Class III malocclusion with missing maxillary central incisor and facial asymmetry treated with orthodontics and intraoral vertical ramus osteotomy

A 28-year-old female with a Class III malocclusion and facial asymmetry was treated with orthodontics combined with intraoral vertical ramus osteotomy (IVRO). She had severe skeletal Class III (Wits: -9.7 mm). She was missing her maxillary left central incisor and had a fixed three-unit bridge on her maxillary anterior teeth. The patient presented a concave profile with a protrusive mandible. Her dental and mandibular midline was shifted 3 mm toward the left. After presurgical orthodontic treatment, IVRO was performed. The total active treatment time was 16 months including surgery. Both occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment. Posttreatment records after 2 years showed excellent results with good, stable occlusion, facial balance and harmony, and long-term stability.