PMC4778176_01
(a-d) Pretreatment extraoral photographs
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F1
Extraoral examination reveals a concave profile, increased lower anterior face height, mild hypoplastic maxilla, positive lip step, hyperdivergent skeletal pattern, and a large mandible [Figure 1a-d].
(a-e) Pretreatment intraoral photographs
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F2
Intraorally, he exhibits a Class III molar and canine relation, mild crowding of upper and lower anterior teeth, dental midlines matching, and reverse overjet of 3 mm [Figure 2a-e].
(a-c) Pretreatment cone beam computed tomography scan images showing Class III skeletal and dental features
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F3
A cone beam computed tomography scan (CBCT) reveals the absence of skeletal asymmetry and no abnormality of the temporomandibular joint [Figure 3a-c].
(a-e) Intraoral images showing bonded teeth with 0.022 "preadjusted brackets and ligated with 0.010" ligature wire
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F4
All teeth were bonded with 0.022" preadjusted brackets (Smartclip , 3M Unitek, St Paul, MN, USA) [Figure 4a-e] and ligated with 0.010 stainless steel ligature wire.
Face-bow transfer was made to ensure the recording of positional relationship of maxillary arch to the temporomandibular joints
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F5
A face-bow transfer recorded the relationship of maxilla to the transverse horizontal hinge axis of the mandible [Figure 5].
(a-d) Immediate postsurgical extraoral images showing fulfillment of surgical objective
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F6
Postsurgically, extraoral images [Figure 6a-d] revealed fulfillment of the surgery objectives.
(a-c) Immediate postsurgical intraoral images showing a transitional occlusion wherein the occlusion is set-up such that the skeletal problem is resolved with near normal correction of overjet and overbite
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F7
One-week postsurgery, 0.014" NiTi wires were placed in the upper and lower arches [Figure 7a-c], and subsequently, wires were changed to 0.016 x 0.022 NiTi archwires, and the case was finished in 0.017 x 0.025" stainless steel with second-order bends.
(a-d) Posttreatment extraoral images showing achievement of orthognathic profile and esthetically pleasing features
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F8
Treatment results: Six months after surgery, the fixed appliances were removed, and posttreatment photographic images [Figures 8a-d and 9a-e] and CBCT [Figures 10a-c and 11] showed excellent esthetic and occlusal results [Figure 10d].
(a-e) Posttreatment intraoral images showing achievement of normal overjet and overbite
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F9
Treatment results: Six months after surgery, the fixed appliances were removed, and posttreatment photographic images [Figures 8a-d and 9a-e] and CBCT [Figures 10a-c and 11] showed excellent esthetic and occlusal results [Figure 10d].
(a-d) Posttreatment cone beam computed tomography scan images showing orthognathic skeletal relationship with normal occlusion. Superimposition of pre (black) and posttreatment (red) lateral cephalometric tracings
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F10
Treatment results: Six months after surgery, the fixed appliances were removed, and posttreatment photographic images [Figures 8a-d and 9a-e] and CBCT [Figures 10a-c and 11] showed excellent esthetic and occlusal results [Figure 10d].
Profile views of pre- and post-treatment images superimposed to show the amount of correction
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F11
Treatment results: Six months after surgery, the fixed appliances were removed, and posttreatment photographic images [Figures 8a-d and 9a-e] and CBCT [Figures 10a-c and 11] showed excellent esthetic and occlusal results [Figure 10d].
PMC4778176_02
(a-g) Pretreatment extraoral photographs. Pretreatment cone beam computed tomography scan images showing Class III skeletal and dental features
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F12
On examination, CBCT scan and extraoral images revealed a severe Class III profile with increased lower anterior face height, shallow mentolabial sulcus, positive lip step, and maxillary hypoplasia with no temporomandibular joint abnormality [Figure 12a-g].
(a-e) Pretreatment intraoral photographs
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F13
(a-e) Intraoral images showing bonded teeth with 0.022 "preadjusted brackets and placement of 0.014 " upper and lower archwires
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F14
All teeth were bonded with 0.022" preadjusted brackets (Gemini , 3M Unitek, St Paul, MN, USA). 0.014Psi NiTi wire were placed in the upper and lower arches [Figure 14a-e] before a BSSO and Lefort I osteotomy of the mandible and maxilla, respectively, and upper bilateral second premolars were extracted.
(a-e) 0.016 x 0.022" NiTi upper and lower arches were placed 1-month postsurgery
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F15
Subsequently, the initial wires were replaced by 0.016 x 0.022" NiTi upper and lower arches [Figure 15a-e].