Periodontium Considerations In Orthodontic-Orthognathic Surgery Combined Treatment

A case report of reducing the risk of periodontal soft tissue loss in lower anterior teeth through periodontal augmentation surgery after orthodontic-orthognathic combined treatment in a high-angle skeletal Class III patient. A 21-year-old male presented with crowded teeth and mandibular prognathism, seeking orthodontic treatment. The diagnosis included Angle Class III malocclusion, skeletal Class III with a high-angle pattern, and concave facial profile. After 3 years of combined orthodontic-orthognathic treatment supplemented by periodontal augmentation surgery, the results showed well-aligned dental arches, normal overjet and overbite, ideal occlusion, improved facial profile and no significant gingival recession observed. Alveolar bone thickness varies among patients with different skeletal patterns. Among sagittal skeletal patterns, patients with Angle Class III malocclusion exhibit less periodontal support in the upper and lower incisor regions compared to Angle Class I patients. Among vertical skeletal patterns, the cortical bone thickness of the mandibular body progressively decreases from low-angle, to average-angle, to high-angle patients. Therefore, for skeletal Class III high-angle surgical patients, periodontal considerations should be emphasized. Techniques such as periodontal tissue regeneration can increase alveolar bone thickness, thereby reducing post-treatment soft tissue loss risk and ensuring safe tooth movement during orthodontics. For skeletal Class III high-angle patients requiring orthodontic-orthognathic treatment, periodontal considerations should be prioritized. Periodontal augmentation surgery can be employed to reduce the risk of post-treatment periodontal tissue loss.