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84 林書丞 / Shu-Cheng Lin
84 林書丞 / Shu-Cheng Lin
Main Instructor Szu-Ching Lee
Department / Institution Taipei Veteran General Hospital
National Yang Ming Chiao Tung University
Classification case report

When we treated a skeletal class III malocclusion patient with severe facial asymmetry, we often chose an orthodontic treatment plan combined orthognathic surgery. Nowadays, we could use CBCT and simulation software to gain more information for diagnosis. However, when we analyzed the 3D image, we usually focused on anterior-posterior discrepancy or facial asymmetry and ignored the transverse discrepancy of upper and lower arch. In this case report, we could see the importance of the arch width analysis.

The patient was a 22 years-old male diagnosed with skeletal class III malocclusion. The ANB was -3 degree and overjet was -5 mm. His menton was deviated to right side 13 mm.

Treatment Overview
We gave him an orthodontic combined orthognathic surgery treatment plan with upper bilateral bicuspid extraction. After decompensation, the surgery was performed with one-piece Lefort I osteotomy combined BSSO rotational setback. However, after surgery, the right posterior teeth crossbite was found because upper and lower arch width was not coordinated enough. We tried to correct the crossbite with cross elastic and tooth torque adjustment. Yet due to the limitation of the basal bone width, we could only finish the occlusion with right side posterior crossbite.

From this case, we can learn that a proper and thorough 3-dimentional diagnosis is crucial for treatment planning. In this case, if we could use maxillary skeletal expander before surgery or design a three-piece Lefort I surgery with upper arch expansion, the bimaxillary arch width would be more coordinated. Then we could reach a better occlusion.
Orthodontic Combined OGS Treatment of Skeletal Class III Malocclusion with Facial Asymmetry– A Case Report