Introduction
The Schuchardt osteotomy procedure is commonly used to create a compatible space for dental prosthetics such as an implant, crown, or bridge. It is an essential part of facial reconstructive or modern-day jaw surgery. By making such prosthetic space available, the Schuchardt osteotomy procedure will ensure a scope for prosthetic or dental rehabilitation to restore dental form and functions.
Originally introduced in 1953, the sagittal ramus split osteotomy was the main technique introduced by Obwegeser. It started to define the concept of prosthetic rehabilitation or adequately gaining space for bone width and height in the jaw, which is the basis of oral and maxillofacial surgery today.
What Is Schuchardt Osteotomy Technique?
Schuchardt Osteotomy Technique is a surgical procedure done to correct the deformities of the upper jaw or to gain access to deep structures in the oral cavity. It provides access to complex surgeries, such as tumor resections or reconstructive procedures in the maxillofacial region.
Why Is the Schuchardt Osteotomy Technique Being Used?
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This is the primary technique in maxillofacial surgery that has seen several small-scale evolutions over 50 years in modern jaw surgery. After a major surgical modification adopted in this technique, in the year 1967, a well-refined biological procedure and surgical protocols for gaining space in the maxilla and mandible (upper and lower jaw) were then proposed by revered surgeon Hunsuck. However, these procedures still had some modifications or changes to be performed such as the possible damage to the major nerve of the lower jaw which is the inferior alveolar nerve, which still needs to be resolved satisfactorily. This necessitated the need for maxillofacial surgeons to discover a technique or modify this jaw technique to restore jaw functions and efficiency, to support dental prosthetics in a broad spectrum of patients who needed full mouth or full oral rehabilitation/prosthetic rehabilitation.
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Further, there was a need for establishing a technique that caused fewer chances of lingual nerve injury and fewer disturbances to the inferior alveolar nerve.
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The neurosensory disturbances during surgical correction of the jaw were a major impediment to this technique. Hence revered surgeon Schuchardt modified the technique successfully which can lead to the possibility of the jaw gaining sufficient space and bone to establish a proper full-fledged dental prosthesis, or to accommodate dental implants, crown, or bridge prosthesis within the jaw, in patients who did not have any bone support.
What Are the Anatomical Considerations?
During osteotomy, the maxilla is the targeted bone, and special care should to taken to preserve it:
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Inferior orbital nerve and its branches.
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Maxillary sinus integrity.
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Blood vessels.
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During surgical planning, the nasal cavity and palatal tissues are considered.
What Are the Indications of This Procedure?
Schuchardt osteotomy has some minor surgical drawbacks that have been corrected in modern bilateral sagittal split osteotomy (BSSO) according to some maxillofacial surgeons.
Schuchardt primarily proposed the concept of a horizontal flat osteotomy procedure in which there will not be a possibility of damage to the inferior alveolar nerve (IAN) of the lower jaw/mandible.
In this procedure, the cortical osteotomy is performed in an oblique fashion or direction just above the lingula region, without any reach or approach to the buccal cortex. The margin would be placed one cm more caudally without any interference or without basically impinging the inferior alveolar nerve (IAN). The Schuchardt operation could be hence a surgery that can be performed both intraorally and led to patients gaining a sufficient amount or attachment of medullary bone. Even in the surgically difficult cases where the integrity of the sinus membrane cannot be preserved, as in the case of ancillary vertical bone deficiencies or alveolar deficiency, Schuchardt osteotomy can prove to be an excellent procedure that can allow scope for the treatment of such bone deficiencies without interfering with the integrity of the maxillary sinus. Similarly, the other major indication of this procedure is for posterior ancillary osteotomy surgery and sinus preservation. In 1957, the modified versions were proposed for psychopathic jaw correction surgically, of anterior open bite. Hence for quick and efficient surgical resistance without post-operative pain or swelling, Schuchardt osteotomy can prove to be a valuable surgical procedure that can serve its benefits to maxillofacial surgeons for all pre-prosthetic surgical purposes.
What Are the Predictable and Successful Digital Outcomes with Schuchardt Osteotomy?
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Digital technology is one of the reasons that can ensure the safety of this operating technique for the jaw. The osteotomy surgery is planned by virtual simulation, and offers enhanced predictability or outcomes surgically, through key steps in digital planning. Traditionally prosthetic models of the patient's upper and lower jaw used to be obtained to simulate the osteotomy surgery on the models. However, with the revolution in digital dentistry, with the wax-up of the teeth present in the patient's mouth, especially considering the antagonist teeth that are missing in the jaw, virtual surgical planning or fabrication can be performed pre-operatively.
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A digital scan would be obtained of the patient's mouth that is in the oral cavity, with the digital impressions being in the STL file format also capturing the occlusion of the patient's dental bite. With the help of present-day DICOM (digital imaging and communication in medicine) which is a specialized virtual planning software format obtained by the radiographic imaging of Cone beam computerized tomography (radiography of the patient's jaw, a digital wax up will be created of the upper and lower teeth.
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Through the implementation of the Schuchardt osteotomy steps indicated for surgery, the position of the upper jaw will be adjusted with that of the lower jaw to achieve the desired space or prosthetic availability in the jaw.
Conclusion
To conclude, the Schuchardt osteotomy procedure is a highly feasible and important maxillofacial surgical procedure that helps not only to reposition the upper and lower jaw for correct prosthetic guidance and rehabilitation but also eliminates the risk of nerve injuries. Further, because this procedure can be easily implemented surgically by overcoming many drawbacks with traditional diagnostic wax-ups, utilizing the digital impressions and cone beam computerized tomography for acquiring the digital wax-up, preoperatively itself would offer great scope to maxillofacial surgeons to resolve the issues with space and bone volume in dental cases or dental rehabilitation.
