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Abstract

Correction of facial asymmetry is one of the most difficult challenges in orthognathic surgery. Bardinet classified facial asymmetries based on three clinical entities: mandibular lateral deviations, dental asymmetries without skeletal involvement, and skeletal asymmetries. In some cases, combinations of soft tissue deformities and skeletal discrepancies complicate treatment outcome and management. This report presents a case of a 29-year-old male with skeletal Class I malocclusion, high mandibular plane angle, facial asymmetry, and dental Class III malocclusion. Mild left-side down occlusal plane canting and chin deviation to right side was observed. The pre-surgical orthodontic treatment started with full-mouth fixed appliance therapy for teeth leveling, alignment, and dental decompensation in both the sagittal and transverse aspects. The canted occlusal plane was corrected by using temporary anchorage devices for intrusion of upper left posterior teeth. Then mandibular surgery with bilateral sagittal split osteotomy was performed. The total treatment time was 20 months. With the aid of TADs to correct the occlusal plane canting, the treatment approach of orthognathic surgery could be simplified to one jaw surgery in patients with vertical maxillary asymmetry.

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