Latest Evidence on Orthognathic Surgery Techniques and Potential Changes in Oral Microbiota related to Intermaxillary Fixation in Orthodontic Patients: A Systematic Review

Orthognathic surgery is often applied for the correction of facial dysmorphia, and different findings were highlighted regarding the techniques applied. After surgical treatment, intermaxillary fixation is placed, which compromises oral hygiene and, consequently, can lead to increased plaque accumulation and microbiological changes, promoting the proliferation of periodontopathogenic bacteria. Therefore, the aims of the present review are to describe the main evidence from the last 20 years of clinical studies concerning surgical techniques applied to orthognathic surgery and, finally, to analyze potential changes in the oral microbiota.

An electronic search was conducted in the PubMed (MEDLINE) and Scopus databases; the MeSH (Medical Subject Heading) terms are bacteria, dental plaque, evidence-based practice, maxillomandibular fixation, microbiota, operative procedures, and orthognathic surgery.

At the end of the search process, 31 relevant articles were finally included and analyzed in this systematic review, which has a low risk of bias. Clinical studies on humans have been considered in this review. Based on the studies included it would be preferable to use piezoelectric technology in osteotomies because of its many advantages, “surgery-first” technique allows for results comparable to the standard technique in Class III malocclusions while improving quality of life more rapidly, the “mandible-first” technique seems to have more advantages than the “maxilla-first” technique, Computer-Aided Design and Manufacturing (CAD/CAM) could provide more accurate and precise results, and finally, Laser can be applied with different advantages. Regarding intermaxillary fixation, no long-term increase in the concentration of periodontal bacteria was recorded.

Several findings still need to be confirmed with reference to the best suturing technique to reconstitute the nasal wing base, the real effectiveness of “surgery-first,” “maxilla-first,” and “mandible-first” approaches in patients with Class III malocclusion, the use of CAD/CAM and Laser, more studies should be conducted to evaluate quantitative and qualitative changes in other microorganisms following intermaxillary fixation.