Early orthognathic surgery in growing Class III patients

This case series suggests that favorable longterm outcomes can be achieved with early surgical intervention in growing Class III patients. The following factors should be considered: 1. Early surgery is indicated in growing Class III patients with severe dentoskeletal misalignment who are unlikely to respond well to orthopedic treatment, based on prediction analysis of their craniofacial characteristics. 2. The optimal timing for early Class III surgery is during the postpubertal phase of the adolescent growth spurt. 3. During presurgical orthodontic treatment, decompensation must be at least adequate, or preferably slightly excessive, to counteract anticipated postsurgical mandibular growth. 4. When orthognathic surgery is performed in the late mixed dentition, as in Case 2, a mandibular sagittal split osteotomy should be avoided because of the risk of damage to the germs of the second molars during surgery and the increased risk of fractures if repeated surgery is required. 5. Early Class III surgery might be particularly valuable for female adolescents, given the potential for a significant psychosocial benefit from an improved appearance. Girls mature earlier than boys and thus undergo less mandibular growth in the postpubertal period, which might translate into a more stable surgical result. The possibility of undertaking early surgery in Class III patients should always be evaluated with caution, and informed consent is mandatory. Since true Class III growth continues during adolescence and the early adult years, there must be a mitigating circumstance, such as a patient's significant psychological need or desire, to justify early treatment.