Minimal presurgical orthodontics for a skeletal Class III patient with mandibular asymmetry

• We treated a skeletal Class III patient with minimal presurgical orthodontics.
• We combined the surgery-first approach with miniscrews.
• This report includes records at pretreatment, progress, and posttreatment.
• The quality of the records was a high priority.

A 19-year-old man with a skeletal Class III malocclusion was treated using minimal presurgical orthodontics. Orthodontic appliances and miniscrews were placed at the beginning of treatment, and the double-jaw-surgery was performed once the maxillary right and left first premolars were intruded, without worsening the concave profile and facial asymmetry presurgically. Different from the traditional combined orthodontic-orthognathic surgery, the jaw discrepancy was corrected first, followed by the orthodontic tooth movement. Miniscrews were used to intrude the premolars presurgically because of their interference and to provide the skeletal anchorage for intermaxillary elastics after the operation. The patient was pleased with the treatment results and satisfied with his facial and dental appearance, as well as his oral function. The 1-year follow-up photographs show a stable result both esthetically and functionally.