Surgery First Treatment of a Skeletal Class II Patient: A Case Report

Abstract

Introduction: Surgery First is an orthognathic surgery protocol performed before the beginning of orthodontic treatment, achieving in an early stage the previously established facial goals thus reducing treatment time. Objective: To present the clinical case of a class II patient treated surgically with the Surgery First technique. Case presentation: A 16-year-old female with cephalometric diagnosis of combined skeletal class II and neutral growth; dental diagnosis class II molar and cuspid bilateral, slight crowding, overjet of 10 mm and overbite of 5 mm, non-coincident dental midlines. Presence of painful joint symptoms; facially convex profile and obtuse nasolabial angle. The proposed treatment is the use of a deprogramming plane to resolve the joint symptomatology, and then performing Surgery First, subsequent postoperative orthodontics and finally retention. In the surgical phase, a mandibular advancement was made with a bilateral sagittal osteotomy and advancement mentoplasty. The orthodontic stage was carried out in twelve months, the retention used was bimaxillary. Conclusion: The results were favorable for the improvement of the profile and facial harmony, as well as for the occlusion, bilateral molar and canine class I was achieved, coincidence of midlines and a correct overjet and overbite.