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KMID : 1149720200100010021
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Clinical Journal of Korean association of Orthodontists
2020 Volume.10 No. 1 p.21 ~ p.33
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Surgery-First Orthognathic Treatment in Class III Patient with Congenital Missing of Unilateral Maxillary Lateral Incisor
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Lim Hee-Jin
Lee Yoon-Jin
Kook Yoon-Ah
Kim Yoon-Ji
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Abstract
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This case report describes a surgery-first orthognathic treatment of a skeletal Class III patient with congenital missing
of a maxillary lateral incisor. A 24-year-old male presented with a chief complaint of mandibular prognathism. Clinical
examination showed concave facial profile with moderate crowding. Intraorally, he exhibited both Class III molar
relationship, mild crowding in both arches, and 3.0 mm negative overjet. The maxillary dental midline was deviated 3.0
mm to the left, caused by congenital missing of the maxillary left lateral incisor. The cephalometric analysis showed
skeletal Class III malocclusion with a hyperdivergent pattern. For skeletal overcorrection of mandibular prognathism
and asymmtery, bilateral sagittal split ramus osteotomy was performed with surgery-first approach. To correct
the maxillary midline deviation, maxillary right second premolar was extracted. Maxillary left lateral incisor was
substituted with the canine by orthodontic space closure. With careful pre-operative orthodontic planning, surgery-first
orthognathic treatment was successfully treated with satisfying esthetics.
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KEYWORD
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Surgery-first approach, Minimal presurgical orthodontics, Class III malocclusion, Congenital missing, Canine substitution
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