Main Article Content

Introduction: The treatment established as the gold standard for skeletal deformities of the craniofacial complex is orthodontic treatment combined with orthognathic surgery, to achieve occlusal stability, facial harmony, improved mastication, phonation and breathing. The conventional orthognathic surgery protocol consists of 3 phases: pre-surgical orthodontic treatment, orthognathic surgery and post-surgical orthodontics.


Case Report: 18 year old female patient with skeletal class III. She presents occasional pain, crepitation and luxation of the temporomandibular joint, laterognathia.


Treatment: Conventional orthognathic surgery of both jaws with unilateral sagittal osteotomy.


Results: The objectives of the treatment plan were achieved 1 year and 9 months after starting orthodontic treatment.


Conclusion: With a good diagnosis and treatment planning orthodontic - maxillofacial surgery ensures excellent results, as well as bone stability and occlusal harmony post-surgery.

Daniela Orozco Jiménez, Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México

Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México.

Orcid: https://orcid.org/0000-0003-3965-9892

Alejandro Andrade Torres, Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México

Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México.

Alejandra Castro García, Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México.

Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México.  

mceclip1.pnghttps://orcid.org/0000-0001-5196-211X

Raul Roca Pereda, Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México.

Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México. 

mceclip0.pnghttps://orcid.org/0000-0002-9192-9880

Miguel Angel Casillas Santana, Benemérita Universidad Autónoma de Puebla

Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue., C.P. 72410, México. 

mceclip2.pnghttps://orcid.org/0000-0003-0288-9117

Orozco Jiménez, D. . . . . . . . ., Andrade Torres, A. ., Castro García, A. . . . . . . . . ., Roca Pereda, R. ., & Casillas Santana, M. A. (2021). Management of an orthognathic surgery treatment in a skeletal class III patient: case report. Revista Estomatología, 29(2). https://doi.org/10.25100/re.v29i2.11311 (Original work published November 3, 2021)

Hu J, Jiang Y, Wang D, Guo S, Li S, Jiang H, et al. Comparison of cost-effectiveness and benefits of surgery-first versus orthodontics-first orthognathic correction of skeletal class III malocclusion. Int J Oral Maxillofac Surg. 2020;6–11.

Dantas JFC, Neto JNN, De Carvalho SHG, Martins IMCLD, De Souza RF, Sarmento VA. Satisfaction of skeletal class III patients treated with different types of orthognathic surgery. Int J Oral Maxillofac Surg [Internet]. 2015;44(2):195–202. Available from: http://dx.doi.org/10.1016/j.ijom.2014.09.015

Eslami S, Faber J, Fateh A, Sheikholaemmeh F, Grassia V, Jamilian A. Treatment decision in adult patients with class III malocclusion: surgery versus orthodontics. Prog Orthod. 2018;19(1):4–9.

Dehghani M, Fazeli F, Sattarzadeh AP. Efficiency and Duration of Orthodontic/Orthognathic Surgery Treatment. J Craniofac Surg. 2017;28(8):1997–2000.

Jacobs JD, Sinclair PM. Principles of orthodontic mechanics in orthognathic surgery cases. Am J Orthod. 1983;84(5):399–407.

Gaitán Romero L, Mulier D, Orhan K, Shujaat S, Shaheen E, Willems G, et al. Evaluation of long-term hard tissue remodelling after skeletal class III orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg. 2020;49(1):51–61.

Hwang HS, Oh MH, Oh HK, Oh H. Surgery-first approach in correcting skeletal Class III malocclusion with mandibular asymmetry. Am J Orthod Dentofac Orthop [Internet]. 2017;152(2):255–67. Available from: http://dx.doi.org/10.1016/j.ajodo.2014.10.040

Uribe F, Adabi S, Janakiraman N, Allareddy V, Steinbacher D, Shafer D, et al. Treatment duration and factors associated with the surgery-first approach: a two-center study. Prog Orthod [Internet]. 2015;16(1):4–9. Available from: http://dx.doi.org/10.1186/s40510-015-0101-1

Mah DH, Kim SG, Oh JS, You JS, Jung SY, Kim WG, et al. Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction. J Korean Assoc Oral Maxillofac Surg. 2017;43(1):23–8.

Uribe F, Agarwal S, Shafer D, Nanda R. Increasing orthodontic and orthognathic surgery treatment efficiency with a modified surgery-first approach. Am J Orthod Dentofac Orthop. 2015;148(5):838–48.

Choi D-S, Garagiola U, Kim S-G. Current status of the surgery-first approach (part I): concepts and orthodontic protocols. Maxillofac Plast Reconstr Surg. 2019;41(1).

Pelo S, Gasparini G, Garagiola U, Cordaro M, Di Nardo F, Staderini E, et al. Surgery-first orthognathic approach vs traditional orthognathic approach: Oral health-related quality of life assessed with 2 questionnaires. Am J Orthod Dentofac Orthop [Internet]. 2017;152(2):250–4. Available from: http://dx.doi.org/10.1016/j.ajodo.2016.12.022

Naran S, Steinbacher DM, Taylor JA. Current concepts in orthognathic surgery. Plast Reconstr Surg. 2018;141(6):925e-936e.

Kwon T-G, Han MD. Current status of surgery first approach (part II): precautions and complications. Maxillofac Plast Reconstr Surg. 2019;41(1).

López Buitrago DF, Corral Saavedra CM. Abordaje terapéutico de la maloclusión de pseudoclase III. Reporte de caso clínico. Rev Mex Ortod. 2015;3(4):249–56.

Seifi M, Matini N-S, Motabar A-R, Motabar M. Dentoskeletal Stability in Conventional Orthognathic Surgery, Presurgical Orthodontic Treatment and Surgery-First Approach in Class-III Patients. World J Plast Surg. 2018;7(3):283–93.

Teramoto A, Suzuki S, Higashihori N, Ohbayashi N, Kurabayashi T, Moriyama K. 3D evaluation of the morphological and volumetric changes of the tongue and oral cavity before and after orthognathic surgery for mandibular prognathism: a preliminary study. Prog Orthod. 2020;21(1).

Ko EWC, Lin SC, Chen YR, Huang CS. Skeletal and dental variables related to the stability of orthognathic surgery in skeletal class III malocclusion with a surgery-first approach. J Oral Maxillofac Surg [Internet]. 2013;71(5):e215–23. Available from: http://dx.doi.org/10.1016/j.joms.2012.12.025

Wei H, Liu Z, Zang J, Wang X. Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol [Internet]. 2018;126(2):107–16. Available from: https://doi.org/10.1016/j.oooo.2018.02.018

Hernández-Alfaro F, Nieto MJ, Ruiz-Magaz V, Valls-Ontañón A, Méndez-Manjón I, Guijarro-Martínez R. Inferior subapical osteotomy for dentoalveolar decompensation of class III malocclusion in ‘surgery-first’ and ‘surgery-early’ orthognathic treatment. Int J Oral Maxillofac Surg. 2017;46(1):80–5.

Parappallil CJ, Parameswaran R, Vijayalakshmi D, Mavelil BGT. A Comparative Evaluation of Changes in Soft Tissues After Single-Jaw Surgery and Bimaxillary Surgery in Skeletal Class III Patients. J Maxillofac Oral Surg [Internet]. 2018;17(4):538–46. Available from: https://doi.org/10.1007/s12663-017-1079-7

Abou Chebel N, Saadeh M, Haddad R. Unilateral sagittal split osteotomy: effect on mandibular symmetry in the treatment of class III with laterognathia. Prog Orthod. 2020;21(1).

Reyneke JP, Ferretti C. Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy. Br J Oral Maxillofac Surg. 2002;40(4):285–92.