PMC4243605_01
Pretreatment facial (a)-(d) and intraoral photographs (e)-(j) and CBTC (k)-(m).
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Facial analysis revealed a Class III skeletal pattern with severe mandibular prognathism and vertical excess (Figures 1(a)-1(d)). Severe tooth compensation of mandibular teeth (lingual inclination of anterior and posterior teeth) and severe mandibular anterior crowding were observed (Figures 1(e)-1(j)). The analysis of initial CBCT images (Figures 1(k)-1(m)) showed very thin buccal and lingual bone plates in the maxillary and especially mandibular incisors.
PMC4243605_02
PMC4243605_03
Postdecompensation CBTC.
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After alignment and leveling and 30 days after placement of 0.019'' x 0.025'' archwires, the patient underwent a second CBCT scan in the same machine to evaluate the biological effects of orthodontic decompensation (Figure 2).
Postdecompensation facial and intraoral photographs.
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At this stage, the facial profile and occlusal relationships were worse than in the initial stage (Figure 3).
Final CBCT.
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Four months after surgery, the final CBCT was requested to evaluate the condyle morphology and evaluate postsurgical dentoskeletal changes (Figure 4).
Intraoral photographs, last phase.
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The postsurgical orthodontics involved finalization bends in the archwires and utilization of Class III intermaxillary elastics (Figure 5).
Final facial and intraoral photographs.
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After six months of surgery stabilization, the fixed appliance was removed and Hawley plate and 3 x 3 mandibular retainers were placed (Figure 6).
30-month posttreatment facial and intraoral photographs.
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The facial and occlusal results remained stable 30 months after removal of appliances (Figure 7), including the clinical periodontal conditions.
Cephalometric superimposition: red line: pretreatment; green line: postdecompensation.
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Cephalometric superimposition: red line: pretreatment; black line: posttreatment.
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