
OVJ | −2.7 ± 2.2 | −0.2 ±1.6 | OVJ | 5.2 * | 3.1 * | ||||||
U1-SN | 109.0 ± 8.0 | 107.2 ± 6.7 | U1-SN | 3.9 | 4.3 | ||||||
L1-Md Plane | 79.8 ± 8.3 | 84.3 ± 6.8 | L1-Md Plane | 6.6 * | −1.7 * | ||||||
Interincisal | 135.0 ± 12.2 | 133.3 ± 9.2 | Interincisal | −13.6 * | −0.6 * |