24 A Pair for the Impaired - Orthodontic and Surgical Combination Treatment of Skeletal Class III Malocclusion: A Two Year Follow up Report Anjuman Preet Kaur Dua 1 , Ajit Jaiswal 2 , Laxman Kumar 3 , Sumir Gandhi 4 , Ekta Singh Suneja 5 , Sunaina Jodhka 6 1 MDS Orthodontics, Professor and Head, Department of Orthodontics, Baba Jaswant Singh Dental College, Ludhiana, Phone: +919814996677, E mail: dranjuman@gmail.com 2 MDS Orthodontics, Professor, Department of Orthodontics, Shahid Kartar Singh Sarabha Dental College, Ludhiana, Phone: 09876445320, E mail: ajitdentist@yahoo.co.in 3 MDS Oral and Maxillofacial Surgery, Consultant,Kingston Public Hospital, Kingston,Jamaica, E mail:bineylax@gmail.com 4 MDS Oral and Maxillofacial Surgery, Professor and Head, Department of Oral Surgery, Christian Dental College, Ludhiana, Phone: 09814433393, sumirgandhi@gmail.com 5 MDS Conservative Dentistry and Endodontics, Professor, Department of Conservative Dentistry, Baba Jaswant Singh Dental College, Ludhiana, Phone: 9815182368, ektasingh.suneja@gmail.com 6 MDS Pedodontics, Reader, Department of Pediatric Dentistry, Baba Jaswant Singh Dental College, Ludhiana Phone: 9815182368, drsunaina79@yahoo.com.sg Case Report To cite: Anjuman Preet Kaur Dua, Ajit Jaiswal, Laxman Kumar, Sumir Gandhi, Ekta Singh Suneja, Sunaina Jodhka, A pair for the impaired- orthodontic and surgical combination treatment of skeletal class III malocclusion: a two year follow up report, Journal of contemporary orthodontics, Nov. 2017, Vol 1, Issue 4, page no. 24-32. Received on: 05/09/2017 Accepted on: 11/10/2017 Source of Support: Nil Confict of Interest: Nil ABSTRACT This case report represents a 19-year-old male who complained of reverse occlusion with problems in mastication and unpleasant facial aesthetics. The lateral view showed a concave profle with a prominent chin and malar defciency. The patient was diagnosed as having a skeletal and dental Class III malocclusion with a negative overjet of – 6 mm. The cephalo- metric readings showed a prognathic mandible and a small maxilla with an ANB angle of -13 degrees. The treatment plan included a phase of presurgical orthodontics with extraction of one lower incisor, alignment of both the arches individually and decompensation of incisors followed by a double jaw surgery. The sagittal split ramus osteotomy and Leforte I osteotomy were performed after sixteen months of presurgical orthodontics. Postoperative orthodontic treatment period was eight months. Total active treatment period was two years and at the end of which good interdigitation leading to better masticatory ability. The esthetics improved remarkably leading to a greater self confdence. Keywords: Orthognathic surgery, Class III malocclusion, lower incisor extraction, bi jaw surgery INTRODUCTION Not all patients reporting to an orthodontist can be treated by means of conventional orthodontics. A synchrony of orthodontics and orthognathic sugery is required to achieve appreciable aesthetic results. The cases that fall under this realm of combination treatment are severe skeletal Class III, Class II and skeletal vertical discrepancies. It has been reported that nearly 4% of the population has a dentofacial deformity that requires surgical – orthodontic treatment to correct. 1 From the standpoint of demographics; this percentage may vary amongst population groups and ethnicities. Class III patients contribute to a large percentage of those looking for a surgical treatment. Proffit et al reported that 20 % of patients at a surgical – orthodontic clinic had mandibular excess, with 17 % having maxillary deficiencies and 10 % having both. 2 A subsequent article from the same centre reported that patients with Class III were more likely to seek clinical evaluation than Class II patients. 3 As a general rule, Class III malocclusions are less likely to benefit from camouflage as retracting the lower incisors may make the chin look even more prominent. 1 Hence, in an adult, if the maxillo- 3.indd 24 17-03-2018 10:30:54