Combined Orthodontic and Surgical Treatment in the Correction of Mandibular Prognathism with Facial Asymmetry: A Case Report

Abstract

This case report presents a 20-year-old Thai female projecting with facial concavity, chin deviation, and anterior crossbite. Upon clinical examination and radiographic analyses, her problems apparently derived from a true skeletal Class III malocclusion combined with the unbalanced growth of ramus and mandibular bodies. Since she had concerned on her facial esthetic and the discrepancies were too severe to succesfully manage with a conventional orthodontic treatment alone, a combination of surgical and orthodontic approach on the protruded and asymmetrical mandible was proposed. Following a pre-surgical orthodontic decompensation without any tooth extraction, bilateral sagittal split osteotomy (BSSO) was performed to set back chin protrusion and solve asymmetry. Both peg-shaped upper lateral incisors were left non-restored for the proper overjet and overbite was beautifully achieved. The patient was debonded after 28 months of treatment. Post-treatment achievements in this case include (1) improvement in facial esthetic, (2) cusp-to-fossa occlusion with normal overjet and overbite, (3) good dental level and alignment, and (4) coincided midlines. The outcome of this case enlightens the success of a precise diagnosis and a careful treatment planning in skeletal Class III correction by an orthodontic treatment combined with orthognathic surgery.