Elimination of transverse dental compensation is critical for treatment of patients with severe facial asymmetry

This case report describes the importance of eliminating transverse dental compensation during preoperative orthodontic treatment for a patient with severe facial asymmetry. The patient, a 17-year-old Japanese woman, had severe facial asymmetry involving the maxilla and the mandible, and extreme transverse dental compensation of the anterior and posterior teeth in both arches. Therefore, the main treatment objectives were elimination of the transverse dental compensation by orthodontic treatment and correction of the morphology of the maxilla and the mandible by orthognathic surgery. The preoperative orthodontic treatment resulted in sufficient elimination of the transverse dental compensation and movement of the teeth into their proper positions so that basal bone firmly supported them. LeFort I osteotomy and sagittal split ramus osteotomy were performed to correct the skeletal morphology. Facial asymmetry was dramatically improved, and a favorable occlusion was obtained. At 1 year 8 months after the surgical orthodontic treatment, the facial symmetry and occlusion remained favorable. The results suggest that sufficient elimination of transverse dental compensation in the maxillary and mandibular arches during preoperative orthodontic treatment is requisite for successful treatment of severe facial asymmetry.