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Abstract

This is a case of a 26 year-old female who complained of mandibular prognathism and malocclusion.Extraoral view revealed a concave profile with midface deficiency, mandibular prognathism, and chin deviation to right side by 4 mm. Class III malocclusion along with bilateral posterior crossbite and severe crowding were noted. Panoramic X-ray showed #83 retained, and #43 deeply impacted approximating to the mandibular lower border with a mass of radiopacity over it. Orthodontic treatment combined with a 2-jaw orthognathic surgery in which removal of #43 deep impaction was suggested. Before full mouth bonding, we referred the patient to remove #83 and the radiopaque mass to facilitate further orthodontic tooth movement. Pathology report confirmed the mass as a compound odontoma. At the preoperative orthodontic stage we performed dental decompensation. In the upper arch, two first premolars and third molars were extracted for crowding relief and alignment. In the lower arch, we created canine space in the lower right region for future prosthesis and proclining lower anteriors. Two jaw orthognathic surgery was performed including a 3-piece LeFort I segmental osteotomy for midface advancement and arch width expansion, and a bilateral sagittal split osteotomy for mandible set-back correcting chin-deviation. Removal of #43 deep impaction was also performed during the surgery. The total treatment period was 29 months and the final result was satisfying. Comparisons between virtual surgical planning by TIOPS software and the real outcome were provided.

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