A 21-year-old male reported to the orthodontic clinic with chief complaint of protrusive lower front teeth and large lower jaw. On examination, CBCT scan and extraoral images revealed a severe Class III profile with increased lower anterior face height, shallow mentolabial sulcus, positive lip step, and maxillary hypoplasia with no temporomandibular joint abnormality [Figure 12a-g].
Intraoral images revealed a full cusp Class III molar with Class III canine, midline diastema, upper incisor proclination, moderate upper and lower crowding, and reverse overjet of 6 mm [Figure 13a-e].
Bimaxillary surgery with surgery-first approach was planned, wherein a BSSO mandibular setback and Lefort I maxillary advancement would be performed to address the Class III skeletal discrepancy.
All teeth were bonded with 0.022" preadjusted brackets (Gemini , 3M Unitek, St Paul, MN, USA). 0.014Psi NiTi wire were placed in the upper and lower arches [Figure 14a-e] before a BSSO and Lefort I osteotomy of the mandible and maxilla, respectively, and upper bilateral second premolars were extracted. One-month postsurgically, 0.014" NiTi wire was placed. Bilateral upper first premolars were extracted to correct the proclination of upper anterior teeth. Subsequently, the initial wires were replaced by 0.016 x 0.022" NiTi upper and lower arches [Figure 15a-e]. Extraoral photographs at 2 months postsurgery showed good improvement [Figure 16a-d]. Subsequently, the case was finished with 0.017 x 0.025 TMA archwires having second-order bends. The overall treatment time took 9 months from start to finish. Treatment results: Posttreatment photographic images [Figures 17a-d and 18a-e] and CBCT showed great improvements in the profile. Class III facial pattern was changed to Class I profile with pleasing esthetics and good occlusion [Figure 19a-e].