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Authors: Dr. Arjun Nayak US, Dr. K Saidath, Dr. Krishna Nayak

A 17 year old female reported to the department with the chief complaint of gap between upper and lower front teeth. On extra oral examination, it revealed that the patient is having a concave facial profile with steep mandibular plane angle. On intraoral examination, the maxillary and mandibular arches were U shaped; Molar relationship was Angle’s Class I bilaterally; Canine relationship was Class III and open bite of 3 mm.
 
Fig.1
Fig.2


On radiographic examination, the cephalometric values indicated the Class III Skeletal pattern due to deficient maxilla with vertical growth pattern. The Jarabak’s ratio showed increased anterior facial height. The upper incisors were proclined whereas the lower anterior were almost upright.

 
Fig.3
Fig.4
DIAGNOSIS

Skeletal Class III malocclusion due to retrognathic maxilla with anterior open bite .


TREATMENT OBJECTIVES
 
  • Correction of Class III skeletal jaw base relationship
  • To attain ideal overbite and overjet
  • To achieve optimal facial balance and esthetics.
 
Fig.5

TREATMENT PLAN

Pre surgical orthodontics:
 
  • Leveling and aligning
  • Retraction of upper anteriors.
 
Fig.6
Surgical Plan:
 
  • LeFort I Osteotomy and Advancement.

Post Surgical Orthodontics
 
  • settling of occlusion.


 
Fig.7
DISCUSSION

The patient when reported to the department for the first time was already under the DENTOALVEOLAR COMPENSATION which is evident by the Molar Class I relationship with proclined upper anteriors and upright lower anteriors on a Skeletal Class III apical base. To manage the malar deficiency, Lefort I advancement was planned. But before proceeding to the surgery, the decompensation had to be done. Extraction of maxillary first premolars were done to create space for uprighting the maxillary anteriors and for their retraction. Reverse overjet was achieved after the retraction of the anterior as a part of decompensation.
 
Fig.8
Fig.9
TREATMENT OUTCOME

Le fort I advancement was done which resulted in an improved skeletal apical base relationship.The ideal overjet and overbite was achieved. The Incisor and Canine relationship became Class I. The profile improved and the lips were competent. Cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations. The post treatment panoramic radiographs showed good root parallelism. Pre and post treatment superimposition showed good soft tissue balance.

RELEVANT CEPHALOMETRIC VALUES:

Cephalometric Values

Pre Treatment

Post Treatment

SNA

750

800

SNB

780

800

WITS

-4mm

0mm

N-A-Pg

-50

-20

Upper Incisor to NA

450 / 10mm

260/6mm

Lower Incisor to NB

27o / 6mm

20o / 4mm

Lower incisor to Mand. plane

91o

86o

Inter-incisal Angle

109o

134o

Nasolabial Angle

78o

100o

Upper lip to E line

4mm

5mm

Lower lip to E line

-4mm

0mm

Upper lip to S line

-1mm

1mm

Lower lip to Sline

-7mm

-3mm

 
Fig.11

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