Treatment of class 2 malocclusion by corrective osteotomy using two short locking compression plates.
Authors: Spoormakers T J P, Wiemer P
Journal: Equine veterinary journal
Summary
# Treatment of Class 2 Malocclusion via Symphyseal Osteotomy with Locking Compression Plates Spoormakers and Wiemer present a surgical technique for correcting class 2 malocclusions (overjets of 6–32 mm and overbites up to 60 mm) in five horses aged 8 months to 5¾ years, using a less invasive symphyseal osteotomy stabilised with two short 3.5 mm locking compression plates rather than the more destructive bilateral rami transection previously described in the literature. The procedure involved creating an osteotomy in the caudal third of the mandibular symphysis, cranial to the interdental space, followed by cranial distraction and ventral rotation of the rostral mandible, with fixation achieved via ventro-lateral plate placement using two or three locking screws per side. Four of the five cases achieved good to excellent final outcomes, with bony bridging occurring between 2 and 6.5 months; two cases required revision surgery—one for persistent cheek tooth mal-occlusion and one for abaxial deviation—whilst three cases developed post-operative fistulae that resolved after plate removal once bridging was confirmed. For practitioners considering surgical correction of severe class 2 malocclusions, this technique offers meaningful advantages in terms of reduced invasiveness, preservation of tooth root anatomy and the mandibular canal, and adequate biomechanical stability with smaller implants, though success depends critically on meticulous incisor alignment during fixation and ensuring cheek tooth occlusion is established before final plate positioning.
Read the full abstract on PubMed
Practical Takeaways
- •This osteotomy technique offers a less invasive surgical option for correcting severe class 2 malocclusions while preserving dentition and neurovascular structures, though it is technically challenging
- •Careful attention to incisor alignment before plate fixation and ensuring good cheek tooth occlusion after fixation are critical; abnormal maxillary incisor arcade complicates alignment
- •Plan for 2-6.5 months healing time and be prepared for potential complications including fistula formation requiring plate removal or need for revision surgery
Key Findings
- •Symphyseal osteotomy with two short locking compression plates achieved good to excellent outcomes in 5 horses with class 2 malocclusions (overjets 6-32 mm, overbites 0-60 mm)
- •Osteotomy gap bridging occurred in 2-6.5 months; two cases required second surgery for non-occlusion of cheek teeth or mandibular deviation
- •Three cases developed persistent fistulas that resolved after plate removal following bridging
- •The technique preserves mandibular canal and tooth root integrity while providing adequate stability with smaller implants than rami transection methods