Posterior Maxillary Segmental Osteotomy–A Paradigm Shift From Orthognathic Surgery to Preprosthetic Surgery: A Case Series
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Abstract
Severe supraeruption of maxillary molars following loss of opposing mandibular teeth can critically reduce interarch space and compromise implant-prosthetic rehabilitation. When extrusion is extensive, orthodontic intrusion or prosthetic reduction may be impractical. Posterior maxillary segmental osteotomy (PMSO), classically indicated in orthognathic surgery, can be repurposed as a pre-prosthetic intervention to restore vertical dimension and occlusal harmony. Two patients presenting with missing mandibular posterior teeth and marked supraeruption of opposing maxillary molars exhibited interarch space of <5 mm. After clinical and radiographic evaluation, PMSO was planned to reposition the extruded maxillary posterior segment. Osteotomy lines were executed under local anesthesia, and the segment was repositioned using a prefabricated surgical stent for guidance and stabilization. Simultaneous placement of endosseous implants was performed in the mandibular posterior region. Patients were followed radiographically and clinically to assess bony union, implant osseointegration, pulpal vitality, and segment stability. Both cases demonstrated satisfactory repositioning of the maxillary segment with immediate restoration of interarch space adequate for prosthetic rehabilitation. Follow-up imaging confirmed successful bony union and implant osseointegration. No postoperative complications, including segmental necrosis, relapse, or pulpal injury, were observed. Definitive prosthetic rehabilitation was completed after three months with stable occlusal relationships and improved function. PMSO can serve as a predictable pre-prosthetic surgical option for immediate correction of severe dentoalveolar extrusion when conventional orthodontic or prosthetic methods are not feasible. This approach facilitates restoration of interarch space and enables successful implant-supported rehabilitation with favorable functional outcomes. Keywords: Posterior maxillary osteotomy; Dentoalveolar extrusion; Interarch space.
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15. Geckili, Onur & Şakar, Olcay & Yurdakuloglu, Tugce & Firatli, Sonmez & Bilhan, Hakan & Katiboglu, Ahmet. (2011). Multidisciplinary Management of Limited Interocclusal Space: A Clinical Report. Journal of prosthodontics : official journal of the American College of Prosthodontists. 20. 329-32. 10.1111/j.1532-849X.2011.00703.x.
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18. NaBadalung DP. Prosthodontic rehabilitation using surgical space modification. J Prosthodontics 1997;6:250–6.
19. Daly PF, Pitsillis A, Nicolopoulos C. Occlusal reconstruction of a collapsed bite by orthodontic treatment, pre-prosthetic surgery and implant supported prostheses. A case report. SADJ 2001;56:278-82.
20. Sherwood KH, Burch J, Thompson W. Intrusion of supraerupted molars with titanium miniplate anchorage. Angle Orthod 2003;73:597–691.
21. Itkin AB, Riker K, McKay K, Zweig BE. Posterior segmental osteotomy with simultaneous endosseous implant placement to facilitate fixed reconstruction. J Oral Implantol 1990;16:116-20.
22. Hibi H, Ueda M. Occlusal restorations with surgical interventions-osteotomy, implant surgery and tooth transplantation- A clinical report. J Prosthetic Dentistry 1997;78:236–40.
2. Meningaud JP, Pitak-Arnnop P, Corcos L, Bertrand JC. Posterior maxillary segmental osteotomy for mandibular implants placement: case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e1-e3. doi:10.1016/j.tripleo.2006.03.013
3. Baeg S, On S, Lee J, Song S. Posterior maxillary segmental osteotomy for management of insufficient intermaxillary vertical space and intermolar width discrepancy: a case report. Maxillofac Plast Reconstr Surg. 2016;38(1):28. Published 2016 Jul 25. doi:10.1186/s40902-016-0074-0
4. Ataoglu H, Kucukkolbasi H, Ataoglu T. Posterior segmental osteotomy of maxillary edentulous ridge: an alternative to vertical reduction. Int J Oral Maxillofac Surg. 2002;31(5):558-559. doi:10.1054/ijom.2002.0288
5. Moloney F, Stoelinga PJW. The posterior segmental maxillary osteotomy: recent applications. J oral maxillofacial Surg 1984;42:771–81.
6. Akkas I, Toptas O, Akpinar YZ, Ozan F. Segmental alveolar osteotomy by palatal approach to correct excessive angulated dental implants in anterior and posterior maxilla. J Clin Diagn Res. 2015;9:ZD03–5. doi: 10.7860/JCDR/2015/11832.5778.
7. Proffit W. Equilibrium theory revisited: Factors influencing position of the teeth. Angle Orthod 1978;48:75-186.
8. Hirschfeld L. The dynamic relationship between pathologically migrating teeth and inflammatory tissue in periodontal pockets: A clinical study. J Periodontol 1933; 4:35-47.
9. Proffit W. Contemporary Orthodontics, 2nd ed. St. Louis: The CV Mosby Company; 1993:123.
10. Kiran P, Sahoo N, Dash B, Mohanty B, Jena S. Effectiveness of Treating Vertical Maxillary Excess Among Non-growing Adult Patients With Skeletal Anchorage System: A Systematic Review and Meta-Analysis of Case Reports From 2008 to 2023. Cureus. 2024;16(12):e76625. Published 2024 Dec 30. doi:10.7759/cureus.76625
11. Mahoorkar S, Puranik SN, Moldi A, Chowdhary R, Majge B. Management of supra erupted teeth – a review. Int J Dental Clin 2010;2:27–30.
12. Joshi, Udupikrishna & Patil, Sathish & Siddiqua, Aaisha & Thakur, Nitin. Posterior Maxillary Segmental Osteotomy for Management of Supraerupted Teeth. INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010
13. Chen, Chun-Ming & Tseng, Yu-Chuan & Huang, I-Yueh & Yang, Chia-Fu & Shen, Yee-Shyong & Lee, Huey-Er & Chen, Chung-Ho. (2004). Interdisciplinary Management of Dental Implant Patient: A Case Report. The Kaohsiung journal of medical sciences. 20. 415-8. 10.1016/S1607-551X(09)70179-2.
14. Punde, Prashant A. Gaining vertical interarch space for implant placement: The surgical protocol - Series of five cases. Journal of Dental Implants 3(1):p 42-45, Jan–Jun 2013. DOI: 10.4103/0974-6781.111689
15. Geckili, Onur & Şakar, Olcay & Yurdakuloglu, Tugce & Firatli, Sonmez & Bilhan, Hakan & Katiboglu, Ahmet. (2011). Multidisciplinary Management of Limited Interocclusal Space: A Clinical Report. Journal of prosthodontics : official journal of the American College of Prosthodontists. 20. 329-32. 10.1111/j.1532-849X.2011.00703.x.
16. Kufner J. Experience with a modified procedure for correction of open bite. Transactions of the third international conference of oral surg E&S; Livingstone 1970.
17. M.R. Philip. Posterior maxillary segmental osteotomy for prosthodontic rehabilitation of vertically excess maxilla -a review. Journal of Stomatology, Oral and Maxillofacial Surgery. Volume 120, Issue 5. 2019.
18. NaBadalung DP. Prosthodontic rehabilitation using surgical space modification. J Prosthodontics 1997;6:250–6.
19. Daly PF, Pitsillis A, Nicolopoulos C. Occlusal reconstruction of a collapsed bite by orthodontic treatment, pre-prosthetic surgery and implant supported prostheses. A case report. SADJ 2001;56:278-82.
20. Sherwood KH, Burch J, Thompson W. Intrusion of supraerupted molars with titanium miniplate anchorage. Angle Orthod 2003;73:597–691.
21. Itkin AB, Riker K, McKay K, Zweig BE. Posterior segmental osteotomy with simultaneous endosseous implant placement to facilitate fixed reconstruction. J Oral Implantol 1990;16:116-20.
22. Hibi H, Ueda M. Occlusal restorations with surgical interventions-osteotomy, implant surgery and tooth transplantation- A clinical report. J Prosthetic Dentistry 1997;78:236–40.
| Files | ||
| Issue | Vol 13, No 3 (Summer 2026) | |
| Section | Case Report(s) | |
| Keywords | ||
| Posterior maxillary osteotomy; Dentoalveolar extrusion; Interarch space. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
A C LR, Jhunjhunwala M, Narayanan V, Subramanian A, Seetaram M. Posterior Maxillary Segmental Osteotomy–A Paradigm Shift From Orthognathic Surgery to Preprosthetic Surgery: A Case Series. J Craniomaxillofac Res. 2026;13(3):398-403.
