Surgery First and Atypical Extraction for a Skeletal Class III with Severe Anterior Open Bite and Severe Crowding— Three-year Stability

Abstract

This case report features a successful combined surgical-orthodontic treatment of a patient with skeletal Class III malocclusion with severe anterior open bite and severe mandibular crowding. Clinical examination revealed concave profile with long-face deformity caused by retrognathic maxilla and excessive vertical growth of mandible, maxillary crowding despite absence of maxillary first premolars, mandibular incisor retroclination, deep curve of Spee, and blocked-out mandibular canines. The treatment involved surgery-first approach with extraction of lower right first premolar and atypical extraction of lower left canine due to its poor periodontal support. Harmonized facial profile, pleasing smile, good occlusal interdigitation as well as skeletal stability were evident 3 years after active orthodontic treatment.