Cant Of Occlusal Plane Research Articles

Cephalometric Study of the Dentofacial Complex of Bangladeshis according to Downs Analysis

Introduction: The purpose of this study is to formulate cephalometric norms of the Bangladeshi population using Downs Analysis; and to evaluate whether significant cephalometric differences exist between Bangladeshi and Caucasian people. Methods: The study was conducted for 91 Bangladeshi young adults (48 males and 43 females), aged 19–27 years, with esthetically pleasing and harmonious faces, Angle I molar relationship, with all permanent teeth present and no history of orthodontic treatment orofacial trauma. Lateral cephalograms taken of these subjects were used for a series of morphometric analysis. Results: There was a significant difference between the genders on some values. Bangladeshi Female showed significantly larger facial angle more protrusive chin and angle of convexity which is more protrusive maxillary part than that of Males. While Bangladeshi male showed significantly greater Y-axis angle that means downward forward growth pattern, and steeper Cant of occlusal plane than that of females. Statistically, several significant differences were noticeable in the results of the present study when compared with the norms suggested for a white Caucasian population by Downs. Bangladeshi’s exhibit significantly smaller facial angle more retrusive mandible, significantly greater Y-axis angle more downward forward growth pattern and also significantly more protrusive anterior teeth than that of the Caucasian population. Conclusion: These results have clinical implications in the diagnosis and treatment of adult Bangladeshis with dentofacial deformities. J Bangladesh Coll Phys Surg 2024; 42: 149-154

Orthognathic Considerations of Maxillary and Mandibular Asymmetry at Skeletal Maturity in Patients with Cleft Lip and Palate.

Improving occlusion and aesthetics is the primary objective of orthognathic surgery for patients with cleft lip and palate (CLP). However, these patients often suffer from horizontal, vertical, and rotational asymmetry in addition to maxillary retrusion. This study aims to describe maxillary and mandibular asymmetry in patients with CLP undergoing orthognathic surgery and analyze its anatomic basis. Patients with isolated CLP undergoing CT imaging prior to orthognathic surgery were retrospectively reviewed. Maxillary and mandibular positioning and dimensional symmetry were evaluated. Incidence of clinically significant asymmetry, correlations between areas of asymmetry, and associations with clinical history were analyzed. Fifty-eight patients, with mean age 17 years were analyzed, including 32 patients with unilateral CLP and 26 with bilateral CLP. Twenty (34%) patients demonstrated chin deviation ≥4mm and 21 (36%) had a ≥5% discrepancy in mandibular ramus lengths. Horizontal occlusal plane cant of ≥2° was seen in 20 (34%) maxillae and 28 (48%) mandibles, with dental arch yaw ≥2° noted in 32 (55%) of both maxillae and mandibles. Chin deviation correlated with maxillary cant, discrepancy in ramus length, discrepancy in mandibular body length, and discrepancy in condylar volume (p<0.05). Bilateral and unilateral CLP did not show significantly different asymmetry on any measure (p>0.05). Both maxillary and mandibular asymmetry is common in skeletally mature patients with CLP and frequently results in notable chin deviation. Preoperative three-dimensional imaging and virtual surgical planning of orthognathic surgery aid in recognition of facial asymmetries and reveal opportunities to optimize results in this population.

The Use of Surgical Plates in Correcting the Canted Occlusal Plane

Clinicians in daily orthodontic practice will face referral cases from another orthodontist; the reasons are variable, from because the patient moved to a new location, being unable to finish the case, or patient dissatisfaction. Most of the time, there will be no reason to reject the inquiry and to continue the treatment as much as possible. The case is a skeletal Class III with extracted left and right upper first bicuspids. All the cusps of the posterior teeth were flattened, with the anterior relation being end-to-end. The cant of the occlusal plane higher on the right side is obvious. The patient suffered from temporal mandibular disorder (TMD) and found it difficult to chew without pain. The TMD might have been related to the one-sided clenching habit as well as the deviated occlusal plane. As the patient refused surgical treatment, all efforts focused on how to bring the case to a better condition for the benefit of the patient and to finish the orthodontic treatment. A modified surgical plate (Anka plate) was used to treat the case, and the results were summarized and reported.

Comparison of pleasant and unpleasant smile characteristics in the perception of the laypeople in an Iranian population

This study aimed to compare the characteristics of pleasant and unpleasant smiles from the perception of laypeople. Two-hundred posed smile photographs were obtained from adult participants with no anomaly, restoration, or severe crowding and spacing in anterior teeth. Photographs were shown to 26 judges to give each photograph a score for attractiveness. Upper and lower quartiles for the most and least rated smiles were determined, and variables including gingival display, smile arc, midline deviation, buccal corridor, smile width, tooth rotation or malposition, diastema, upper and lower vermilion show, and tooth form were measured. Independent-sample t test and Pearson chi-square analysis were used to determine the differences between the pleasant and unpleasant groups for quantitative and qualitative variables, respectively. The linear regression model revealed variables with the most significant impact on the mean score. All quantitative and qualitative variables except tooth form significantly differed between pleasant and unpleasant smile groups (P<0.05). The consonant smile arc was associated with an increase of 12.59% in mean scores compared with the inconsonant smile arc. Each tooth reported with malposition was correlated with a decrease of 9.37% in the scores. In the same way, each 1-mm increase in midline diastema and occlusal cant coincided with a drop of 8.73% and 3.59% in scores, respectively. The results of this study suggested that smile arc, tooth malposition, midline diastema, and occlusal plane canting had the most impact on smile esthetics and should be given priority by orthodontists in the treatment plan of choice.

Facial Asymmetry Phenotypes in Adult Patients With Unilateral Cleft Lip and Palate and Skeletal Class III Malocclusion Using Principal Component Analysis and Cluster Analysis

The purpose of this study was to classify and characterize facial asymmetry (FA) phenotypes in adult patients with unilateral cleft lip and palate (UCLP) and skeletal class III malocclusion. The samples comprised 52 adult UCLP patients (36 men and 16 women; mean age, 22.43y) who had undergone orthognathic surgery for correction of class III malocclusion. After measurement of 22 cephalometric parameters in posteroanterior cephalograms taken 1 month before orthognathic surgery, principal component analysis was performed to obtain 5 representative parameters [deviation (mm) of ANS (ANS-dev), maxillary central incisor contact point (Mx1-dev), and menton (Me-dev); cant (degree) of the maxillary anterior occlusal plane (MxAntOP-cant) and mandibular border (MnBorder-cant)]. K-means cluster analysis was conducted using these representative parameters. The differences in cephalometric parameters among the clusters were statistically analyzed. The FA phenotypes were classified into 4 types: No-cant-and-No-deviation type (cluster-4, n=16, 30.8%); MxMn-cant-MxMn-dev to the cleft-side type (cluster-3, n=4, 7.7%); Mx-cant-Mn-shift to the cleft-side type (cluster-2, n=15, 28.8%); and Mn-cant-Mn-dev to the noncleft-side type (cluster-1, n=17, 32.7%). Asymmetry in the maxilla and/or mandible were observed in 70% of patients. One third of patients (cluster-2 and cluster-3; sum, 36.5%) exhibited significant cant of MxAntOP induced by cleft and cant or shift of the mandible to the cleft side. Another one third of patients (cluster-1, 32.7%) demonstrated significant deviation and cant of the mandible to the noncleft-side despite cleft in the maxilla. This FA phenotype classification might be a basic guideline for diagnosis and treatment planning for UCLP patients.

Complex case treatment: Is there a limit for surgery-first approach?

Are there any limits for Surgery-first approach? the article strives to identify the tenets of effective management of complex cases, such as facial asymmetry, with surgery-first approach. The main purpose of the article is in attempting to itemize prerequisites or determining factors, through various degrees of facial asymmetry severity, for the successful management of facial asymmetry cases. The key factors such as (1) assessment of chin deviation, (2) quantification or discernment of transverse occlusal plane canting, (3) spatial orientation evaluation of differential anterior and posterior region transverse occlusal canting, and (4) contemplations of six degrees of freedom (6DoF) (translation movements combined with rotation axis - pitch, roll and yaw) are evaluated. Furthermore, dental alignment, severity of mandibular and maxillary occlusal (anterior and posterior) plane canting, critical cephalometric parameters, such as, incisor mandibular plane angle, and other vital sub- components of facial asymmetry are analysed, in detail. Subsequently, these are coherently synchronized with the maxillomandibular complex (MMC) rotation surgery during planning for the successful execution of facial asymmetry correction. Additionally, the article describes the (1) usage of orthodontic arch wires, (2) selection criteria of specific surgical osteotomies, and (3) coordination of maxillary and mandibular dentition to establish a transitional or treatable malocclusion. In conclusion, a thorough evaluation of the determining factors, as described in the article, for the correction of facial asymmetry with surgery-first, aid in categorising facial asymmetry cases that require minimal pre-surgical orthodontics or without pre-surgical orthodontic treatment, thereby defining the limits of surgery-first.

Effect of orthodontic treatment with premolar extractions on occlusal planes: A retrospective study.

To figure out whether premolar extractions treatment would influence the cant of the occlusal planes and thus affect dentoskeletal patterns in patients with different types of malocclusions. A total of 140 post-orthodontic treatment subjects (96 females, 44 males) were included in this study, and their lateral cephalograms and demographic information were collected and analysed. The patients were divided into extraction and non-extraction groups. The ANB, SNA, SNB, Wits, Facial Height Index (FHI), SN-MP, SN-AOP, SN-POP and AOP-POP angle were measured on the cephalograms. Other possible confounding factors were recorded. Data were analysed by univariate analysis, stratified analysis, multivariate analysis, and coefficient analysis. After treatment, the changes in the AOP-SN, POP-SN and AOP-POP angle were statistically different between the extraction and non-extraction groups. The results were consistent in different skeletal malocclusions and extent of crowding according to stratified analysis. After adjusting all confounding factors, the cant of the posterior occlusal plane was flattened further by 2.14 degrees in the extraction group than the non-extraction group after orthodontic treatment, and the AOP-SN and AOP-POP angle would further increase by 1.72 and 3.81 degrees, respectively. Although no significant differences were found between the two groups, the SNA, ANB, and Wits in the extraction group decreased more with increased counterclockwise rotation of the mandible. Compared to the non-extraction group, there were more increases in the AOP-SN and AOP-POP angle and more posterior flattening in patients with four premolar extractions despite different types of dentoskeletal malocclusion, which were correlated to the change of variables in sagittal and vertical dimensions such as Wits and FHI.

Correction of Extruded Upper First Molars and Bimaxillary Protrusion by Temporary Anchorage Device

Early loss of the lower first molar may cause extrusion of the upper first molar and mesial tipping of the lower second molar. It could be locked by the mesial contour of the upper second molar, causing the door-wedge effect which impedes the intrusion of the upper first molar. Skeletal Class II malocclusion, canting, and the need for anterior retraction on the upper arch was adding space requirement and anchorage problem to the case. Treatment by using absolute anchorage would be the most efficient way to treat this case. This case report aims to show how to manage molar extrusion, bimaxillary protrusion, and occlusal plane canting using temporary anchorage devices (TADs). A 30-year-old Portuguese-Ambonese female complained about her protruded front teeth. The patient had mild skeletal Class II malocclusion, bimaxillary protrusion, occlusal plane canting, skeletal asymmetry, extruded upper first molars, missing lower first molars and upper left second premolar, crowding on the upper arch, and multiple diastemas on the lower arch. The patient had deviation when opening the mouth. The treatment was initiated by very light intrusion forces by using a power chain that crosses the occlusal side from buccal TAD to palatal TAD. Leveling the upper and lower arch was done simultaneously without including the upper first molar. The upper right first premolar was then extracted to balance the missing upper left second premolar and the anterior retraction was done using TAD as anchorage. The active orthodontic period was 23 months. The intrusion of 2.5 mm and 3.5 mm of left and right upper first molar was achieved. The facial profile and occlusal plane canting were corrected. The patient was satisfied with the result.

Maxillary sinus volume in patients with canted occlusal plane: A cone-beam computed tomography study.

To compare the maxillary sinus volume between both sides in adult patients with upper occlusal canting (>2 mm cant) and a control group (≤2 mm cant) using cone-beam computed tomography scans. This retrospective study included a total of 84 scans (42 scans per group) according to predetermined selection criteria. OnDemand 3-D™ software was used for volumetric and linear measurements of the maxillary sinus. Maxillary occlusal canting was determined at the level of the maxillary first molars. It was defined as the vertical difference between right and left sides relative to the Frankfort horizontal plane. Non-parametric tests were applied. The median difference in the maxillary sinus volume between the sides was statistically significant between the control and cant groups (P< 0.001). Also, the median difference in the maxillary sinus craniocaudal height and apex sinus distance between the sides was statistically significant between the control and cant groups (P< 0.05 and P< 0.001, respectively). In adult patients, maxillary occlusal canting of more than 2 mm was associated with asymmetric maxillary sinus volumes. In the cant group, maxillary first molars on the canted-down side were in close proximity to the sinus floor, which suggests a limited leeway for molar intrusion.

A cone beam computed tomography study based on three-dimensional cephalometric analysis of relationships between the lip-line and jaw deformity

ObjectiveThe aim of this study was to use the cone beam computed tomography (CBCT) to study the relationships between the lip-line and mandible deformity. DesignCBCT data of 20 patients with jaw deformity (experimental group) and 20 patients without mandible deformity (control group) were selected. Use three-dimensional cephalometry to measure the reconstructed images of CBCT data simulated by the Materialise Interactive Medical Image Control System (Mimics), mark the related points, lines and planes of the three-dimensional craniomaxillofacial structure, and measure relevant distances and angles. The T-test, Pearson correlation analysis and Linear regression were used to analyze the characteristics of the lip-line and jaw deformity. ResultsThere was a significant difference in the lip-line between mandible deformity group and control group. Significant positive correlations could been found among the lip-line cant, the occlusal plane cant, the mandibular plane cant and the degree of mandible deformity (r=0.964, 0.942, 0.611, P < 0.01). A linear relationship was found between the left lip-line cant Y and the menton deviation X [the mandible deflection to the right was defined as positive, and the left lip-line below frankfort horizontal was viewed as positive] as Y= 0.340 + 0.505X. ConclusionsThe lip-line of patients with jaw deformity was inclined, and the lip-line cant was positively correlated with the degree of mandible deformity, and there was a certain linear relationship between the two, which could provide a theoretical reference for clinicians to diagnose and treat patients with mandible deformity.

Severe Obstructive Sleep Apnea with Skeletal Class II Malocclusion Treated with MARPE and Maxillomandibular Advancement Surgery

A 27-year-old male patient was diagnosed as severe obstructive sleep apnea (OSA), having problems of skeletal Class II jaw related with mandibular retrognathism, orthodivergent facial pattern, dental Class II malocclusion, and occlusal plane canting. By intervention of miniscrew assisted rapid palatal expansion (MARPE) and maxillomandibular advancement (MMA), the clinical result presented significant improvement in functional and esthetic aspects after 18 months of treatment.

Occlusal deviations in adolescents with idiopathic and congenital scoliosis.

ObjectiveThis cross-sectional study aimed to investigate the characteristics of malocclusions in scoliotic patients through clinical examinations.MethodsFifty-eight patients with idiopathic scoliosis (IS) and 48 patients with congenital scoliosis (CS) participated in the study. A randomly selected group of 152 orthopedically healthy children served as the control group. Standardized orthodontic and orthopedic examination protocols were used to record the occlusal patterns and type of scoliosis. Assessments were made by three experienced orthodontists and a spinal surgery team. The differences in the frequency distribution of occlusal patterns were evaluated by the chi-squared test.ResultsIn comparison with patients showing IS, patients with CS showed a higher incidence of Cobb angle ≥ 45° (p = 0.020) and included a higher proportion of patients receiving surgical treatments (p < 0.001). The distribution of the Angle Class II subgroup was significantly higher in the IS (p < 0.001) and CS (p = 0.031) groups than in the control group. In comparison with the healthy controls, the CS and IS groups showed significantly higher (p < 0.05) frequencies of asymmetric molar and asymmetric canine relationships, upper and lower middle line deviations, anterior deep overbite, unilateral posterior crossbite, and canted occlusal plane, with the frequencies being especially higher in CS patients and to a lesser extent in IS patients.ConclusionsPatients with scoliosis showed a high frequency of malocclusions, which were most obvious in patients with CS.

Comparison of the Accuracy of Maxillary Repositioning Between Using Splints and Templates in 2-Jaw Orthognathic Surgery

Printed cutting and repositioning templates could bring superior accuracy when transferring a maxillary plan to the operating room compared to a wafer-based method. However, the effect of these methods in different types of cases is inconclusive. The objective of the study was to compare the accuracy when using printed occlusal splints versus templates in simple and complicated cases. A retrospective cohort study design was used. Complicated cases were defined as cases involving impaction movement of more than 2mm, occlusal plane canting of more than 3°, or midline discrepancies of more than 2.5mm. Other cases were simple cases. Enrolled patients were randomly allocated into the digital occlusal splint (DOS) cohort and the digital templates (DT) cohort. The outcome variable was surgical accuracy, defined as the average deviation between the planned and postsurgical locations of bilateral maxillary central incisors, canines, first premolars, and first molars. Predictor variables were 1) operative complexity, simple versus complicated; and 2) technique for positioning the maxilla, DOS versus DT. Covariates were age and planned surgical movement. Two-way analysis of variance was used. Seventy patients were included in this study. Thirty-three were in the DOS cohort, and 37 in the DT cohort. The average deviation was significantly smaller in the complicated cases in the DT cohort (1.37mm; 95% confidence interval, 1.08-1.66mm) than that in the DOS cohort (2.47mm; 95% confidence interval, 1.92-3.02mm) (P=.002). The deviations in anteroposterior direction of complicated cases in the DT cohort were smaller than the corresponding values of the DOS cohort (P=.035). There is no significant difference between the deviation values of simple and complicated cases using templates (P=.116). These results indicate that in complicated cases, printed guiding templates exhibit better accuracy for repositioning the maxilla than printed occlusal splints, and the effect of templates in different cases proved to be stable.

Management of Occlusal Cant using intrusion arch: A case report

A canted occlusal plane is the cause of unaesthetic smile, and also represents a challenge, due to the complex orthodontic procedures involved in its treatment. LeFort I osteotomy with asymmetric maxillary impaction is often used to correct this problem. However, canting caused by extruded teeth can be corrected easily with normal orthodontic appliances like intrusion arches. The correction occurs through intrusion of the extruded teeth on one side of the maxilla. A 41-year-old female with canted maxillary occlusal plane was treated in this manner showing the possibility of correcting occlusal plane canting with intrusion arch thus avoiding surgical intervention.

Relationship between Maxillary Sinus Hypoplasia and Maxillary Occlusal Cant: A Cone Beam CT Study

Introduction. Maxillary sinus hypoplasia (MSH) has been reported to cause a cant in the orbital plane. No similar reports exist about the possible impact on the maxilla. The aim of this study was to assess if MSH is associated with maxillary occlusal plane (MOP) cant and if dental or mandibular factors influenced the existence of the MOP cant. Methods. 80 cone beam CT images of subjects with MSH were analyzed for the type of MSH, degree of MOP cant, open or cross bite, mandibular asymmetry, and degenerative joint disease of the temporomandibular joints. The subjects were compared with a control group matched by age and gender. Results. The degree of MOP cant (range 0–5.1°) was not statistically significantly different in unilateral vs. bilateral MSH or between the different types of MSH. The frequency of open bite, crossbite, mandibular asymmetry, or degenerative joint disease in unilateral vs. bilateral MSH or between the different types of MSH was not statistically significantly different. Between the case and control, there was no statistically significant difference in the degree of MOP cant ( 1.3 ± 1.1 ° vs. 1.1 ± 0.9 ° , respectively) or frequency of dental and mandibular factors. There was low positive linear correlation between MOP cant and mandibular symmetry in MSH subjects (Spearman’s rho = 0.23 ) and controls (Spearman’s rho = 0.18 7). Conclusions. The data suggests a view of the alveolar bone as the adaptable skeletal unit to ensure and bridge the functionality between the nasomaxillary complex and TMJ system–two systems with very different function, and therefore largely independent “matrix units.”

Influence on smile attractiveness of occlusal plane cant in conjunction with axially dental midline deviation

Today, smile esthetics are the primary concern of patients and orthodontists. Very limited studies have assessed the interactions between beauty variables. This study aimed to investigate the impact of the occlusal plane cant combined with midline axial deviation on smile attractiveness and determine the combined esthetic threshold of these two variables. The study was performed in a population in Zanjan, Iran. Frontal photos of a woman and a man with an ideal smile were downloaded from the Inte

Surgical Orthodontic Treatment for Skeletal Class I with Facial Asymmetry and Occlusal Cant: A Case Report

Background: Cases of facial asymmetry with chin deviation and canted occlusal plane represent a challenge in orthodontic treatment. Case Report: We report successful surgical orthodontic treatment for skeletal Class I with severe facial asymmetry. Miniscrew anchorage was used to decompensate the canted occlusal plane in presurgical orthodontic treatment with a fixed appliance by the intrusion of the maxillary right molars and extrusion of the left molars. Then, orthognathic surgery consisting of bilateral sagittal split osteotomy for asymmetric mandibular setback was performed. Treatment resulted in marked improvement of facial asymmetry. Conclusion: The use of miniscrew implant anchorage may represent a superior presurgical orthodontic treatment and expand the possibility of treatment by one-jaw surgery.

Analysis of the effect magnitude of different parameters on smile attractiveness.

To evaluate the effect magnitude of different parameters on smile attractiveness. A reference and 13 images were produced by manipulating 13 parameters. Image rating was performed with a 4-point Likert scale from least attractive (1) to most attractive (4). Image raters included laypeople, dental students, dentists, and dental specialists. Friedman and Wilcoxon image were used for estimate of effect size. Parameters were classified into small (0.10- < 0.30), medium (0.30- < 0.5), or large (≥0.50). A total of 1040 people participated with good consistency (α=0.861), and moderate reliability (0.64-0.7). The reference image had the highest rank (laypeople:11.79, dental background: 12.55). For effect size; gingival margin level (-0.11, -0.01), teeth width proportion (-0.09, -0.10), inverted smile arch (-0.09, -0.21), commissure line cant (-0.15, -0.17) and low smile (-0.24, -0.23) had small effect size; occlusal plane cant (-0.36, -0.49), midline cant (-0.36, -0.48), and midline shift (-0.37, -0.49) had medium effect size; diastema (-0.55, -0.54) and color (-0.56, -0.56) had large effect size for the laypeople and dental groups. High smile (-0.42, -0.51), incisor edge symmetry (-0.46, -0.54) had medium effect size in laypeople group and large effect size in the dental group. Width to length tooth proportion (-0.26, -0.39) had small effect size in the laypeople group and medium effect size in the dental group. Smile parameters had different effect magnitude on smile attractiveness and were classified into small, medium, or large parameters. Neither laypeople nor professionals have a collective judgment on what constitutes a beautiful smile. This study investigated the effect magnitudes of 13 smile parameters and presented a small, medium, and large smile parameters classification. It should provide the clinician with an insight into the expected effect each parameter has on the smile.

Using orthodontic elastic traction during the active period of distraction osteogenesis to increase the effective vertical extension of hemifacial microsomia patients: A multi-center randomized clinical trial

In this study, the aim was to assess whether using elastic traction during the active period of distraction osteogenesis could effectively increase the vertical extension.Patients with Pruzansky-Kaban Type II mandibular deformity were recruited and randomly assigned into Elastic traction + Distraction Osteogenesis group or Distraction Osteogenesis group, respectively. During the active period, the experimental group received orthodontic elastic traction 3 days after distraction osteogenesis implantation, while the control group received no treatment. All the participants underwent computed tomography (CT) examination before surgery, at the end of the active period, 6 months and 2 years after distraction osteogenesis tractor implantation. The primary outcome was the effective vertical extension rate of the mandible from the baseline to the end of the active period after operations, and there were 7 secondary outcomes used.70 patients were included. The effective vertical extension rates were 85.021% ± 7.432% (mean ± SD) and 68.811% ± 9.510% (mean ± SD) in the experimental and control groups, respectively (P = 0.001). The average distances between the lower middle incisor point to the sagittal plane at the end of the active period were 2.485 ± 1.411 mm and 3.938 ± 2.293 mm in the experimental and control groups, respectively (P = 0.026). At the end of the active period of distraction osteogenesis, the average values of the mandibular occlusal plane canting were −4.887 ± 3.126 mm and −0.177 ± 4.029 mm in the experimental and control groups, respectively (P = 0.026).Elastic traction-assisted distraction osteogenesis could improve traction efficiency and facial symmetry.

Obstructive Sleep Apnea Treated with Maxillomandibular Advancement Surgery by Computer-Assisted Simulation

This 23-year-old female patient was diagnosed as a severe type of obstructive sleep apnea (OSA), skeletal Class II jaw relation with mandibular deficiency, hyper divergent facial pattern, dental Class II malocclusion, midline deviation and occlusal plane canting. By the assistance of virtual surgical simulation and maxillomandibular advancement (MMA) approaching, patient was satisfied the improvement of functional and esthetic changes after the 18-months treatment.