**9. Orthognathic surgery**


**•** Levelling and aligning

114 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**Figure 3.** Before treatment records of an orthognathic surgery case with high angle skeletal class III malocclusion, se‐

vere maxillary retrognathia, lingually tipped lower incisors, upper crowding and mandibular prognathism.

**•** Decrowding

**•** Chin augmentation with Medpor ®

## **10. Post-surgical orthodontics**

After the surgery the patient had very mild paraesthesia in the lower lip. One month after the surgery postsurgical orthodontics was started by replacing surgical wires with 0.016 stainless steel wires. Class III elastics were placed and Torque adjustment was done in the upper and lower jaws. After debanding and debonding upper and lower Hawley appliances were placed.

The post-surgical cephalogram of the patient showed significant improvement of the upper and lower jaws. Facial profile was more balanced and had improved significantly. Advance‐ ment of the Maxilla and setback of the mandible were obvious in the cephalogram. Chin augmentation with Medpor® could also be seen in the cephalometric image. The patient had satisfactory positive overjet and overbite. Overall, a pleasing Class 1 occlusion had been achieved in the patient. (Figure 5)

**Figure 4.** Presurgical orthodontics of the same patient. Upper and lower 0.018 standard edgewise fixed appliances

Intraoral examination showed that the patient had molar and canine class I relationship with no discrepancy between the jaws.

The intercuspation was satisfactory and no signs of bruxism or other dysfunction was detected. The lips were competent and the patient was very satisfied with his appearance. No clicking or no signs and symptoms of temporomandibular dysfunction were noted.

**Figure 5.** Same patient after surgery and retention

Intraoral examination showed that the patient had molar and canine class I relationship with

**Figure 4.** Presurgical orthodontics of the same patient. Upper and lower 0.018 standard edgewise fixed appliances

no discrepancy between the jaws.

116 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2
