Surgical and orthodontic treatment of skeletal Class III featuring severe transversal and sagittal discrepancy

Abstract

Aims: Anterior cross-bite is a difficult malocclusion to treat in adult patients, especially if compounded by skeletal discrepancy. The present study describes a dentoskeletal Class III case and aims to provide the clinician with rational guidelines for presurgical orthodontic preparation and postsurgical finishing.

Patient and methods: In this case, a 20-year-old male patient, R.M, was treated for severe dental and skeletal Class III malocclusion on both the transversal and anteroposterior planes via combined orthodontics and surgery. Initially, the treatment involved surgically-assisted expansion of the upper jaw (total 1 month), followed by a fixed-orthodontics phase to decompensate for the malocclusion in preparation for movement of the osseous bases with the aim of achieving maximum coordination of the dental arches. After 19 months of orthodontic preparation, the patient underwent combined orthognathic surgery (upper and lower jaws). In the subsequent 4 months, orthodontic stabilization and finishing were performed, and debonding was carried out 24 months after the start of active treatment.

Results: The combined orthodontic and surgical treatment adequately corrected the severe Class III over a period of 2 years, leading to a satisfactory occlusal, functional and aesthetic result.

Conclusions: Thorough diagnosis and close communication between the orthodontist and maxillofacial surgeon, operating as an interdisciplinary team, ensures good outcomes, even in complex orthodontic and surgical cases.