Combined Orthodontics and Orthognathic Surgery for the Correction of Class II Div I Malocclusion – Two Days Post-operative Recovery. Case Report

Case Report

Austin J Dent.2015;2(1): 1014.

Combined Orthodontics and Orthognathic Surgery for the Correction of Class II Div I Malocclusion – Two Days Post-operative Recovery. Case Report

Prithiviraj Jeyaraman1*, Narendran Kesavaraj2, Priti S. Mulimani1

1Department of Orthodontics, Faculty of Dentistry, Melaka Manipal Medical College, Malaysia

2Consultant Oral and Maxillofacial Surgon, Amsa Dental Clinic, Nandhi Koil Street, Trichy, India

*Corresponding author: Prithiviraj Jeyaraman, Department of Orthodontics, Faculty of Dentistry, Melaka Manipal Medical College, Melaka – 75150, Malaysia

Received: October 09, 2014; Accepted: January 30, 2015; Published: February 02, 2015


An adult patient with severe skeletal deformity and Class II Division 1 malocclusion was treated with orthodontic appliances and orthognathic surgery. The combined orthodontic-orthognathic surgical procedure, with proper planning and collaboration of the specialists, resulted in a successful, satisfactory and quick outcome for the patient, by restoring facial aesthetics, occlusal balance and functional efficiency in a relatively short period of time.

Keywords: Orthognathic; Orthodontics; Aesthetics; Surgery; Anterior maxillary Osteotomy


Deformities of the jaws result in skeletal and dental malocclusions which often cause dysfunction and distress to the patients and provide a challenging task to the Orthodontist to restore occlusal harmony, muscular balance and optimum function. These deformities at an early age, when the patient is still growing, have the potential to be corrected with growth-modifying appliances. However, in adults, depending upon the case, the jaws may be left in the same position and the underlying skeletal deformity can be camouflaged by dental correction or a combined orthodontic and surgical approach can be adopted, which would correct both the jaws and the occlusion [1]. An inter-disciplinary and planned approach in collaboration with the Oral and Maxillofacial surgeons, in the latter option, provide outcomes which restore aesthetics, function and balance, which go a long way in improving the confidence, psychosocial well-being and prospects of the patient [1]. However, there are also associated risks and complications with this approach, one of them being the trauma of the surgical procedure which the patient has to undergo. The accompanying oedema, pain and loss of function during the immediate post-operative phase often make the patient apprehensive about the whole procedure. Gentle tissue-manipulation and handling of the tissues to minimize surgical trauma on the operating table and frequent flushing with povidone-iodine solution [2] during the surgery are the key in providing an un-eventful and relatively smooth recovery for the patient from this procedure. We present a case, in which, such an approach was adopted while carrying out the orthognathic surgery, which consequently resulted in two days immediate recovery and rapid healing and restoration of function and aesthetics after the surgical procedure in the patient.

Diagnosis and Etiology

A 23 year old female patient, presented with the chief complaint of severely protruding upper front teeth, inability to close the lips and an unsatisfactory smile. The patient was quite concerned about her appearance and desired orthodontic treatment to correct her proclined incisors and improve the smile at the earliest, as she was planning to take up a career inmodelling.

On extra-oral examination, the patient had a class II skeletal pattern with convex profile, decreased lower facial height,a potentially competent lip and lower lip trap with deep mentolabial sulcus. The skeletal convexity was observed to be maxillary. Frontal view of the face showed chin deviation to the right. The lower lip was everted. Incisor visibility at rest was around 4-5 mm and in smile the full length of incisor crowns was seen with no excessive gingival display. (Figures 1-3).