Combined orthodontic and surgical treatment supported by virtual planning in a severe mandibular asymmetry: A case report

This article describes the complex dental treatment of a 17-year-old girl with skeletal Class I, severe mandibular asymmetry, maxillary retrusion, normodivergent pattern, left canine and molar Class II, canting of the occlusal plane, lateral left cross-bite, deep bite, upper and lower incisors retrusion and an increased curve of Spee. To achieve optimal results, a multidisciplinary approach to treatment was adopted involving orthodontics and maxillofacial surgery. The surgical phase was supported by virtual surgical planning with dedicated software. Thanks to the development of the three-dimensional radiological findings, a visualization and an accurate simulation of all the surgery-steps help to determine reproducibly and with high precision the best adjustments to do. Firstly, the excessive curve of Spee, the incisors retrusion and the deep bite were corrected with orthodontic treatment. The surgical treatment plan consisted of a palatal expansion, maxillary advancement, zygomatic grafts, bilateral sagittal osteotomy for mandibular correction and genioplasty. Orthodontic treatment was continued to finish with all the objectives achieved. After two years, the patient was satisfied with her facial and dental treatment results and with her oral function as well.