Camouflage Versus Orthognathic Surgery With 3D Digital Aligner Planning in Class III Malocclusion: A Retrospective Comparison of Aesthetic and Dentoskeletal Outcomes

Class III skeletal malocclusion can be managed with surgical or nonsurgical orthodontic therapy. In selected cases, camouflage treatment may be planned after an accurate evaluation, also including Wits appraisal and Holdaway angle. Several studies have already analyzed the achieved outcomes between orthodontic camouflage and surgical therapy using multibracket appliances. However, recent advances in three-dimensional (3D) digital planning with clear aligners (CA) have opened new opportunities for managing Class III discrepancies. This research aims to evaluate, retrospectively, the dentoskeletal and aesthetic outcomes obtained using three-dimensional (3D) digital planning with clear aligners with 2 different protocols (surgical approach versus camouflage). Lateral x-rays of 23 Class III patients treated successfully (8 patients with a camouflage protocol and 15 with bimaxillary surgery) were collected and analyzed using Dolphin (Dolphin Imaging & Management Solutions, Chatsworth, CA) before (T0) and after (T1) treatment. Statistical comparisons between the 2 groups were performed using the t test and ANCOVA test (P < 0.05). Independent t tests revealed statistically significant improvements in the surgical group for SNB (-2.7 degrees), Wits (+6.8 mm), Overjet (+5.7 mm), and IMPA (+3.3 degrees). However, ANCOVA revealed significant group effects only for SNB and ANB, favoring the surgical approach, and for upper-incisor inclination, favoring the camouflage approach, indicating that baseline severity accounted for most of the differences observed in unadjusted analyses. Both camouflage and surgical protocols with clear aligners achieved clinically meaningful outcomes; however, statistically significant dentoskeletal improvements were observed only in the surgical group, while the camouflage approach showed satisfactory root torque control.