An adult patient has a skeletal Class III relationship with a crossbite, obstructive sleep apnea, and a poor occlusion. What treatment is indicated?

Correct answer: A. Combined orthodontic treatment and orthognathic surgery

• A. CORRECT. In a SKELETALLY MATURE adult, a true skeletal Class III discrepancy cannot be corrected by tooth movement — growth modification is no longer possible. Orthodontics alone would only camouflage (and often worsen) the problem. The correct plan is presurgical orthodontic decompensation, then orthognathic surgery (commonly maxillary advancement with or without mandibular setback), then postsurgical finishing. Maxillomandibular advancement is also one of the most effective surgical treatments for obstructive sleep apnea, so both problems are addressed together.
• B. Removable appliances cannot address a skeletal discrepancy in an adult.
• C. Surgery without presurgical orthodontics leaves dental compensations that prevent the jaws from being placed in their correct skeletal position, limiting the achievable movement and stability.
• D. Camouflage orthodontics in a significant skeletal Class III typically requires extreme dental compensation, worsens the profile, and does nothing for the airway.

Note: Maxillomandibular advancement enlarges the pharyngeal airway in all dimensions and reports success rates approaching those of CPAP in selected OSA patients.