Dental and periodontal post-operative complications in patients treated with multisegmented LeFort I (MSLFI) osteotomy in the upper maxilla: a retrospective evaluation

The aim of this retrospective study was to evaluate dental and periodontal complications in patients who underwent Multi-Segment LeFort I osteotomy (MSLFI) as part of ortho-surgical procedure performed to correct dento-skeletal malocclusion. The study specifically focused on issues concerning the maxillary bone, maxillary soft tissues, dental pulp and dental roots. A sample of patients treated between 2008 and 2015 at the University of Verona was considered; all patients underwent MSLFI with interdental osteotomies in the area between upper lateral incisor and canine, bilaterally. The following parameters were assessed on teeth: mobility, probing pocket depth (PPD), gingival recession (GR), pain at palpation, sensitivity and vitality - through percussion test, cold test (CT) and electric pulp test (EPT) - and external root resorption (ERR). All patients underwent pre/post-operative radiographic evaluation with the use of Cone-Beam Computed Tomography (CBCT) and panoramic radiograph. In case of suspect of endodontic or periodontal lesions, or loss of tooth vitality, periapical intraoral radiographs were also performed. 420 teeth in 52 patients were evaluated with a mean follow-up of 42 months. Vascular complications or bone necrosis, unproper union of bone segments and oronasal fistulas were not reported. Despite 49 (11,67 %) teeth did not respond to CT, and 6 of them were also insensitive to the EPT, only 4 teeth (0,95 %) required root canal therapy following surgery. No dental elements showed mobility greater than grade 1; 22 GR (5,34 % of the analyzed sites) of at least 1 mm were observed in 11 patients. As segmented osteotomies are associated with a moderate incidence of dental and periodontal trauma, a proper pre-surgical plan seems to be essential in minimizing complications.