Skeletal Class III Surgical-Orthodontic Treatment and Remote Digital Monitoring during COVID-19 Pandemic: A Case Report

Abstract

Moderate to severe cases of skeletal Class III malocclusion, where residual growth is no longer present and orthodontic camouflage would not achieve satisfactory outcomes, are good candidates for a combined surgical-orthodontic approach. We present the case of a 34-year-old healthy male with skeletal Class III malocclusion, where aesthetics and masticatory function were further worsened by maxillary and mandibular transverse discrepancy, hyperdivergent pattern, moderate dental crowding, occlusal contacts present only on molars, negative overjet and overbite. The management of the case included a pre-surgical phase of surgically assisted rapid palatal expansion (SARPE) and an orthodontic treatment with fixed multi-bracket appliance, a surgical phase consisting in Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), and a myofunctional physical therapy targeting orofacial muscles following the orthognathic surgery. The pre-surgical phase was additionally integrated with a system of remote digital monitoring, such as Dental Monitoring®, to early detect any orthodontic emergency. As in-office visits were abruptly interrupted because of COVID-19 pandemic, the remote digital system also permitted to regularly monitor the patient at long-distance. In conclusion, a case of skeletal Class III malocclusion was successfully managed with a multidisciplinary approach which involved orthognathic surgery, orthodontic treatment, and myofunctional physical therapy. The additional integration of remote digital technologies, such as Dental Monitoring®, may provide a continuity of care to orthodontic patients in times of COVID-19 pandemic, when the regularity of non-urgent chairside appointments might be disrupted.