Put the maxilla in the right place
Reviewed by Stuart Clark

This is a paper from Singapore where they attempted to validate the position of the maxilla in the sagittal plane against several reference lines arising from the position of the forehead in orthognathic surgery. The position of the maxilla was electronically adjusted for eight patients using Steiner’s analysis, Glabella Vertical, Andrew’s Element II and the Barcelona reference lines. A total of 128 responses were then gained from dental professionals and laypersons as to which was the most preferred simulation ranked on a 1:4 scale. The most preferred position was achieved using the Barcelona reference (soft tissue nasion to most prominent convex position of the labial surface of the upper incisor). There is no significant difference in results according to sex, age or profession of the respondents. They also found that protrusive profiles with the maxillary incisors anterior to the glabella were judged to be unattractive. The authors acknowledged the limitations of the lack of any compensating adjustments of the mandible or chin and the limited population of local Chinese in Singapore who required bi-maxillary orthognathic surgery. Nonetheless this is a useful paper that supports Barcelona reference in the critical stage of getting the maxilla in the right place first as part of orthognathic surgery treatment planning and prediction tracing.

Placing the maxilla in the most aesthetic sagittal position: validation of several reference lines in relation to the forehead shape.
Chen MWJ, Lum JL, Yong CW, et al.
INT J ORAL MAXILLOFAC SURG
2024;53(5):405–12.