Combined Orthodontic and Surgical Management for Treatment of Severe Class III Malocclusion with Anterior and Posterior Crossbites

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.

Orthodontic Management of Anterior and Unilateral Posterior Crossbite: A Case Report

“…However, the case treated by them was different as their case was in the mixed dentition but this case was in the permanent dentition stage. Alogaibi et al, 7 performed surgery on both jaws, involving bilateral sagittal split osteotomies in the mandible and Le Fort I osteotomies in the maxilla, to treat skeletal class III malocclusion with both anterior and posterior crossbites. Their case was different from the presented case in terms of severity which was beyond the scope of orthodontic treatment alone.…”

“…The conservative orthodontic solution for the patient presented in this case report can potentially shorten the duration of treatment and lessen the risk of patient burnout. 7 Tanaka et al, 12 treated complete maxillary crossbite using Haas expansion. It was, nevertheless, distinct from the presented case because it was more severe and in the period of mixed dentition.…”

“…However, its drawbacks include root resorption and condyle damage. 7 Anterior crossbite can be managed utilizing removable appliances with z-spring, functional appliances, cemented appliances, fixed appliances, and a combination of these techniques. 5 Fixed appliances are bonded to the teeth, while removable appliances can be taken out of the mouth by patients.…”