Miniscrew-assisted multidisciplinary orthodontic treatment with surgical mandibular advancement and genioplasty in a brachyfacial Class II patient with mandibular asymmetry

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This article describes the complex dental treatment of a 43-year-old man with skeletal Class II, mandibular asymmetry, severe brachyfacial pattern, Class II Division 2, canting of the occlusal plane, and an increased curve of Spee. To achieve optimal results, we adopted a multidisciplinary approach to treatment, involving periodontics, oral surgery, orthodontics, maxillofacial surgery, and prosthetics specialists. After periodontal treatment, miniscrews were placed to correct the occlusal plane canting and the excessive curve of Spee with orthodontic treatment. The surgical treatment plan consisted of a bilateral asymmetric sagittal split osteotomy for mandibular advancement and genioplasty. The patient had an infection after the surgery at the site of the right fixation plate, so the plate was removed, and active orthodontic treatment was continued and finished. Mandibular first molar implants and maxillary ceramic crowns using the Digital Smile Design method (Digital Smile Design, Doral, FL) were placed at the end of orthodontic treatment. The patient was satisfied with the treatment results and with his facial and dental appearance, as well as his oral function. The 2-year follow-up pictures show a stable result both esthetically and functionally.HighlightsAdults with skeletal and dental problems require a multidisciplinary approach.Miniscrews used as auxiliary elements shorten preoperative treatment.Miniscrews can correct occlusal plane canting and excessive curve of Spee easily.Orthognathic surgery has risks sometimes requiring reoperation to remove plates.After mandibular advancement surgery, the volume of the pharyngeal airway increases.

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