Orthodontic-surgical treatment of a female patient with skeletal class III malocclusion due to maxillary deficiency – case report

Skeletal class III malocclusions may be associated with mandibular protrusion, maxillary retrusion or a combination of the two factors. In the treatment of adult patients with skeletal class III, orthognathic surgery must be considered, especially when a deformity has a significant impact on facial esthetics.

Aim
The aim of this paper is to present interdisciplinary treatment that required comprehensive orthodontics with the surgical intervention in a 28-year old female with a skeletal class III malocclusion.

Material and methods
In order to qualify a patient for combined orthodontic-surgical or non-surgical treatment, a thorough orthodontic diagnosis is necessary. In the present case, intraoral scans, extraoral scans, plaster models, and radiographs were taken. Cephalometric scans were used to perform measurements according to the Tweed orthodontic analysis and the Arnett analysis.

Case report
A 28-year old female with a skeletal class III malocclusion referred to a clinic seeking malocclusion correction and profile change. Based on the intraoral, extraoral and radiological photographs analysis two treatment plans were made: with orthodontic-surgical treatment and a non-invasive approach. Because of the patient’s desire to change her profile, an interdisciplinary treatment plan was chosen. The treatment started with a fixed appliance in the upper and lower arches. The preoperative phase was aimed to achieve incisor decompensation in the maxilla and mandible, crowding elimination, leveling and dental arches coordination for the purpose of obtaining maximum intercuspation during surgery. After 11 months of orthodontic preparation, the patient underwent orthognathic surgery, then the post-surgical phase was started. Debonding was performed 16 months after the start of active treatment. The patient’s facial profile was enhanced, stable, class I occlusion was attained bilaterally.

Summary
A correct diagnosis and appropriate planning are determinant factors for having success and long-term stability.