Skeletal class III correction by advancing and descending the maxilla with a bone graft. Case report

Resumen

Class III malocclusion can involve a lot of factors such as excessive mandibular growth, defi cient maxillary growth, other environmental factors and maxillary trauma. The correction of this malocclusion can be with orthodontic treatment (camouflage) and when there is a more significant bone discrepancy, esthetic or functional problems; it can be solved with a combination of orthodonticsurgical treatment. In this case report, a 17-year-old patient with a dental and maxillofacial deformity (Angle class III malocclusion) due to a deficient vertical and sagittal maxillary growth, with no transverse discrepancy; excessive mandibular growth, brachyfacial with concave profile, a 1 mm incisor display when smiling which had a major impact on the patient’s aesthetic perception of herself. An orthodontic-surgical treatment was planned using Roth 0.018” x 0.025” slot appliances. The surgical treatment was a maxillary inferior repositioning and advancement using an autogenous chin graft. Maxillary segmentation was performed to coordinate both arches. Le Fort I surgery is an effective procedure in the correction of dentofacial discrepancies with maxillary defi ciency. The aesthetic and functional results obtained by using this type of surgery were successful and treatment was continued with postsurgical-orthodontic treatment to get a detailed fi nishing of the case. Conclusion: Maxillary repositioning is used nowadays to achieve long term stability in the correction of class III skeletal discrepancies, when in the past the only solution was to treat with mandibular surgery only, thus producing poor facial aesthetics.

Key words: Sagittal maxillary defi ciency, vertical maxillary defi ciency, Lefort I surgery, maxillary inferior repositioning and advancement, autogenous bone graft, sagittal maxillary segmentary surgery.