A patient has a significant skeletal Class III malocclusion with sleep apnea who is unhappy with facial appearance. What is the recommended treatment?

Correct answer: D. Orthodontic treatment combined with orthognathic surgery

• A. Incorrect. Orthodontic camouflage cannot correct a significant skeletal Class III discrepancy — only mild cases.
• B. Incorrect. Extraction-based camouflage can mask mild Class III, but is inadequate for significant skeletal discrepancy with facial concerns.
• C. Incorrect. CPAP manages sleep apnea symptoms but does not correct the skeletal discrepancy or facial appearance.
• D. Correct. Significant skeletal Class III with facial appearance concerns requires COMBINED ORTHODONTICS + ORTHOGNATHIC SURGERY. Orthodontics aligns the teeth on their respective bases; surgery (Le Fort I and/or BSSO) corrects the underlying skeletal discrepancy. This also frequently improves airway and sleep apnea.