Treatment of a Skeletal Class Iii Pati̇ent With Surgery First Approach Without Fixed Appli̇ance: Case Report and 5 Years Follow Up

Aim: This case report presents the treatment of an adult Class III female patient with a "surgery-first" approach without fixed orthodontic appliances. Subject and Method: A 22-year-and-3-month-old female patient who had previously been treated with a combination of face mask therapy, rapid palatal expansion, and fixed orthodontic appliances at the age of 10 referred to our clinic with a relapse due to late mandibular growth. Clinical and radiographic examinations revealed bimaxillary skeletal retrognatia , skeletal Class III malocclusion with increased vertical development, bilateral Class III molar and canine relationships, retroclined upper incisors, negative overjet, and reduced overbite. Orthognathic surgery was performed, including 5 mm maxillary advancement and 3 mm intrusion via a stepwise high Le Fort I osteotomy in order to correct mid-face retrognathia. Maxillomandibular stabilization was achieved using intermaxillary elastics and splints attached to six intraoral surgical screws placed under CBCT guidance before surgery.) Minor occlusal discrepancies were resolved with the support of the regional acceleratory phenomenon (RAP). Discussion and Conclusion: Relapse may occur in skeletal Class III malocclusions due to continued mandibular growth. When dental arches are already in relative occlusal harmony, a surgery-first approach without fixed appliances, supported by mini-screw-based intermaxillary fixation and the RAP effect, may provide an efficient and effective treatment solution to achieve both orthodontic and orthognatic surgery objectives in a significantly shorter treatment time with an approvement in aesthetics