Objective: To present the process of treatment in a patient with severe skeletal malocclusion, where after pre-orthodontic treatment surgical procedure in maxilla and mandible was necessary.
Subject and Method: A 33-year-old female patient with a skeletal Class III malocclusion ( Maxillary retrognathism and Mandibular laterogeny) and open bite. Long face, concave profile, prominent chin and abnormal tongue posturing were also diagnosed. The data were gained by clinical examination, study cast analysis, lateral cephalometric analysis and extra- and intraoral photographs. The orthodontic treatment plan before surgical intervention was to align and level dental arches and to establish good anteroposterior and vertical position of the incisors, using SWA fixed appliances. LeFort I downfracture procedure was used to reposition the maxilla and a bilateral sagittal split osteotomy to set back and rotate the mandible. By post-surgical orthodontic treatment final detailing of the occlusion was accomplished.
Results: After a total treatment time of 24 months, skeletal and dental Class I occlusion with stable overjet and overbite was achieved. The final result was satisfactory aesthetically and functional. Our patient is content and her expectations were realized.
Conclusions: Skeletal Class III cases can be treated by modifing growth pattern at early stages of age or using orthodontic camouflage therapy after the growth is finished. In severe cases combined orthodontic-surgical therapy is required to guarantee good occlusion and soft tissue paradigm. To achieve good end- results interdiscipline treatment planning from the beginning is important.