**6. Summary**

Successful treatment of patients who are candidates for orthognathic surgery requires close cooperation between the orthodontist and surgeon. Prior to surgery, the patients undergo orthodontic treatment in order to be prepared for corrective jaw surgery. Presurgical ortho‐ dontics involves dental decompensation, alignment of the dentition within the arches, leveling of the curve of Spee, and coordination of the maxillary and mandibular dentition. These steps vary from case to case based on the type of malocclusion and its severity.

## **7. Case report**

#### **7.1. Case summary**

A 17 year-old boy with marked high angle skeletal class III malocclusion with severe maxillary retrognathia and mandibular prognathism. The patient had crowding in the upper jaw and the lower incisors were tipped lingually due to Class III malocclusion compensation. Class III molar and canine relationship with posterior cross bite with high maxillary-mandibular plane angle and incompetent lips were noticeable. The patient did not complain from any TMJ signs or symptoms.

### **Examination of head and face**

In the frontal plane the face of the patient had an elongated shape. Skeletal Class III pattern with severe maxillary retrusion, mandibular prognathism and concave profile.

#### **Functional examination**

**5. Post-surgical orthodontics**

112 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

intermaxillary elastics.

upper and lower retainers.

cases

**6. Summary**

**7. Case report**

**7.1. Case summary**

**The orthodontist should avoid:**

**5.1. Common mistakes in presurgical orthodontics**

**•** Masking skeletal discrepancies by dental camouflage

**•** Correction of overjet in class II malocclusion cases

**•** Aligning dental midlines in transverse plane discrepancy cases

vary from case to case based on the type of malocclusion and its severity.

**•** Correction of reverse overjet in class III malocclusion cases

Approximately four to six weeks after surgery the patient should return to the orthodontist to begin post-surgical treatment. This short phase of orthodontic treatment postoperatively is necessary to detail the final occlusion and improve the stability of surgery. The goal is to settle the teeth in good occlusion and alignment and correct any possible skeletal relapse following surgery. Post-surgical orthodontics usually takes about six months and may involve use of

It is noteworthy to mention that precise and proper presurgical orthodontics minimalize postsurgical orthodontics. After debanding and debonding the patients should be provided with

**•** Closing the anterior open bite presurgically by extruding the anterior teeth in open bite cases **•** Closing the anterior open bite presurgically by intruding the posterior teeth in open bite

Successful treatment of patients who are candidates for orthognathic surgery requires close cooperation between the orthodontist and surgeon. Prior to surgery, the patients undergo orthodontic treatment in order to be prepared for corrective jaw surgery. Presurgical ortho‐ dontics involves dental decompensation, alignment of the dentition within the arches, leveling of the curve of Spee, and coordination of the maxillary and mandibular dentition. These steps

A 17 year-old boy with marked high angle skeletal class III malocclusion with severe maxillary retrognathia and mandibular prognathism. The patient had crowding in the upper jaw and The patient's path of closure showed no deviation. Maximum jaw opening was normal at 49 mm.

#### **Intraoral examination**

Severe Class III molar and canine relationship with 9 mm of reverse overjet. Anterior and posterior cross bite could be detected. Crowding was also seen in the upper jaw. The lower incisors were retroclined.

**Mandibular arch:** Good arch form; Lingual displacement of lower incisors.

**Maxillary arch:** Good arch form; crowding in the upper anterior segment

**Occlusion (Sagittal):** Severe Class III with reverse overjet of 9 mm; Very severe Class III molar and canine relationship on both sides

**Occlusion (Vertical):** Anterior open bite of 2 mm

**Occlusion (Transversal):** Upper midline coincided with facial midline; lower midline deviated 1 mm to the left

### **Cephalometric assessment**

Cephalometric assessment shows skeletal Class III malocclusion with excessive growth of the mandible and reduced growth of the maxilla. The mandible was elongated. It also shows a degree of dento-alveolar compensation present in the lower anterior region. Upper incisors are positioned labially (Figure 3).

The patient's chief complaints:


### **Treatment Plan:**

Considering the severity of the malocclusion, the underlying skeletal discrepancy, age of the patient, a surgical-orthodontic approach was chosen.

The treatment plan was as follows:

**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.

