if so , will the patient and/or parents be amenable to a surgical treatment plan ? as graber states in his text ,  many diagnostic factors must be analyzed , a differential diagnosis must be made and in light of your clinical experience as well as that of others , the indication and the contraindications of therapeutic modifiability must be weighed .  in today 's often complex treatment plans , other physicians and dentists are integrated into the planning and treatment process . the contemporary orthodontist must not only keep up with current technical trends in orthodontic treatment but also successfully communicate , negotiate , and navigate the patient to a successful result . often the patient 's primary reason for seeking treatment is to improve his or her dental and /or facial esthetics . today 's orthodontist has many treatment options to choose from in reaching his or her goals . virtually all these treatment options are designed to reach the same general orthodontic goal : class i occlusion . however , each treatment choice almost always has an effect on the face and facial esthetic . this is very true in orthodontic treatment and may be even more dramatic in the area of combined orthodontics and orthognathic surgical cases . adult patients with dentofacial skeletal deformities like a class iii malocclusion require careful treatment planning , an integrated approach , and patient cooperation . in almost all soft - tissue relationships of the face , the position of the underlying hard tissue is a primary determinant of overlying soft - tissue morphology . this is true for the lips , teeth , chin and bony chin projection , and malar prominence . growth of the face is an enormously complex function of skeletal , dental and soft - tissue growth , with genetic and environmental factors both playing significant roles in the final facial form . facial esthetics has been of great interest to orthodontists in the year since angle , hellman , case and farkas opinions of what constitutes an attractive face have come from many sources and have been more than adequately covered in the orthodontic literature.[512 ] contemporary orthodontists are familiar with the principles of designing treatment to improve the profile rather than affecting it adversely . although class ii dentofacial deformities are more common , the need for treatment and improvement in terms of facial profile is generally greater in class iii patients . the purpose of this article is to illustrate such a case and to show the positive effect that certain treatment decisions have on the profile . a 26-year - old male patient presented with the chief complaint of unaesthetic facial and dental appearance [ figures 1a1c ] . to allow adequate surgical movement , 14 were extracted and the maxillary incisors were retracted . no extractions were performed in the mandibular arch because there was minimal crowding , no retraction was necessary , and a class ii molar relationship at the end of the treatment was considered acceptable . the mandibular incisors were aligned and the archforms were coordinated [ figures 2a and 2b ] . ( a - b ) prior surgery photographs surgery included a bsso set back of about 7.5 mm bilaterally which was as determined by the prediction tracing [ figures 3a and 3b ] . rigid internal fixation with screws and plates was used to stabilize the osteotomy site , and splint fixation was done during the surgery to maintain the result [ figures 4a4c ] . the patient was followed up closely after the procedure and orthodontic treatment was resumed 6 weeks after the surgery . ( a - b ) surgical treatment objective ( sto ) ( a - c ) splint fixation and postsurgical photographs six months later , the fixed appliances were removed [ figures 5a and 5b ] , and a retention program was initiated . ricketts superimposition of pre- and post - treatment cephalometric tracings confirmed the success of treatment [ figures 6a6d ] . ( a - b ) post - treatment photographs ( a - d ) rickett 's superimposition ( a - f ) post - retention photographs surgical - orthodontic treatment is sometimes the only option for achieving an acceptable occlusion and a good esthetic result in a patient with a class iii dentofacial deformity , as illustrated in this case report with [ figure 8 ] showing the improvement in the profile of the patient . correction of a class iii dentofacial deformity requires a multi - disciplinary team approach to ensure a satisfactory outcome .
this case report describes the surgical - orthodontic treatment of a 26-year - old post - pubertal male patient with a class iii dentofacial deformity . in the pre - surgical orthodontic phase of treatment , 
 a reverse overjet of 5.5 mm was created and arch compatibility was obtained . 
 a mandibualr set back with bsso was performed during surgery to restore ideal overjet , overbite , occlusion and optimal esthetics . 
 after 1 year of treatment , the results remained stable .