Analysis of the sagittal positioning of the maxilla in the planning of orthognathic surgery: case report

Abstract

Objective: To report the planning and management of a clinical case of Class III deformity, discussing the main methods for determining the sagittal positioning of the maxilla in orthognathic surgery planning. Case report: A 21-year-old male patient presented with the complaint of a “large chin” and was diagnosed with Class III dentofacial deformity associated with maxillary deficiency and mandibular prognathism. Planning was performed using virtual software, applying the true vertical line combined with soft tissue analysis to define the anteroposterior position of the maxilla. Treatment included preoperative orthodontics followedby bimaxillary orthognathic surgery (Le Fort I osteotomy and sagital split ramus osteotomy) with genioplasty. Facial aesthetic parameters and the relationship of incisors to soft tissue references were considered. Conclusion: The exclusive use of skeletal cephalometric references has limitations. The association with soft tissue parameters improves aes-thetic predictability, especially in maxillary deficiency cases, highlightingthe importance of individualized surgical planning.