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ortho-surgery section

ORTHO-SURGICAL (ORTHOGNATHIC)

MANAGEMENT OF SEVERE SKELETAL CLASS III

MANAGEMENT: A CASE REPORT

D.K.GUPTA, ABHISHEK KSHETRAPAL AND GAURAV GUPTA

ABSTRACT mandible prognathism [6,7] . Nevertheless, poor facial aesthetics is
Management of skeletal Class III malocclusion requires comprehen- most common chief complaint of Class III patients [8] . Combined
sive approach since several factors such as severity of reverse surgical and orthodontic treatmentis most common therapy for
overjet and facial divergence govern treatment plan. Management of treatment of skeletal Class III patients, because it is effective and
non-growing skeletal Class III individual with moderate-to-severe predictable [8-10] .
skeletal discrepancy is either by surgical management or by In skeletal Class III cases, it is usually difficult to achieve an
orthodontic camouflage. Although various reports emphasize that excellent occlusal outcome only with orthodontic treatment and to
both treatment option are equally successful, degree of correction maintain stable post treatment occlusion [11] . There are three main
which can be achieved differs. This report describes comprehensive treatment options for skeletal Class III malocclusion:
management of a case of severe skeletal Class III malocclusion i) Growth modification
through a combined surgical-orthodontic approach. ii) Dentoalveolar compensation
iii) Orthognathic surgery
INTRODUCTION
Orthognathic comes from Greek terms. Ortho means “straight, in Growth modification should be initiated before pubertal growth
order” [1] and gnathic means “jaw” [2] . Orthognathic surgery is spurt; afterwards, only two options are possible [12] . Thus, treatment
procedure that combines orthodontia and maxillofacial surgery to of skeletal ClassIII malocclusion in an adult requires orthognathic
align maxilla and mandible to correct dental and skeletal position of surgery combined with orthodontic treatment to improve self-
maxilla and mandible, improve temporomandibular joint esteem and achieve normal occlusion and for improvement of facial
function and oropharyngeal airway [3,4] . Speaking and masticatory aesthetics [13] . Traditionally, maxillofacial deformities are being cor-
difficulties, dental crowding with skeletal class II or III rected surgically after an initial orthodontic treatment phase.
malocclusion, open bite, congenital defects, retrognathia, prog- However, here the authors emphasize the postsurgical therapeutic
nathia, difficulty in closing lips effortlessly and sleep protocol followed with post-surgical orthodontic treatment and
apnoea are frequent indications for orthognathic surgery [4] . retention which is extremely important for determining the final
Le Fort I and bilateral sagittal split ramus osteotomy corrected occlusion.
are the most common methods to correct these Dentofacial In this case skeletal class III malocclusion is corrected with com-
deformities. bined treatment approach of surgical and orthodontics, BSSO
Class III malocclusion has been defined as a skeletal facial defor- (bilateral sagittal split osteotomy), was done to correct the occlusion
mity characterized by a forward mandibular position with respect to with regular follow ups. Retainers were provided to prevent relapse
the cranial base and / or maxilla. This may be as a result of true denoting comprehensive management.
mandibular prognathism, maxillary retrognathism or a combina-
tion of the two. [5] Some Class III malocclusions are also the result of CASE REPORT
a functional shift. A 22 year old boy reported with the chief complaint
Class III patients show wide range of variation in dentofacial fea- of forwardly placed lower jaw. No familial history of such
tures, as result of interaction between genetic and environment fac- malocclusion was reported. Intraoral examination reveled a
tors. Long face patients usually have maxillary retrognathism and/or concave profile, excessive mandibular prognathism,
anterior and posterior cross bite, and increased lower facial height,
reduced labiomental fold and acute lip-chin-throat angle. Occlusion
Article Citation was not in alignment but mouth opening was normal with no TMJ
Gupta, G. Gupta, DK. Kshetarpal, A. (2022) Ortho-surgical abnormality observed. Patient had Angle Class III malocclusion
(orthognathic) management of severe skeletal class III man- with complete cross biteand reverse over jet (-8mm), reverse over
agement: A case report. Dental Practice, 18(4), 54-58 bite (-3 mm). Mandibular incisors were lingually inclined.
(Figure 1)

54 Dental Practice // July-August 2022 // Vol 18 No 4