This article describes the treatment of a skeletal Class III patient with a severe anterior cross-bite, open-bite, crowding and a tongue thrust habit. Two treatment options were proposed: -conventional orthodontics to camouflage the skeletal anomaly and traditional orthodontics/orthognathic surgery approach. The surgical orthodontic approach was selected, but treatment was started 3 years 8 months from the treatment plan presentation appointment. Surgery was scheduled when pre-surgical orthodontics was finished; a Le Fort I osteotomy was performed for maxilla advancement and a bilateral sagital split osteotomy (BSSO) for mandibular setback. Post-surgical orthodontics was applied for finishing and detailing the occlusion. Total treatment time was 24 months. Good facial balance and occlusal relationships were achieved.
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