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Case Reports
. 2022 Apr;50(4):3000605221094524.
doi: 10.1177/03000605221094524.

Combining a digital design-mediated surgery-first approach and clear aligners to treat a skeletal Class III defect for aesthetic purposes: a case report

Lei Kong  1   2 , Xinqiang Liu  1   2 , Jie Zhang  1   2
Affiliations
Case Reports

Combining a digital design-mediated surgery-first approach and clear aligners to treat a skeletal Class III defect for aesthetic purposes: a case report

Lei Kong et al. J Int Med Res. 2022 Apr.

Abstract

This case report introduces digital surgery-first approach orthognathic surgery assisted by three-dimensional virtual planning and combined with invisible orthodontic treatment for a 21-year-old female patient with a skeletal Class III high-angle gummy smile malocclusion. We explored the clinical significance of the widespread application of digital technology for rapid development of the orthodontic/orthognathic field. The regional acceleratory phenomenon and clear aligners were used to achieve fast and aesthetic tooth movement after surgery. The treatment lasted only 8 months, and the patient was satisfied with the aesthetic results. The results remained stable after 1 year of follow-up. This case report highlights the advantages of combining a digital design and a surgery-first approach to produce accurate, rapid, safe, stable, and fulfilling cosmetic results. The combination of the surgery-first approach and clear aligners can facilitate patient-oriented surgical orthodontic treatment.

Keywords: Surgery-first approach; case report; clear aligner; digital technology; regional acceleratory phenomenon; smile aesthetics.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Pretreatment facial and intraoral photographs.
Figure 2.
Figure 2.
Pretreatment panoramic radiograph, lateral cephalometric radiograph, and cephalometric analysis.
Figure 3.
Figure 3.
Preoperative digital surgery design. (a) A 0.5-mm right shift was performed to align the midline of the tooth with the midline of the face. (a–c) With the upper central incisor as the center of rotation, the sagittal plane was rotated 2.0° obliquely, the coronal plane was counter-rotated by 0.5°, and the horizontal plane was counter-rotated by 0.5° to adjust the symmetry and (c) The bone was raised 3.0 mm to improve the gummy smile.
Figure 4.
Figure 4.
Digital invisible design. (a) Initial ClinCheck images and (b) Final ClinCheck images.
Figure 5.
Figure 5.
Facial and intraoral photographs after 4 months of treatment.
Figure 6.
Figure 6.
Facial and intraoral photographs after another 8 months of treatment (completion).
Figure 7.
Figure 7.
Post-treatment panoramic and lateral cephalometric radiograph.
Figure 8.
Figure 8.
One-year post-treatment follow-up facial and intraoral photographs.
Figure 9.
Figure 9.
Superimposition of cephalometric tracings. black, pretreatment; red, post-treatment; blue, 1-year follow-up.
See this image and copyright information in PMC

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