Bella Smile ↗Case report · Surgical orthodontics
Severe Skeletal Class III Correction with Invisalign and Two-Jaw Surgery
28-year-old female with severe skeletal Class III, underbite, open bite, posterior crossbites, and prognathic mandible
- Patient
- Adult (18–39), female
- Classification
- Class III
- Active treatment
- 20 months
- Published
- September 16, 2026
Presentation
Chief complaint. " I want to fix my underbite."
Diagnosis. 28-year-old female with a severe skeletal and dental Class III malocclusion characterized by a prognathic mandible, increased lower facial height, anterior open bite, and 2 mm negative overjet. She presented with posterior crossbites involving the maxillary second premolars, a maxillary dental midline shifted to the left, severely proclined maxillary incisors, and severely retroclined mandibular incisors.
Records
Before — Intraoral Photos
After — Intraoral Photos
Before — Profile Photo
After — Profile Photo
Before — Lateral Cephalometric Radiograph
After — Lateral Cephalometric Radiograph
Before — Panoramic Radiograph
After — Panoramic RadiographMeasurements
| Measure | Norm | Pre | Post |
|---|---|---|---|
| SNA | 82 | 80 | 85 |
| SNB | 80 | 85 | 83 |
| ANB | 2 | -6 | 2 |
| Wits | 0 | -15 | 6 |
| SN-MP | 32 | 32 | 35 |
| U1-SN | 102 | 117 | 107 |
| L1-MP | 90 | 79 | 84 |
| Overjet (mm) | 2–3 | -2 | 2 |
| Overbite (mm) | 2–3 | 1 | 2 |
Treatment
Objectives. Decompensate the maxillary and mandibular dentition for orthognathic surgery by retracting upper anterior teeth and proclining lowers, coordinate the arches and midlines, correct the skeletal Class III discrepancy and open bite, establish positive overjet and overbite, and achieve Class I canine and molar relationships with a stable functional occlusion.
Plan. Use Invisalign with micro-osteoperforations (MOPs) to accelerate treatment so she could have surgery sooner. to level, align, and presurgically decompensate the dentition. Place a surgical orthodontic appliance two weeks before surgery. Perform two-jaw orthognathic surgery with maxillary advancement and mandibular setback. Remove the surgical appliance six weeks postoperatively, rescan for Invisalign, and complete two refinements for final detailing and bite correction. Finish with bonded permanent retainers.
Appliances and materials
- Invisalign
- Bella Smile Surgical Appliance
Progress records
Outcome
The maxilla was advanced and inferiorly repositioned, while the mandible was set back, increasing the mandibular plane angle by 3°. The maxillary incisors were retracted, and the mandibular incisors were slightly proclined. The patient achieved Class I molar and canine relationships with a 2 mm overjet and ideal overbite. Facial balance improved significantly, with a more convex and harmonious profile.
Retention
- Fixed U2-2 permanent retainer
- Fixed L3-3 permanent retainer
- Invisalign Vivera retainers to be worn at night
Case reports are shared with patient authorisation. Individual results vary.