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CASE REPORT
Year : 2010  |  Volume : 1  |  Issue : 2  |  Page : 107-110 Table of Contents     

Surgical-orthodontic correction of a Class III dentofacial deformity


Department of Orthodontics, A.M.E's Dental College, Hospital and Research Center, Raichur, Department of Orthodontics, Vydehi Dental College, Hospital and Research Center, Bangalore, India

Date of Web Publication21-Aug-2010

Correspondence Address:
Raghu Devanna
Department of Orthodontics, A.M.E’s Dental College, Hospital and Research Center, Raichur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-237X.68598

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   Abstract 

This case report describes the surgical-orthodontic treatment of a 26-year-old post-pubertal male patient with a Class III dentofacial deformity. In the pre-surgical orthodontic phase of treatment, a reverse overjet of 5.5 mm was created and arch compatibility was obtained. A mandibualr set back with BSSO was performed during surgery to restore ideal overjet, overbite, occlusion and optimal esthetics. After 1 year of treatment, the results remained stable.

Keywords: Interdisciplinary approach, orthognathic surgery, skeletal Class III


How to cite this article:
Devanna R, Kakkirala N. Surgical-orthodontic correction of a Class III dentofacial deformity. Contemp Clin Dent 2010;1:107-10

How to cite this URL:
Devanna R, Kakkirala N. Surgical-orthodontic correction of a Class III dentofacial deformity. Contemp Clin Dent [serial online] 2010 [cited 2020 Jan 19];1:107-10. Available from: http://www.contempclindent.org/text.asp?2010/1/2/107/68598


   Introduction Top


Many things must be considered when a patient presents with a class III malocclusion. Is growth still present? Will a surgical procedure be necessary? If so, will the patient and/or parents be amenable to a surgical treatment plan? As Graber [1] states in his text, "Many diagnostic factors must be analyzed, a differential diagnosis must be made and in light of your clinical experience as well as that of others, the indication and the contraindications of therapeutic modifiability must be weighed."

In today's often complex treatment plans, other physicians and dentists are integrated into the planning and treatment process. The contemporary orthodontist must not only keep up with current technical trends in orthodontic treatment but also successfully communicate, negotiate, and navigate the patient to a successful result. Often the patient's primary reason for seeking treatment is to improve his or her dental and /or facial esthetics. [2] Today's orthodontist has many treatment options to choose from in reaching his or her goals. Virtually all these treatment options are designed to reach the same general orthodontic goal: class I occlusion. However, each treatment choice almost always has an effect on the face and facial esthetic. This is very true in orthodontic treatment and may be even more dramatic in the area of combined orthodontics and orthognathic surgical cases. [3] Adult patients with dentofacial skeletal deformities like a Class III malocclusion require careful treatment planning, an integrated approach, and patient cooperation. [4]

In almost all soft-tissue relationships of the face, the position of the underlying hard tissue is a primary determinant of overlying soft-tissue morphology. This is true for the lips, teeth, chin and bony chin projection, and malar prominence. Growth of the face is an enormously complex function of skeletal, dental and soft-tissue growth, with genetic and environmental factors both playing significant roles in the final facial form. The idea that orthodontics and facial esthetics should be considered concurrently is not new.

Facial esthetics has been of great interest to orthodontists in the year since Angle, Hellman, Case and Farkas Opinions of what constitutes an attractive face have come from many sources and have been more than adequately covered in the orthodontic literature. [5],[6],[7],[8],[9],[10],[11],[12] Contemporary orthodontists are familiar with the principles of designing treatment to improve the profile rather than affecting it adversely.

Although Class II dentofacial deformities are more common, the need for treatment and improvement in terms of facial profile is generally greater in class III patients. The purpose of this article is to illustrate such a case and to show the positive effect that certain treatment decisions have on the profile.


   Case Report Top


A 26-year-old male patient presented with the chief complaint of unaesthetic facial and dental appearance [Figure 1]a-c. He was treated by a general dentist when he was 14 years old. The dentist had extracted in-standing 22. He also reported that there was no family history of class III malocclusion. After thorough clinical examination and cephalometric analysis, surgical-orthodontic treatment was recommended.
Figure 1 : (a-c) Pre-treatment photographs


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   Discussion Top


To allow adequate surgical movement, 14 were extracted and the maxillary incisors were retracted. No extractions were performed in the mandibular arch because there was minimal crowding, no retraction was necessary, and a class II molar relationship at the end of the treatment was considered acceptable. The mandibular incisors were aligned and the archforms were coordinated [Figure 2]a and b.
Figure 2 : (a-b) Prior surgery photographs


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Surgery included a BSSO set back of about 7.5 mm bilaterally which was as determined by the prediction tracing [Figure 3]a and b. No surgery was planned for the maxilla as the patient had a prominent nose. Rigid internal fixation with screws and plates was used to stabilize the osteotomy site, and splint fixation was done during the surgery to maintain the result [Figure 4]a-c. The patient was followed up closely after the procedure and orthodontic treatment was resumed 6 weeks after the surgery.
Figure 3 : (a-b) Surgical treatment objective (STO)


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Figure 4 : (a-c) Splint fi xation and postsurgical photographs


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Six months later, the fixed appliances were removed [Figure 5]a and b, and a retention program was initiated. Ricketts superimposition of pre- and post-treatment cephalometric tracings confirmed the success of treatment [Figure 6]a-d. Intentional root canal treatment and tooth reshaping was done w.r.t. 13. Another 1 year later, the results had remained stable [Figure 7]a-e.
Figure 5 : (a-b) Post-treatment photographs


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Figures 6 : (a-d) Rickett's superimposition


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Figure 7 : (a-f) Post-retention photographs


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Surgical-orthodontic treatment is sometimes the only option for achieving an acceptable occlusion and a good esthetic result in a patient with a class III dentofacial deformity, as illustrated in this case report with [Figure 8] showing the improvement in the profile of the patient. Correction of a Class III dentofacial deformity requires a multi-disciplinary team approach to ensure a satisfactory outcome. This case report emphasizes upon an interdisciplinary approach to improve the quality of life.
Figures 8 : Pre-and Post-surgical comparison


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   References Top

1.Graber TM. Orthodontics, principles and practice. Philadelphia: WB Saunders; 1967.  Back to cited text no. 1      
2.Dann C 4th, Phillips C, Broder HL, Tulloch JF. Self-concept, class II malocclusion, and early treatment. Angle Orthod 1995;65:411-6.  Back to cited text no. 2  [PUBMED]    
3.Sarver DM. Esthetic Orthodontics and orthognathic surgery. St. Louis, Missouri, U. S. A: Mosby; 1998.  Back to cited text no. 3      
4.Vig KD, Ellis Erd. Diagnosis and treatment planning for the surgical-orthodontic patient. Dent Clin N Am 1990;34:361-84.  Back to cited text no. 4      
5.Tweed CH. Indications for the extraction of teeth in orthodontic procedures. J Orthod Oral Surg 1944;30:401-28.  Back to cited text no. 5      
6.Angle EH. Treatment of malocclusion of teeth and fractures of the maxilla. 6th ed. Philadelphia: SS White Dental Mfg; 1900.  Back to cited text no. 6      
7.Peck S. A concept of facial esthetics. Angle Orthod 1970;40:284-317.  Back to cited text no. 7  [PUBMED]    
8.Shaw WC. The influence of childrens' dentofacial appearance on their social attractiveness as judged by peers and lay adults. Am J Orthod 1981;79:299-314.  Back to cited text no. 8      
9.Burstone CJ. The integumental profile. Am J Orthod 1958;44:1-25.  Back to cited text no. 9      
10.Holdaway RA. A soft tissue cephalometric analysis and its use in orthodontic treatment planning. Am J Orthod 1984;84:1-28.  Back to cited text no. 10      
11.Holdaway RA. A soft tissue cephalometric analysis and its use in orthodontic treatment planning. Am J Orthod 1984;85:279-93.   Back to cited text no. 11  [PUBMED]    
12.Merrifield L. The profile line as an aid in critically evaluation facial esthetics. Am J Orthod 1966;52:21-84.  Back to cited text no. 12      


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]


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