Presurgical Orthodontics And Ivro In Class III Patient With Asymmetry

Class III malocclusions are more prevalent in Asians, particularly Southeast Asians, compared to Caucasians. In Southeast Asians, the incidence is as high as 15.8%. Treatment for severe mandibular protrusion may require orthodontic surgery, and 3D CBCT data is crucial for surgical planning, considering both aesthetic and functional factors. For mandibular setback, IVRO and SSRO are common, with IVRO offering a lower risk of nerve damage and temporomandibular joint disorders, though it requires careful post-operative management due to its sensitivity to stability. This case presents an IVRO surgery in a patient with mandibular protrusion and asymmetry, emphasizing preoperative and postoperative considerations. A 21-year-old male with skeletal Class III malocclusion, mandibular prognathism, and facial asymmetry was referred for orthodontic evaluation. The asymmetry involved maxillary canting and mandibular yawing, with no evidence of TMJ damage. He exhibited moderate crowding and a Class III molar relationship. After minimal presurgical orthodontics, the maxilla underwent Le Fort I osteotomy with impaction to correct the cant, and the mandible was repositioned with IVRO, correcting the yaw. Postoperatively, vertical skeletal elastics were applied to prevent anterior open bite. Close monitoring during follow-up minimized complications, achieving a satisfactory result. Post-surgical use of vertical elastics between maxillary and mandibular teeth enhances tooth extrusion and promotes stability. After IVRO, careful management of muscular forces and elastic application is vital to avoid relapse and ensure a successful outcome.