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Panthipa Chayutthanabun
Panthipa Chayutthanabun
Main Instructor Yi-Chin Wang
Department / Institution Department of Craniofacial Orthodontics, Chang Gung Memorial hospital, Taipei, Taiwan
Classification Case report
 This case report describes a modified-surgery first approach to an adult patient who had skeletal Class III malocclusion with facial asymmetry and proclination of upper anterior teeth.
A 27-year-old female complained that her mandible was prognathic, upper teeth were proclined and chin deviation. She had hypodivergent skeletal Class III malocclusion with concave facial profile and chin deviation to right. Intraoral examination presented anterior lingual cross bite from upper right to upper left canine and posterior lingual cross bite. Upper incisor were severely proclined and there was only mild crowding of upper and lower teeth. Lower right first molar showed incomplete endodontic treatment with excessive caries and large apical lesion. A pre-surgical orthodontic treatment was performed for five months. Upper right and left first premolar were extracted to correct proclination of upper anterior teeth. Then two-jaw orthognathic surgery, Le Fort I osteotomy with bilateral sagittal split osteotomies were performed. Lower right first molar and all third molar were extracted in the surgery. The surgery was performed to improve facial profile with maxillary advancement and mandibular setback. Pitch and roll rotation of maxillary-mandibular complex were conducted to correct occlusal plane cant and to upright upper anterior teeth. Genioplasty advancement also was performed to improve chin profile. Post-operative orthodontic treatment included closing upper remaining spaces and detailing in occlusion. Kept the space at lower right first molar for future implant. The total treatment duration was one year and six months. After treatment, the patient’s facial esthetics, symmetry, occlusion, and chewing function were all considerably improved.
Discussion and Summary
In this case, the pre-surgical orthodontic treatment was prepared for only five months to correct upper teeth proclination partly without completely closure of extraction space before surgery. By doing so, can be avoided segmental osteotomy in the maxilla or exaggerated overjet setup for surgery first approach. The patient showed satisfactory treatment result in facial appearance and dental manifestation in the end. However, long-term follow up is still needed to assess the stability.
A Modified- First Approach to Skeletal Class III with Severe Proclination of Upper Anterior Teeth in An Adult Patient