To achieve these objectives, an orthodontic-orthognathic combined treatment was planned.įor this patient, in the field of the orthodontic and orthognathic surgery approach, there were two treatment options, namely surgically-assisted rapid palatal expansion followed by fixed orthodontic treatment and final double jaw orthognathic surgery or orthodontic decompensation followed by double jaw surgery with multipiece Le Fort I osteotomy. Treatment objectives were the following: (1) relieving dental crowding and gaining an ideal dental arch alignment (2) obtaining Class I dental and skeletal relationship with an ideal functional occlusion 3) fitting maxilla and mandible transversally by maxillary expansion (4) gaining ideal teeth and gingival exposure and (5) improving facial esthetics. This case report describes the orthodontic-orthognathic surgery treatment in a 22-year-old woman with skeletal Class II malocclusion due to mandibular retrognathia. During this phase of treatment, the aim is to remove dental interferences for the ideal correction of existing skeletal discrepancies. During the presurgical orthodontic treatment, dental decompensation by moving teeth to a proper position relative the skeletal bases, which is just the opposite of the camouflage treatment, is performed ( 3, 4). Therefore, in patients with severe A-P skeletal discrepancies, transverse maxillary skeletal constriction, airway problems, and improper facial esthetics, orthognathic surgery combined with orthodontic treatment is the best treatment alternative to gain ideal results regarding function, esthetics, and stability ( 4, 8– 10, 12– 18). In severe cases, camouflage treatment means that fitting teeth on improper skeletal bases can lead to possible periodontal problems, such as gingival recession in the lower anterior region, root resorptions, worsening of facial esthetics, and occlusal instability ( 3, 4, 8– 10). However, this treatment is limited by tooth movements for compensating the underlying skeletal discrepancies ( 3). In some instances, extractions of the mandibular second premolars are also performed for obtaining a Class I molar relationship by lower molar mesialization. Camouflage treatment is mainly based on the retraction of the upper incisors by extracting the upper first premolars or whole maxillary arch distalization using temporary anchorage devices and protraction of the lower incisors to resolve increased overjet ( 8– 14). In adult patients, camouflage orthodontic treatment can be an option when there are mild-to-moderate anteroposterior (A-P) skeletal discrepancies with acceptable vertical facial proportions and no transverse skeletal problems ( 8– 10). In growing patients, growth modification treatments either with removable or fixed functional applications, in which patient cooperation is the primary concern, are preferred ( 2– 7). In skeletal Class II patients, treatment alternatives vary according to the skeletal maturity level, severity of the malocclusion, facial appearance, and patient’s expectations and cooperation ( 1– 4). The treatment results were stable at the 1-year follow-up. After the orthodontic and orthognathic surgical treatment, the skeletal and dental imbalance was corrected, and functional occlusion and dental and skeletal Class I relationship were achieved. During the double jaw surgical procedure, the maxilla expanded and impacted with multisegmented Le Fort I osteotomy and the mandible advanced with BSSO. Because we used continuous mechanics, at the end of the decompensation period, we cut the maxillary arch wire distal to the lateral incisors into three pieces and waited for 3 months for vertical and transversal dental relapse. During orthodontic decompensation to relieve the crowding and to gain an ideal incisor inclination, four bicuspid extractions were performed. We planned orthodontic-orthognathic surgery with multipiece Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) to achieve ideal occlusion, stability, and facial esthetics. Skeletally, she showed transverse maxillary deficiency, maxillary vertical excess, and mandibular retrognathia. She had Class II molar and canine relationship with increased overjet, moderate crowding in both upper and lower jaws, and proclined upper and lower incisors. A clinical examination revealed a convex soft tissue profile and increased teeth and gingiva exposure both while smiling and in the natural rest position. A 22-year-old woman with severe skeletal Class II malocclusion was referred to our clinic.