Combined Orthodontic, Orthognathic Surgical, and Prosthodontic Treatment for Severe Class III Malocclusion Using...

The patient underwent combined orthodonticorthognathic surgical treatment due to her skeletal Class III malocclusion. In the first phase, orthodontic decompensation was performed with maxillary and mandibular fixed appliances. The maxillary first premolars were extracted; the created space was closed by anterior retraction. The posterior anchorage was reinforced with interradicular temporary anchorage devices. In the second phase, a digital surgical treatment plan was made with intra- and extraoral simulation (including occlusion and profile). During the orthognathic surgery, a bilateral sagittal split osteotomy with mandibular setback was combined with maxillary movements, using 3D-printed surgical splints. In the third phase, the orthodontic treatment continued to finish and settle the occlusion. Spaces were created between the upper incisors for ceramic veneers to gain proper overjet and occlusion. The last phase was prosthetic and esthetic rehabilitation. During the planning, a 2Dand 3D-smile design was created and presented to the patient as a mock-up. After digital impression and design, four E-max veneers were milled and cemented using dual cement to finish the workflow. Retention splints were created to preserve the new status as a final step.