Abstract
Severe class III malocclusion can be a great challenge, especially in adult patients. This case report describes an adult patient with severe skeletal class III malocclusion and with an obvious maxillary deficiency and mandibular excess causing both anterior and posterior crossbites in addition to a shift in the upper and lower midlines to the left concerning the facial midline. This was complicated by compensatory mechanisms such as the proclination of upper incisors and retroclination of lower incisors. Decompensation of the upper and lower arches was performed combined with upper arch expansion to relieve crowding in the upper arch and correct the posterior crossbite. This was followed by double jaw surgeries, including Le Fort I osteotomy in the maxilla and bilateral sagittal split osteotomy (BSSO) in the mandible. Orthodontic finishing procedures were then used to correct any other dental discrepancies. Remarkable esthetic and functional results were achieved with high patient satisfaction.
Highlights
Skeletal class III malocclusion is considered to be one of the most difficult cases to treat especially if a severe form is found in adult patients
We describe treatment of an adult patient with a severe skeletal class III malocclusion using a combination of orthodontic treatment and orthognathic surgery, and orthodontic expansion of the upper arch was performed followed by Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) to correct this severe malocclusion
Combined orthodontic and orthognathic surgical treatment may be required in some cases to achieve the required esthetic and functional results [8]
Summary
Skeletal class III malocclusion is considered to be one of the most difficult cases to treat especially if a severe form is found in adult patients. Most of the patients with class III malocclusions show a combination of both skeletal and dento-alveolar components. There are three available treatment options for management of skeletal class III malocclusions. These are modification of growth, orthodontic camouflage treatment, or combination of orthodontic treatment and orthognathic surgery. Camouflage orthodontic therapy can be considered to correct mild skeletal class III patients with acceptable profiles. Management of this problem in adult patients will usually require considering the option of orthognathic surgery, especially if the problem was severe [4, 5]
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