Main Instructor 陳宜宏
Department / Institution Division of Orthodontics, Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
This case report describes a patient who received orthodontic treatment, orthognathic surgery, surgical exposure and traction of right maxillary secondary molar to obtain balanced occlusion and acceptable esthetics.
A 25-year-old male with chief complaint of poor chewing function and long lower jaw visited our hospital for help. Clinical examination revealed concave facial profile, Class III canine and molar relationship, crowding in the upper arch, and impaction of upper right second molar. Overjet and overbite were -11 and 1 mm, respectively. The lateral cephalometric analysis showed skeletal Class III relationship and mandibular prognathism. The panoramic radiograph showed impaction of #17,#18,#28,#38,#48. We extracted all the impacted third molars, exposed #17 surgically, and performed pre-surgical alignment. The two-jaw surgery included LeFort I impaction with advance and bilateral sagittal split osteotomies with genioplasty. Upper and lower arches coordinated well soon after surgery. Through the 12-months treatment, we corrected the severe Class III malocclusion and brought #17 into occlusion via traction.
Discussion and Summary
The prevalence of Class III problem in China and impacted second molars are nearly 2%. Surgical exposure of the impacted second molar seems to be the best choice of treatment, with a success rate of 70%. In this case, we significantly improved the patient’s facial and dental esthetics, masticatory function, and quality of life.
Surgical- Orthodontic Treatment of Skeletal Class III Malocclusion with An Impacted Maxillary Molar