Main Instructor 張懿欣
Department / Institution Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Classification Case report
Advantage of surgery first approach includes immediate resolution of the soft tissue and skeletal imbalance. In cases of mild to moderate crowding and minimal transverse discrepancies, surgery first approach can be applied but clinicians still should pay attention to posterior lingual crossbite that exists immediately after the mandibular setback surgery.
A 23 years-old male patient who complained of protruded mandible. Dental examination showed Class III malocclusion with anterior cross bite and posterior lingual crossbite caused by a block-in upper first molar. Cephalometric analysis showed skeletal Class III jaw relation, mandibular prognathism and hyperdivergent facial pattern. Through “Surgery First” treatment, mandibular setback was achieved by bilateral intraoral vertical ramus osteotomy (IVRO), followed by full-mouth fixed edgewise orthodontic treatment. Selective grinding of surgical wafer splint was done to provide stable occlusal contact during post-surgical orthodontic correction of unilateral dental lingual cross bite. Total treatment time was 1 year and 8 months. Well aligned dentition, solid occlusion and balanced facial profile were achieved.
Although “Surgery First” approach for severe skeletal Class III provides immediate improvement in facial profile and eliminates the time-consuming pre-surgical orthodontic treatment, it may lead to more challenge and difficulty in post-surgical orthodontic treatment.
Surgery First Orthodontic Treatment of Mandibular Prognathism with Anterior Crossbite and Unilateral Posterior Lingual Crossbite- A Case Report.