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Rehabilitation of angle class III deformity concomitant with oligodontia with great functional, esthetic and social impairment for the patient needs a combined orthodontic-surgical treatment. To achieve secure, quick and stable dental and facial rehabilitation, backward planning with cone-beam CT navigation best supports the multidisciplinary approach. Here we show longtime stability of more than 5 years after thoroughly planning, bimaxillary osteotomy with an implant guided transpalatal distractor (Surgi-Tec All-in-One), conceptional extractions and alveolar augmentation in a male patient with ICD10 (K00.0; K07.1). The diagnosis included craniomandibular malfunction, dysgnathia class III, maxillary retrognathia with horizontal and transverse narrowing of the maxilla, mandibular prognathia with lingual tipping of the mandibular front teeth, multiple missing of permanent teeth and hypodontia of deciduous teeth with cones and platelet deficiency and thrombocytopenia. The treatment included orthodontics with multi-brackets in the mandible, maxillofacial surgery with Le-Fort-Osteotomy and reconstruction and augmentation of the maxilla with a bone graft of the iliac crest with vertical subtotal separation, Obwegeser/Dal Pont-osteotomy, modified according to Hunsuck-Epker in the mandible, implantation and prosthetics. The result was good osseointegration > 80 on the Ostell ISQ-scale and the successful healing of the augmentation even for the enossal implants. Facial proportions and the profile expression showed harmonized. The dental situation was satisfying in function as well as in the esthetic aspect. At the follow-up dates after 6, 12, 18, 24, 36 and 60 months the results remained stable. The patient was highly satisfied. Discussion of methods is performed additionally. ISSN: 2643-3907 DOI: 10.23937/2643-3907/1710027 Nilius et al. Res Rep Oral Maxillofac Surg 2019, 3:027 • Page 2 of 9 • craniomandibular malfunction, dysgnathia class III, maxillary retrognathia with horizontal and transverse narrowing of the maxilla, mandibular prognathia with lingual tipping of the mandibular front teeth (Figure 1). Additionally, we diagnosed multiple missing of permanent teeth and hypodontia of deciduous teeth with cones (Figure 2, Figure 3 and Figure 4). Systemically, the tion of the maxilla needs fixation in the palate and not only along the teeth to avoid cortical decay and root resorptions because of teeth movements. The first bone-borne device with a titanium implant in the palatal bone developed by Surgi-Tec was published by Mommarts [15] and since then has been proved well [16-18]. A combination of bimaxillary osteotomie with palatal distraction, necessary extractions and alveolar augmentation can be the best procedure, as was shown formerly and also in the presented case [1921]. Therefore, the implant guided transpalatal distractor (IGPD) is an improved instrument for jaw stabilization and transversal elongation in adult patients with severe class III malocclusions [20-23]. The gentle distraction usually in combination with a Le Fort-osteotomy leads to supporting osteogenesis and therefore longtime stability of the additional procedures like implant insertion [17,19,24-27]. To achieve secure, quick and stable dental and facial rehabilitation in such complicated anatomic situations, backward planning with 3D navigation best supports the multidisciplinary approach. Cone-beam CT (CBCT) with flat-panel detectors and devices for dose reduction has been proved first in oncology and angiography, but nowadays is used widely in maxillofacial practice [28]. Additional planning software like NobelGuide® (Sweden) with Procera [29-33] or SIMPLANT® (module craniofacial, Materialize, Belgium) [27,34,35] facilitate planning and lead to precise positioning of the implants especially in the esthetic zone in implant supported reconstruction [27,32,36-40]. The procedure is minimal invasive with the possibility to insert dental and facial implants in one time. More than this, for the patient, the CT-guided planning and surgery means reduction of time of surgery as well as reduction of trauma and postoperative complications, which was confirmed by several studies, especially the randomized studies of [41-46]. The aim of our all-in-one concept was to reduce the necessary orthodontic as well as the surgical efforts but always on the background of the best possible dental and prosthetic rehabilitation. With the presented case, we show longtime stability of more than 5 years after thoroughly planning, bimaxillary osteotomy with an implant guided transpalatal distractor (Surgi-Tec All-in-One), conceptional extractions and alveolar augmentation in a patient with class III malocclusion and oligodontia. Material and Methods

Dental Rehabilitation in Class III Anomaly with Oligodontia after Palatal Distraction and Osteotomy under Cone-Beam CT Assistance