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林展甲
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林展甲
Taiwan
Main Instructor 張文忠
張瑞青
Department / Institution Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
Classification Case report
  • ABSTRACT
  • TITLE
Objective: Surgery first treatment protocols achieve immediate facial improvement for orthognathic patients by eliminating the presurgical orthodontic treatment phase. Because prediction of the desired final occlusion is a difficult task, surgery first candidates have generally been patients with mild facial asymmetry, minimal crowding and compatible dental arches. Due to new methods and technologies such as rigid fixation, skeletal anchorage system (SAS) and computer-aided surgical simulation (CASS). We describe a nonextraction surgery-first approach in correcting asymmetrical skeletal Class III with severe maxillary crowding patient.
 
Case: An adult male asked for treatment with the chief complaints of facial asymmetry, concave profile, short lower third facial height, skewed front teeth, and unaesthetic smile. By clinical examination and cephalometric analysis, he was diagnosed as skeletal Class III with maxillary retrognathism, mandibular prognathism, and hypodivergent facial pattern with severe crowded upper dentition. We provided a nonextraction surgery-first approach. Bilateral upper and lower TADs were placed for postsurgical distalization of dentition to relief anterior crowding.
 
Discussion and Summary: The surgery-first approach has improved rapidly since its introduction. The indication for the surgery-first approach has widened with technical advancement such as SAS, CASS and 3D printing cutting guide. However, the limitations and skeletal implications of this approach should be considered. Team approach between surgeons and orthodontists is a vital component for successful treatment.
Nonextraction Surgery- First Approach in Correcting Asymmetrical Skeletal Class III Patient with Severe Maxillary Crowding