This case report features a successful combined surgical-orthodontic treatment of a patient with skeletal Class III malocclusion with severe anterior open bite and severe mandibular crowding. Clinical examination revealed concave profile with long-face deformity caused by retrognathic maxilla and excessive vertical growth of mandible, maxillary crowding despite absence of maxillary first premolars, mandibular incisor retroclination, deep curve of Spee, and blocked-out mandibular canines. The treatment involved surgery-first approach with extraction of lower right first premolar and atypical extraction of lower left canine due to its poor periodontal support. Harmonized facial profile, pleasing smile, good occlusal interdigitation as well as skeletal stability were evident 3 years after active orthodontic treatment.

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Pretreatment facial and intraoral photographs.

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Initial lateral cephalometric, posteroanterior, and panoramic radiographs.

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Pretreatment three-dimensional tomographic image with soft tissue composite: A, pretreatment; and B, surgical simulation.

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Surgical occlusion setup.

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Intraoral photographs at 5-month post-operation.

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Posttreatment facial and intraoral photographs.

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Posttreatment lateral cephalometric, posteroanterior, and panoramic radiographs.

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Two-dimensional superimposition between initial and debonding (posttreatment): A, overall superimposition; B, regional superimposition at maxilla; C, regional superimposition at mandible.

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Three-dimensional superimposition between initial (grey), immediate 1-week post-operation (red) and debonding (posttreatment - blue). The superimposition between the initial and 1-week post-operation images revealed the outcome after mandibular setback and shortening of lower anterior face height. The superimposition between the 1-week post-operation and the debonding images showed continued change of mandibular position in counterclockwise direction.

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Facial and intraoral photographs 3 years after treatment.