A novel approach for a prosthetically driven treatment planning of a class III skeletal malocclusion: A case report

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IntroductionClass III malocclusion is primarily a skeletal condition characterized by the protrusion of the mandible, or the retrusion of the maxilla, or both. Orthodontic treatment alone, or in combination with orthognathic surgery, usually resolves most cases of class III malocclusion after growth completion. Conversely, oral rehabilitation of partially edentulous patients is challenging and sometimes requires surgical, orthodontic and prosthetic treatments.The aim of this case report is to compare the end results of treatment of a partially edentulous patient with class III skeletal malocclusion prosthetically planned before or after the orthognathic surgery. Case reportA 30 years old twin sisters were referred to prosthodontic clinics for full mouth rehabilitation in National Guard Dental Center. They reported that they were unhappy with their masticatory function and the esthetic appearance of their smile. Medical evaluation revealed that the patients presented satisfactory general health. They underwent orthodontic treatment, the first twin will undergo a comprehensive prosthodontic planning and treatment prior to the orthognathic surgery to correct the anteroposterior discrepancy between the arches by having her diagnostic wax up on the mock surgery casts, while the second twin underwent the surgery without any prosthetic consultation nor planning.Intraoral examination revealed that the first twin had an anteroposterior discrepancy between the dental arches and multiple missing teeth, second twin had almost edge to edge teeth relationship with tendency to class III and multiple missing teeth. ResultsThrough this approach an improvement in the maxillo-mandibular relationship is expected, giving proper occlusal function, canine guidance will be achieved by means of prosthetic treatment, improvement of the smile and periodontal health are also expected to be better in the first twin than the second. ConclusionSkeletal class III malocclusions, are cases prognosis, due to the complexity of situations. Suggesting a multidisciplinary treatment is of great importance for achieving the objectives of therapeutic plan, as the orthodontics alone would not be capable of restoring dentofacial harmony and thus avoiding success and stability in the treatments.