Combined Orthodontic-Orthognathic Retreatment of Adult Skeletal Class II Deformity With Mandibular Deviation: A Surgery-Early Approach.

Objective: To assess clinical outcomes of the surgery-early approach in managing skeletal Class II malocclusion and mandibular deviation.

Materials and methods: A 21-year-old female underwent staged treatment: (1) limited presurgical orthodontics for dental alignment, (2) bimaxillary surgery (LeFort I impaction, BSSRO, and genioplasty) to correct skeletal discrepancies, and (3) postoperative orthodontic refinement using miniscrews and progressive archwires. Progress was monitored through clinical examinations, cephalometric analysis, and CBCT imaging.

Results: Skeletal Class I relationship, reduced mandibular plane angle, and stable TMJ function were achieved. Total retreatment duration was 24 months.

Conclusion: The surgery-early approach effectively addresses complex skeletal discrepancies with reduced retreatment time, contingent upon meticulous preoperative 3D assessment to define the safe anatomic range for tooth movement, ensuring periodontal integrity and stable outcomes. This necessitates interdisciplinary collaboration to achieve optimal outcomes.