The Treatment Of Adult Skeletal Class â…¢ Malocclusion With Presurgical Orthodontics

Objective: To discuss the clinical effects of pre-surgical orthodontic treatment ofskeletal Class III malocclusion in adults.Method: This case report describes the surgical-orthodontic treatment of a19yearsold male patient presented to the stomatology department in July2012with a skeletal classIII malocclusion, Anterior openbite, posterior crossbite, upper midline shift of3mm to theright and concave facial profile. The patient treatment plan involvedorthodontic-orthognathic surgery treatment. Maxillary first premolars were extracted.Pre-surgical orthodontic treatment involved aligning the right canine of the upper jaw intoocclusion, uprighting and retracting anterior segment. Adjust midline by forward movementof upper left second pre-molar to the mesial with elastomeric power chain. Upper posteriorsegment added progressive buccal crown torque. Put square wire into the mandibular archto upright lower incisors so that the lower anterior tipping labially. Post-surgical orthodontictreatment involved the maintenance of occlusion of maxillary and mandibular with Class Ⅲelastics；adjustment of midline with inter diagonal elastics, improvement of occlusion andintermaxillary relationship with triangular elastics.Results: The active treatment period was22months.(1)The facial profile improvedand good occlusion achieved, and confirmed by SNA angle altered from75°to81°, SNBangle altered from87°to80°, A-NaPerp. increased from-10mm to-7.5mm, Po-NaPerp.altered from8.5mm to-8mm, Co-Gn altered from143mm to130mm, Co-A increased from81mm to90mm,ANB angle increased from-12°to1°,Wits appraisal increased from-32mm to-6mm, ANS-Me decreased by8mm, and FMA decreased by2°that meant jaws changedfrom Class Ⅲ to Class I in the sagital relationship, and counterclockwise mandibularrotation occurred.(2)U1-SN decreased from117.5°to110°,U1-NA decreased by10mm,U1-NA decreased from40°to31°, however, IMPA altered from72°to81°, this indicatedthat the increased jaw size was decompensated lead to the lingual compensation of thelower incisors.(3)With soft tissue pogonion changing backward and E-line retruding in aclockwise direction, soft tissue profile transfered towards a more aesthetic face aftertreatment. ULP increased slightly, UL-EP changed from-9mm to-2mm, facial convexityangle changed from2°to10°. The patient was satisfied with the treatment.Conclusion: Orthognathic surgery combined with orthodontic treatment is treatmentof choice in cases with dento-facial deformity, because it can greatly improve the patient’sfacial profile, regain oral function normally and ensure the long-term stability of the results.Presurgical and postsurgical orthodontics treatment is the key to the success of thesurgical-orthodontic treatment cases.