Surgical-Orthodontic Diagnosis and Treatment Planning in an Asymmetric Skeletal Class III Patient - A Case Report

The skeletal Class III pattern is characterized by a sagittal intermaxillary mesial discrepancy. This discrepancy may have an unfavorable impact on function and aesthetics, which can be aggravated by the presence of facial asymmetries. This case report describes the diagnosis and treatment planning of a 19-year-old male patient with a skeletal Class III, maxillary hypoplasia, anterior crossbite, and mandibular asymmetry. When the patient reached skeletal maturity at the end of puberty, the definitive diagnosis was skeletal Class III with hyperdivergent profile and mandibular asymmetry, and a surgical-orthodontic treatment was proposed. At the end of the treatment, bimaxillary surgical correction allowed a skeletal Class I with mandibular symmetry, improving the function of the stomatognathic system and facial aesthetics.

[1]  U. Garagiola,et al.  Skeletal stability in orthognathic surgery with the surgery first approach: a systematic review. , 2019, International journal of oral and maxillofacial surgery.

[2]  R. Cibrián,et al.  Orthodontic camouflage versus orthognathic surgery for class III deformity: comparative cephalometric analysis. , 2017, International journal of oral and maxillofacial surgery.

[3]  Massoud Seifi,et al.  Dentoskeletal Stability in Conventional Orthognathic Surgery, Presurgical Orthodontic Treatment and Surgery-First Approach in Class-III Patients , 2018, World journal of plastic surgery.

[4]  M. Sasiadek,et al.  Genetic Factors Involved in Mandibular Prognathism. , 2017, The Journal of craniofacial surgery.

[5]  S. Rizzatto,et al.  Conventional surgical‐orthodontic approach with double‐jaw surgery for a patient with a skeletal Class III malocclusion: Stability of results 10 years posttreatment , 2018, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[6]  A. Iglesias-Linares,et al.  Genetic factors contributing to skeletal class III malocclusion: a systematic review and meta-analysis , 2021, Clinical Oral Investigations.

[7]  Leilei Zheng,et al.  A three-dimensional analysis of skeletal and dental characteristics in skeletal class III patients with facial asymmetry. , 2018, Journal of X-ray science and technology.

[8]  P. Pirttiniemi,et al.  Management of facial asymmetry. , 2007, Oral and maxillofacial surgery clinics of North America.

[9]  H. Schliephake,et al.  Orthodontic incisor decompensation in orthognathic therapy—success and efficiency in three dimensions , 2020, Clinical Oral Investigations.

[10]  M. F. Sfondrini,et al.  Orthodontic Treatment and Healthcare Goals: Evaluation of Multibrackets Treatment Results Using PAR Index (Peer Assessment Rating) , 2020, Healthcare.

[11]  Seiji Haraguchi,et al.  Facial asymmetry in subjects with skeletal Class III deformity. , 2009, The Angle orthodontist.

[12]  Jae Hyun Park,et al.  A conservative approach for an adult patient with a fractured tooth and crowding: Autotransplantation at the fracture site. , 2021, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[13]  R. Abouqal,et al.  Treatment of skeletal Class III malocclusions: orthognathic surgery or orthodontic camouflage? How to decide. , 2011, International orthodontics.

[14]  E. Ko,et al.  Dentoskeletal parameters related to visual perception of facial asymmetry in patients with skeletal class III malocclusion after orthognathic surgery. , 2018, International journal of oral and maxillofacial surgery.

[15]  K. Dhingra,et al.  Developing Class III malocclusions: challenges and solutions , 2018, Clinical, cosmetic and investigational dentistry.

[16]  Luminița Ligia Vaida,et al.  The Behavior of Two Types of Upper Removable Retainers—Our Clinical Experience , 2020, Children.

[17]  H. Hwang,et al.  Surgery‐first approach in correcting skeletal Class III malocclusion with mandibular asymmetry , 2017, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[18]  Jae Hyun Park,et al.  Adult skeletal Class III correction with camouflage orthodontic treatment. , 2019, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[19]  Ki Beom Kim,et al.  Maxillofacial Features Related to Mandibular Asymmetries in Skeletal Class III Patients. , 2017, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[20]  I. Kocadereli,et al.  Long-term stability of surgical-orthodontic treatment for skeletal Class III malocclusion with mild asymmetry. , 2017, Journal of oral science.

[21]  S. Kok,et al.  Characterization of facial asymmetry in skeletal Class III malocclusion and its implications for treatment. , 2019, International journal of oral and maxillofacial surgery.

[22]  K. Vig,et al.  Comparison of incisor inclination in patients with Class III malocclusion treated with orthognathic surgery or orthodontic camouflage. , 2009, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[23]  T. Kobayashi,et al.  Impact of orthognathic surgery on oral health-related quality of life in patients with jaw deformities. , 2016, International journal of oral and maxillofacial surgery.

[24]  Farha Philippe,et al.  Surgical Treatment of a Borderline Skeletal Class III Patient: an Interdisciplinary Approach , 2021, Medical archives.

[25]  Xing Wang,et al.  Three-Dimensional Dynamic Analysis of the Facial Movement Symmetry of Skeletal Class III Patients With Facial Asymmetry. , 2020, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[26]  C. Sforza,et al.  The Effect of Orthognathic Surgery on Soft-Tissue Facial Asymmetry: A Longitudinal Three-Dimensional Analysis. , 2020, The Journal of craniofacial surgery.

[27]  Ki Beom Kim,et al.  Prevalence and Associated Factors of Mandibular Asymmetry in an Adult Population. , 2017, The Journal of craniofacial surgery.

[28]  Hao Tan,et al.  Three-dimensional evaluation of skeletal and dental changes in patients with skeletal class III malocclusion and facial asymmetry after surgical-orthodontic treatment. , 2020, Journal of X-ray science and technology.

[29]  G. Janson,et al.  Comparison of Profile Attractiveness between Class III Orthodontic Camouflage and Predictive Tracing of Orthognathic Surgery , 2020, International journal of dentistry.

[30]  A. Rabie,et al.  Treatment in Borderline Class III Malocclusion: Orthodontic Camouflage (Extraction) Versus Orthognathic Surgery , 2008, The open dentistry journal.

[31]  Seong-Hun Kim,et al.  Lip line changes in Class III facial asymmetry patients after orthodontic camouflage treatment, one-jaw surgery, and two-jaw surgery: A preliminary study. , 2017, The Angle orthodontist.

[32]  Hyeon-Shik Hwang,et al.  Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry. , 2006, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[33]  J. Faber,et al.  Treatment decision in adult patients with class III malocclusion: surgery versus orthodontics , 2018, Progress in Orthodontics.