Optimizing Maxillomandibular Position in Orthognathic Surgery: Introducing the T Concept in Treatment Planning

Abstract Purpose: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This study introduces the T concept, incorporating the maxillary central incisor, chin, and occlusal plane as a novel predictor for properly positioning the maxillomandibular complex (MMC). Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: phase one involves correcting frontal deformity and various asymmetries, phase two involves correcting chin anterior-posterior deformity, phase three involves correcting anterior-posterior and vertical MMC position, and phase four involves correcting MMC rotation. Results: The T concept provided a structured approach to MMC positioning, considering the vertical alignment of the maxillary central incisor, occlusal plane angulation, and chin positioning. The resulting postoperative outcomes showed an improved facial profile without the need for unnecessary genioplasty. Conclusion: A reliable MMC positioning in orthognathic surgery is offered by the T concept, addressing both functional and aesthetic concerns. By incorporating the chin as a key landmark, surgeons can achieve better alignment and avoid compensatory procedures. This method serves as a checkpoint where the MMC position is verified.