2.1.3.2. Postsurgical phase

Maintaining normal anterior overjet and overbite, plus ideal incisors, canines, and molar relationship during this phase is crucially important. The healing of bony parts during detailing of occlusion and any minor corrections if they ever exist is the key for success at this stage. Full-time wear of heavy elastics for 2 weeks after surgery to assure full dental interdigitation, arch symmetry, and stable treatment outcome. 4 month later, the appliance was removed, and the necessary retainers were constructed, the prosthodontist took good care of the four maxillary incisors upon the patient's request. Follow up for almost 5 years was planned, and the interdisciplinary approach yielded realistic adequate treatment outcome (Figures 5–7).

Figure 5. Pre- and postfrontal (PA) cephalometric analysis and occlusal view depicting the transverse surgical expansion

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Figure 6. Pre and post photos and Lat Ceph analysis of Jarabak depicting the changes in profile.

of the maxilla with relevant min-plates in situ.

Figure 3. Treatment progress: decompensation of the incisor inclination and uprighting buccal teeth, leveling and alignment of teeth, flattening curve of Spee, restoring normal arch form, preparing model surgery, and constructing surgical hooks prior to surgery.

Figure 4. Models of the presurgical arches were constructed and mounted on semi-adjustable articulator, simulation of the surgical act included: superior maxillary repositioning and advancement, splitting the maxilla into two pieces for expansion, displaying final movements of the jaws and cant of the occlusal plane, and monitoring any possible occlusal interference to be resolved.

2.1.3. Treatment progress 2.1.3.1. Presurgical phase

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2.1.3.2. Postsurgical phase

surgical hooks prior to surgery.

interference to be resolved.

Preparing the dentoalveolar arches for orthognathic surgery necessitated leveling and alignment of teeth, decompensating the retroclination of lower incisors, and achieving ideal arch form that allows surgical expansion through median maxillary split. Figures 3 and 4 depict the

Maintaining normal anterior overjet and overbite, plus ideal incisors, canines, and molar relationship during this phase is crucially important. The healing of bony parts during detailing of occlusion and any minor corrections if they ever exist is the key for success at this stage. Full-time wear of heavy elastics for 2 weeks after surgery to assure full dental interdigitation, arch symmetry, and stable treatment outcome. 4 month later, the appliance was removed, and the necessary retainers were constructed, the prosthodontist took good care of the four maxillary incisors upon the patient's request. Follow up for almost 5 years was planned, and the

interdisciplinary approach yielded realistic adequate treatment outcome (Figures 5–7).

Figure 3. Treatment progress: decompensation of the incisor inclination and uprighting buccal teeth, leveling and alignment of teeth, flattening curve of Spee, restoring normal arch form, preparing model surgery, and constructing

Figure 4. Models of the presurgical arches were constructed and mounted on semi-adjustable articulator, simulation of the surgical act included: superior maxillary repositioning and advancement, splitting the maxilla into two pieces for expansion, displaying final movements of the jaws and cant of the occlusal plane, and monitoring any possible occlusal

sequence of orthodontic work and the simulation of surgical movements in 3Ds.

Figure 5. Pre- and postfrontal (PA) cephalometric analysis and occlusal view depicting the transverse surgical expansion of the maxilla with relevant min-plates in situ.

Figure 6. Pre and post photos and Lat Ceph analysis of Jarabak depicting the changes in profile.

Figure 7. Pretreatment occlusion, presurgical orthodontic preparation, postsurgical occlusion, and final prosthetic reconstruction of occlusion.

#### 2.1.4. Treatment results

The following photos and radiographs reveal the impeccable improvement in the harmony and balance of the facial form in 3Ds, successful surgical expansion, and superior repositioning of the maxilla resulted in ideal functional and static occlusion. Postoperative radiographs have shown a well seated condyle in the glenoid fossa in an appropriate physiologic rest position. Patient's satisfaction was rewarding (Figures 8–10).

2.1.5. Conclusions

form stable occlusion.

occlusion, and posttreatment occlusion.

Attempt to treat dentofacial deformities without comprehensive data analysis and collaboration with other health care providers will not yield acceptable results and may need retreatment. Medical ethics obligate us to consider the patients' interest and welfare. This case, from the very beginning, was diagnosed as severe skeletal deformity in 3Ds and disproportionate dentoalveolar arches. The dentofacial imbalance and disharmony imposed the

Figure 10. The final occlusion 5 year postretention focusing on the median maxillary surgical split to restore ideal arch

Figure 9. Pretreatment occlusion, presurgical preparation phase, surgical procedures, postsurgical phase to detail the

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Figure 8. Pretreatment, presurgical preparation phase, postsurgical phase, and postsurgical radiographs.

Figure 9. Pretreatment occlusion, presurgical preparation phase, surgical procedures, postsurgical phase to detail the occlusion, and posttreatment occlusion.

Figure 10. The final occlusion 5 year postretention focusing on the median maxillary surgical split to restore ideal arch form stable occlusion.

#### 2.1.5. Conclusions

2.1.4. Treatment results

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struction of occlusion.

Patient's satisfaction was rewarding (Figures 8–10).

The following photos and radiographs reveal the impeccable improvement in the harmony and balance of the facial form in 3Ds, successful surgical expansion, and superior repositioning of the maxilla resulted in ideal functional and static occlusion. Postoperative radiographs have shown a well seated condyle in the glenoid fossa in an appropriate physiologic rest position.

Figure 8. Pretreatment, presurgical preparation phase, postsurgical phase, and postsurgical radiographs.

Figure 7. Pretreatment occlusion, presurgical orthodontic preparation, postsurgical occlusion, and final prosthetic recon-

Attempt to treat dentofacial deformities without comprehensive data analysis and collaboration with other health care providers will not yield acceptable results and may need retreatment. Medical ethics obligate us to consider the patients' interest and welfare. This case, from the very beginning, was diagnosed as severe skeletal deformity in 3Ds and disproportionate dentoalveolar arches. The dentofacial imbalance and disharmony imposed the orthosurgical treatment approach which was agreed upon by orthodontist and maxillofacial surgeon and readily accepted by the patient.
