Modified surgery-first approach for management of severe class III malocclusion with maxillary skeletal midline discrepancy


  • Amrit Thapa Department of Dental Surgery, AFMC, Pune, Maharashtra, India
  • Andrews Navin Kumar OMFS, Leh, Ladakh, Jammu & Kashmir, India
  • Saugat Ray Department of Dental Surgery, AFMC, Pune, Maharashtra, India
  • B. Jayan Commandant CMDC (CC), Lucknow, Uttar Pradesh, India
  • S. S. Chopra Commandant ADC (R and R), Delhi, India



This case report describes orthosurgical case that used the recently introduced surgery-first approach to correct a severe skeletal class III malocclusion with severe maxillary midline discrepancy. A 23-year-old adult male presented with severe mandibular prognathism and midline discrepancy associated with upper jaw. Firstly partial orthodontic movement were facilitated to decrowd the lower teeth in order to avoid any hindrance while anterior tooth advancement.  After which prediction of the postsurgical tooth movement and surgical simulation was done by using Nemoceph software than 2-jaw surgery that included maxillary advancement differentially initiated to correct midline followed by mandibular setback was performed using a surgery-first approach. Immediate facial improvement was achieved and postsurgical orthodontic treatment was efficiently carried out. The total treatment time was 11 months. The patient's facial appearance improved significantly and a stable surgical orthodontic outcome was obtained even after patient was followed for six years.


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