COMBINED ORTHODONTIC AND SURGICAL TREATMENT IN PATIENT WITH CLASS III AND FACIAL ASYMMETRY

Abstract

Severe skeletal Class III and facial asymmetry requires combined orthodontic and surgical procedure In order to correct of sagittal and transversal deviations between upper and lower jaw. Aim: The aim of this case was to present effects of combined orthodontic and surgical treatment on craniofacial morphology and whole facial aesthetics. Material and method: In this case a 17-year-old female patient years was treated. Patient had severe skeletal Class III caused by mandibular prognathism, latherognathism, open bite and crossbite. At the beginning of the treatment overbite was - 3.5mm and overjet - 6mm. Parameters on lateral cephalogram at the beginning of the orthodontic procedure were: SNA 83°, SNB 88°, ANB -5°, SN/SpP 9°, SN/MP 38°, SpP/MP 29°, sum of angles of Björk’s polygon 396°, Jarabak ratio 63.26%, I/SpP 47°, i/MP 98°. Orthodontic preparation for surgical treatment lasted 21 months with upper and lower fixed appliance. Surgical procedure was done on both jaws and lower wisdom teeth were extracted. Orthodontic treatment was finished 6 months after surgical intervention. Results and conclusion: Parameters on control lateral cephalogram at the end of treatment were: SNA 83°, SNB 85°, ANB -2°, SN/SpP 10°, SN/MP 32°, SpP/MP 22°, sum of angles of Björk’s polygon 394°, Jarabak ratio 64,20%, I/SpP 47°, i/MP 94°. Patient had stable occlusion in Class I with overjet 1.5mm and overbite 3mm. Both segment of treatment improved significantly facial aesthetics in profile and en face and provided correct occlusion in all three directions.