Class III malocclusion of skeletal origin manifests as a result of skeletal imbalances in the sagittal relationship between the maxilla and mandible. These imbalances are either associated with deviations in the size of the jaws or their position. 1 Different components of the craniofacial complex contribute to the development of a skeletal Class III malocclusion, which is mainly characterized by a retrognathic maxilla, prognathic mandible or a combination of both. [2][3][4][5] The aetiology of Class III malocclusion has been attributed to both environmental and genetic

Summary Background and objectives High-angle Class II malocclusion is considered challenging to treat to a stable result and, although studies report treatment outcome in terms of morphology, patient satisfaction has not been addressed. The objectives of the present study were to examine patients’ motives for treatment and satisfaction with the results. Material and methods A structured questionnaire was distributed 3 years post-operatively to 93 consecutively treated patients with an initial diagnosis of mandibular-plane angle (ML/NSL) ≥34.0 degrees and ANB angle ≥4.0 degrees. Three surgical subsamples were defined: one-piece Le Fort I, bilateral sagittal split osteotomy, or a combination of the two (Bimax). Lateral cephalometric radiographs were used to assess morphological characteristics and post-treatment changes. Results Questionnaire participation was 69.8 per cent. The most frequently reported motives for seeking treatment were to improve oral function (85.0 per cent) and dental appearance (71.7 per cent). Thirty per cent were very satisfied, 53.3 per cent were satisfied, and 16.7 per cent were dissatisfied with the overall treatment result. Dissatisfaction was associated with a persisting post-treatment anterior open bite (AOB), horizontal relapse at B point, and with sensory impairment. Conclusions and implications A higher rate of dissatisfaction was found than what has usually been reported for othognathic surgical patients, and this was associated with a persisting AOB. In addition, mandibular relapse and impaired sensory function were related to dissatisfaction and are associated with mandibular surgery. Prospective high-angle Class II patients should be comprehensively informed about the unpredictability of treatment outcomes in terms of occlusion and facial appearance.

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Summary Background and objectives High-angle skeletal Class II malocclusion is one of the most challenging dentofacial deviations to treat and, in adults, a combination of orthodontic treatment and bimaxillary orthognathic surgery is often indicated. This study examines the rate of clinically significant relapse and whether a genioplasty affects the treatment outcome of high-angle Class II malocclusions. Material and methods Cephalometric tracings of 36 consecutively treated high-angle Class II patients were evaluated from pre-surgery to 3 years post-surgery. All patients had undergone bimaxillary surgery (Le Fort I and BSSO), 13 of them had in addition a genioplasty. Results The maxilla remained stable, whereas relapse (greater than or equal to 2 mm) of the mandibular advancement was seen in 40 per cent of the patients. Advancement greater than 10 mm increased the risk for horizontal relapse. The overjet was normalized and remained stable despite mandibular relapse. Half of the patients had an anterior open bite 3 years post-surgery. A supplemental genioplasty did not affect the relapse rate. Conclusions and implications Overjet was normalized and remained stable long term; there was an open bite in half of the patients. Combined orthodontic and bimaxillary surgical treatment of high-angle Class II patients showed skeletal relapse (greater than or equal to 2 mm) of the mandible in 40 per cent of patients. Mandibular advancement greater than 10 mm increased the risk for relapse. There was no increased risk for dental or skeletal instability associated with a genioplasty in combination with maxillary and mandibular surgery in the treatment of high-angle skeletal Class II malocclusion.

Standardized video recordings improved the reliability of the recordings of the oral soft tissue dysfunctions. Their overall reduction after the end of orthodontic treatment coincided with a normalization of the sagittal skeletal and dental variables.