This case report presents a case that underwent orthognathic treatment with intra-oral vertical ramus osteotomy (IVRO). The patient was a 19-year-old female with mandibular protrusion and severe maxillary anterior crowding. The overbite was +0.5 mm and the overjet -1.5 mm. She had orofacial pain and tenderness of the temporomandibular joints (TMJ) and surrounding muscles. The pre-surgical orthodontic treatment included the extraction of the maxillary right lateral incisor, maxillary right second premolar, maxillary left canine, mandibular left second molar and mandibular right second premolar. After 18 months of pre-surgical orthodontic treatment, the left and right sides of the mandible were set back 8 and 6 mm, respectively, via IVRO to improve mandibular protrusion. The total treatment period was 26 months. The patient showed the backward reaction of the mandible, which occurred after release of the maxillo-mandibular fixation. The usage of the Class II elastics during the post-surgical phase to maintain the overjet made the inclination of the maxillary incisors more lingual.
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