The correction of roll-type asymmetry using surgery first approach and minimal orthodontic treatment

Abstract

Conventionally, pre-surgical orthodontic treatment has been considered mandatory to eliminate transverse dental compensations in patients with severe facial asymmetry. Recently, surgery-first approach has been gaining popularity. However, this approach requires 3-D simulation of movements of bony segments during surgery because the occlusion before decompensation cannot be used as a guide for surgical planning. In some roll-type asymmetries, transverse dentoalveolar compensation can be resolved by the roll correction of both jaws. Antero-posterior dentoalveolar compensation also can be resolved by the clockwise rotation of both jaws. In this case report, we described a surgery-first approach including 3-D surgical simulation, fabrication of CAD/CAM surgical splint, and minimal postsurgical orthodontic treatment in a patient with roll-type asymmetry and mandibular prognathism. To select this kind of approach, the possibility of decompensation using roll correction and clockwise rotation should be evaluated using 3-D simulation of the surgery.