Mandibular Asimetrinin Şeffaf Plaklar İle Ortognatik Cerrahi Tedavisi: Vaka Raporu/ Skeletal Class III Malocclusion And Mandibular Asymmetry Treatment With Clear Aligners in Orthognathic Surgery: A Case Report

Abstract

Objective: Aim of this case report is to present the stages and outcomes of orthognathic surgical treatment using clear aligners for an adult patient with skeletal Class III asymmetry. Case: 20-year-old female patient applied to our clinic with complaints of malocclusion and asymmetry. She had dental Class IV, skeletal Class III relationship (SNA: 74°, SNB: 77°, ANB: -3°), anterior open bite (overjet: 0 mm, overbite: -2 mm). Harmonious upper midline with the face and 5 mm deviated lower midline to the left. She had protruded and proclined upper incisors (U1-PP: 118°), protruded and retroclined lower incisors (IMPA: 82°). Orthognathic surgery with either fixed orthodontic treatment or clear aligners were recommended, and she chose to undergo orthognathic surgery with the Invisalign® system (Align Technology, California). In the 43-aligner treatment plan, lower incisor proclination improvement, and correction of incisor inclination through 50% sequential distalization in the upper jaw were aimed. To support decompensation, patient used Class II elastics, 3/16 inch 4.5 oz on the right and 1/4 inch 4.5 oz on the left. 2 mm maxillary impaction, 5 mm advancement, and asymmetric mandibular setback planned on Nemoceph 3D software. Patient was stabilized postoperatively with IMF screws and 3/16 inch 4.5 oz Class II triangular elastics on the left and vertikal on the right were used. At 45 days post-operation, refinement aligners were requested for occlusal improvements, with 22 and 10 additional aligners planned for leveling and alignment. Results: At the conclusion of treatment, Class I molar and canine relationships were achieved along with ideal overjet and overbite. The patient exhibited improved upper lip projection and symmetrical lower jaw, resulting in aesthetic and functional occlusion. Conclusion: Clear aligners are an effective method for treating Class III asymmetry with orthognathic surgery, providing an alternative treatment option that enhances both aesthetic and functional outcomes.