Abstract:
Background: Orthodontic-surgical planning is based on precise cephalometric investigations, which
highlight dentoalveolar compensations that require preoperative decompensation. Soft tissue profile analysis
(according to Arnett) complements the esthetic evaluation, while CBCT provides information regarding
alveolar bone sufficiency for planning dental movements.
Objective of the study: to describe the diagnostic criteria and the clinical reasoning that led to the selection
of an integrated orthodontic-surgical strategy in a clinical case with skeletal Class III malocclusion according
to Angle, associated with maxillary constriction and transverse deficiency.
Material and methods: A 27-year-old female patient presented with skeletal Class III malocclusion
according to Angle, with severe maxillary constriction. Preoperative orthodontic treatment with a fixed
appliance was initiated, followed by dental alignment and decompensation, achieving adequate sagittal
relationships and functional anterior contact. However, CBCT analysis confirmed a transverse osseous
deficiency, which contraindicated purely orthodontic expansion. Thus, a complex orthodontic-surgical
treatment was planned, consisting of bimaxillary osteotomy with maxillary segmentation for correction of the
transverse discrepancy.
Results: The respective case highlights the importance of integrated orthodontic-surgical planning, based on
cephalometric analysis and three-dimensional CBCT evaluation. Establishing the biological limits of dental
movements is essential to avoid unstable compensations. Although decompensation allowed sagittal
correction, transverse analysis demonstrated the necessity of a complex approach. Rigorous planning
facilitated the selection of multisegmental osteotomy to obtain functional and stable occlusion.
Conclusions: Orthognathic treatment of skeletal discrepancies requires integration of three-dimensional
diagnosis and proper orthodontic biomechanics. Dental decompensation ensures correct sagittal relationships
but cannot substitute surgical correction in cases with severe transverse deficiency. Segmental maxillary
osteotomy allows augmentation of osseous defects, restoration of the transverse dimension, and achievement
of long-term stable functional occlusion.
