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Abstract

This case report describes the treatment of a 24-year-old woman with chief complaints of anterior open bite and long lower jaw. She had a skeletal Class III with concave facial profile, hyperdivergent facial pattern, long lower facial height, and excessive anterior open bite. Intraoral examination revealed 26 tooth ankyloses and 32, 42 congenital missing teeth. The 26 was highly-locked, showing root penetrating into the sinus floor. Treatment was performed with a modified surgery-first approach, which included 5 months of presurgical alignment phase to upright the 27 mesially-tilted tooth and to correct upper dental midline by 14 extraction. The surgeries included 3-pieces LeFort I impaction by using 14 and 26 extraction spaces as well as bilateral sagittal split ramus osteotomies setback with closing rotation and genioplasty. Upper and lower arches coordinated well soon after surgery. The posterior open bite settled well during postsurgical orthodontic phase. Appropriate vertical facial proportion and solid interdigitation were achieved after treatment. The treatment had successfully corrected the anterior open bite and long face problems, concomitantly solved her difficult molar ankyloses issue during the time of surgery, no further prostheses were required. Pleasing esthetic outcomes were achieved, contributing to patient’s psychosocial satisfaction.

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