Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy
For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatment to be carried out successfully for patients with a severe dentofacial problem of any type. This case report provides an overview of the current treatment methodology in managing a combination of asymmetrical mandibular prognathism and vertical maxillary excess. 1. Introduction The correction of dentoskeletal malocclusions has always had a threefold goal of achieving functional efficiency, structural balance, and aesthetics [1, 2]. The physical health of patients with severe malocclusion may be altered or compromised in various ways such as inducing masticatory dysfunction, speech disorders, upper airway resistance, compromised oral hygiene, and temporomandibular joint dysfunction. Nevertheless, above all in a modern society, the aesthetic aspect of severe malocclusion with its related psychosocial impact is more important than the associated physical problems [3]. The positive effects of having an attractive face on an individual’s mindset are clear, in terms of self-confidence and self-respect. In cases of severe malocclusion with dentoskeletal discrepancy there are generally only three possible therapeutic options: early modification of growth, orthodontic camouflage through dental compensation, or combined orthodontic and surgical (orthognathic) repositioning of the jaw bases [1]. In recent years, an increasing number of patients elect to undergo orthognathic treatment to correct severe malocclusion that is not susceptible to a comprehensive orthodontic solution. This case report presents the treatment of an adult girl with skeletal discrepancies in all three planes of space: sagittal (Class III malocclusion), vertical (vertical maxillary excess) and transverse (facial asymmetry). 2. Case Report An adult female patient with a chronological age of 19 years and 4 months and an ectomorphic body type reported to the Department of Orthodontics, Pushpagiri College of Dental Sciences, with the chief concern of unattractive facial appearance due to forwardly placed lower jaw and teeth. (Figures 1–4). Her parents pointed out that she was greatly dissatisfied by her
References
[1]
J. P. Reyneke, Essentials of Orthognathic Surgery, Quintessence, Carol Stream, Ill, USA, 2003.
[2]
H. L. Legan, “Orthodontic considerations of orthognathic surgery,” in Principles of Oral and Maxillofacial Surgery, L. J. Peterson, Ed., vol. 3, pp. 1237–1278, Lippincott, Philadelphia, Pa, USA, 1992.
[3]
Z. Liu, C. McGrath, and U. Hagg, “The impact of malocclusion/orthodontic treatment need on the quality of life a systematic review,” Angle Orthodontist, vol. 79, no. 3, pp. 585–591, 2009.
[4]
W. R. Proffit and D. M. Sarver, “Treatment planning: optimizing benefit to the patient,” in Contemporary Treatment of Dentofacial Deformity, W. R. Proffit, R. P. White Jr., and D. M. Sarver, Eds., pp. 172–244, Mosby-Year Book, St Louis, Mo, USA, 2003.
[5]
J. Shepherd, “Hypotensive anaesthesia and blood loss in orthognathic surgery,” Evidence-Based Dentistry, vol. 5, no. 1, article 16, 2004, Comment on British Journal of Oral and Maxillofacial Surgery, vol. 39, no. 2, pp. 138–140, 2001.
[6]
B. N. Epker, “Modifications in the sagittal osteotomy of the mandible,” Journal of Oral Surgery, vol. 35, no. 2, pp. 157–159, 1977.
[7]
M. S. Leonard, P. Ziman, R. Bevis, G. Cavanaugh, M. T. Speidel, and F. Worms, “The sagittal split osteotomy of the mandible,” Oral Surgery Oral Medicine and Oral Pathology, vol. 60, no. 5, pp. 459–466, 1985.
[8]
J. D. Smith, P. M. Thomas, and W. R. Proffit, “A comparison of current prediction imaging programs,” American Journal of Orthodontics and Dentofacial Orthopedics, vol. 125, no. 5, pp. 527–536, 2004.
[9]
G. Jakobsone, A. Stenvik, and L. Espeland, “Soft tissue response after Class III bimaxillary surgery,” The Angle Orthodontist, vol. 83, no. 3, pp. 533–539, 2013.
[10]
W. R. Proffit, C. Phillips, and T. A. Turvey, “Stability after surgical-orthodontic corrective of skeletal Class III malocclusion—3. Combined maxillary and mandibular procedures,” The International Journal of Adult Orthodontics and Orthognathic Surgery, vol. 6, no. 4, pp. 211–225, 1991.
[11]
F. Costa, M. Robiony, S. Sembronio, F. Polini, and M. Politi, “Stability of skeletal Class III malocclusion after combined maxillary and mandibular procedures,” The International Journal of Adult Orthodontics and Orthognathic Surgery, vol. 16, no. 3, pp. 179–192, 2001.
[12]
S.-H. Baek, T.-K. Kim, and M.-J. Kim, “Is there any difference in the condylar position and angulation after asymmetric mandibular setback?” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 101, no. 2, pp. 155–163, 2006.
[13]
M. Kawakami, K. Yamamoto, T. Inoue, A. Kajihara, M. Fujimoto, and T. Kirita, “Disk position and temporomandibular joint structure associated with mandibular setback in mandibular asymmetry patients,” Angle Orthodontist, vol. 79, no. 3, pp. 521–527, 2009.
[14]
B. P. Maloney, M. E. Tardy Jr., D. M. Toriumi, and D. A. Hecht, “Aesthetic surgery of the lip,” in Facial Plastic and Reconstructive Surgery Ed, D. Ira Papel, Ed., pp. 459–468, Thieme Medical Publishers, New York, NY, USA, 3rd edition, 2009.
[15]
F. Luther, D. O. Morris, and K. Karnezi, “Orthodontic treatment following orthognathic surgery: how long does it take and why? A retrospective study,” Journal of Oral and Maxillofacial Surgery, vol. 65, no. 10, pp. 1969–1976, 2007.
