Orthodontic surgical management of a skeletal class III patient with laterognathia

Resumen

This is a case report of a 17-year-old male patient, with previous orthodontic treatment, who was admitted to the orthodontics clinic for the correction of a skeletal class III malocclusion (Wits -11 mm) due to a combination of maxillary hypoplasia and prognathism that was aggravated by an excessive unilateral laterognathia by excessive unilateral mandibular growth. Dentally the patient presented a class III molar and canine relationship, anterior and bilateral posterior cross bite, and upper and lower crowding, lower midline deviation of 7 mm o the right. Treatment goals were: improve the facial profi le, establish a molar class I, canine class I, to achieve an adequate anterior guidance (overjet, overbite) and dental arch coordination. The treatment was performed in three phases: A) presurgical orthodontic phase: alignment and leveling, dental decompensation, correction of the curve of Spee, and coordination of the upper and lower arches. B) Surgical phase: 2 mm maxillary impaction and advancement of 5 mm; 7 mm mandibular retroposition with Dal Pont technique and a 4 mm advancement genioplasty to improve facial aesthetics. C) Postsurgical phase: detailing and settling of the occlusion, fi nal upper and lower arch correlation. The treatment was fi nished in a period of two years with a successful outcome.