**Author details**

of 3D surgical planning in orthognathic surgery cases is on the market more than 10 years. Meanwhile we also published a paper with 3D tomographic DICOM data transferred to software and completed the operation virtually in 2009 (**Figure 11**) [18]. Depending on surgeons and orthodontist's choice, currently there are many alternatives to each other starting from conventional cast model articulating and model set up on casts, to 3D analyze and 3D printing of surgical splints and titanium fixation plates. On the other hand, higher technology for planning and manufacturing with 3D printers increases the financial expenses. After rigid fixation of the maxilla, the alar wings, nasal tip, and nostril symmetry and projection of the upper lips and the gums should all be evaluated. If the maxilla has been impacted, the nostrils and the nasal soft base will be wider, and alar chinch suture is essential to control the

**Figure 11.** 3D evaluation and planning of a hemimandibular hyperplasia case using DICOM data with a surgical

The sequence of these surgeries may vary from surgeon to surgeon. My traditional way to do double jaw is to start with the maxilla first then complete the mandible. But in one indication, one should always start with mandible first which is the double-jaw counterclockwise surgery. Especially Class II with maxillary excess with gummy smile cases associated with OSAS or airway limitations, there is indication for counterclockwise double surgery. The surgical strategy should be mandibular advancement surgery with posterior inferior repositioning and anterior superior rotation. The space created at posterior occlusion is then filled with inferior rotation of the posterior maxilla with anterior maxillary impaction with Le Fort I osteotomy. The pivot point to perform this maneuver is premolar and zygomatic buttress region.

width. Also, a V–Y closure will help to improve the philtrum projection.

software, published in Journal of Cranio-Maxillofacial Surgery in 2009.

**4. Bimaxillary surgery**

122 Current Approaches in Orthodontics

Mustafa Sancar Atac

Address all correspondence to: msatac@gmail.com

Faculty of Dentistry, Gazi University, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
