A surgery-first approach using single-jaw rotational mandibular setback in low-angle mandibular prognathism

For the treatment of low-angle mandibular prognathism, rotational mandibular setback surgery is usually performed with Le Fort I maxillary osteotomy to rotate the maxillomandibular complex simultaneously. However, this maxillary surgery can be replaced with the orthodontic intrusion of maxillary posterior teeth. Single-jaw rotational mandibular setback surgery can be done with a surgery-first approach by planning orthodontic rotation of the maxillary occlusal plane with the simulation of the postsurgical forward mandibular rotation. This case report describes this approach applied to a 19-year-old female patient with low-angle mandibular prognathism but without maxillary deficiency. A Class II open bite was formed by the rotational setback surgery. During postsurgical orthodontic treatment, the maxillary total arch was distalized with maxillary molar intrusion using palatal mini-implants and lever. This case report demonstrates that orthodontic rotation of the maxillary occlusal plane and simulation of mandibular rotation can replace maxillary surgery and enable single-jaw rotational mandibular setback surgery with a surgery-first approach. (Am J Orthod Dentofacial Orthop 2021;160:617-28)