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Case Reports in Medicine
Volume 2014, Article ID 314179, 11 pages
Case Report

Evaluation of a Three-Stage Method for Improving Mandibular Retrognathia with Labially Inclined Incisors Using Genioplasty, Segmental Osteotomy, and Two-Jaw Surgery

1Division of Oral Pathobiological Science, Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, N13 W7 Kita-ku, Sapporo, Hokkaido 060-8586, Japan
2Department of Molecular Cell Pharmacology, Graduate School of Dental Medicine, Hokkaido University, N13 W7 Kita-ku, Sapporo, Hokkaido 060-8586, Japan

Received 31 August 2013; Revised 11 December 2013; Accepted 25 April 2014; Published 15 May 2014

Academic Editor: George K. Sándor

Copyright © 2014 Kazuhiro Matsushita et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We have sometimes encountered difficulty in improving labially inclined teeth, particularly in patients with mandibular retrognathia, because the symphysis menti is often thin and insufficient space is available to permit sagittal rotation of the teeth without root exposure from the alveolar bone. We have previously described a three-stage method to overcome this problem, involving genioplasty for improving the retruded chin, and to construct the infrastructure for subsequent subapical segmental alveolar osteotomy, subapical segmental alveolar osteotomy itself, and, finally, two-jaw surgery. Bone augmentation with thin cortical bone at the gap created on the upper surface of the advanced genial segment was also addressed in the previous report. In the present study, to confirm the benefits of the three-stage method using objective data, cephalometric evaluation was performed in each step. In all cases, pogonion (Pog) was moved forward substantially. Net linear forward movement of Pog and net changes in SN-Pog were from 12 mm to 20 mm and from 4.8° to 7.0°, respectively. Angle of mandibular incisors and interincisal angle also improved to desirable levels. Although this method requires three separate surgeries, the approach safely improves the clinical situation and accentuates treatment efficacy.