Introduction: The routine use of antibiotic prophylaxis in dental implant surgery remains controversial. This systematic review and meta-analysis aimed to evaluate the effectiveness of preoperative antibiotics in preventing early implant failure and postoperative infection in healthy individuals. Materials and Methods: An electronic search of PubMed, Scopus, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Library was conducted for studies published between 2000 and 2024. Randomized controlled trials and clinical studies comparing preoperative systemic antibiotic administration with placebo or no antibiotic use were included. The primary outcome was early implant failure; secondary outcomes included postoperative infection and complications. Two reviewers independently extracted data using a standardized form. Methodological quality was assessed with the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated using GRADE. Meta-analysis was performed in Review Manager (RevMan) v5.4 using a fixed-effect Mantel-Haenszel model to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs); heterogeneity was assessed with I2 and Cochrane Q statistics. Results: Eight studies involving 2,026 evaluable patients met the inclusion criteria. The pooled patient-level implant-failure rate was 2.7% in the antibiotic group and 6.9% in the control group. The overall RR was 0.42 (95% CI: 0.27-0.66; p < 0.001), indicating a statistically significant 58% relative risk reduction; the 95% CI did not cross the null (RR = 1). Postoperative infection rates were lower with antibiotics in several trials, although definitions varied across studies (I2 = 0%; Cochrane Q p = 0.730). Conclusion: Preoperative antibiotics significantly reduced early implant failure in pooled analysis, yet absolute event rates remained low in healthy patients. Routine antibiotic prophylaxis should be individualized, balancing modest clinical benefit against antibiotic stewardship principles. Keywords: Antibiotic; Antibiotic prophylaxis; Dental implant; Implant failure; Implant placement; Preoperative antibiotics.

Introduction: Rhinoplasty remains one of the most technically demanding procedures in facial plastic surgery. Artificial intelligence (AI) has emerged as a transformative technology with po-tential to address longstanding challenges in surgical subjectivity, outcome prediction, and patient communication. This narrative review synthesizes current evidence on AI applications across all phases of rhinoplasty care—from preoperative simulation and patient counseling to in-traoperative guidance and postoperative outcome assessment—while critically exam-ining persistent limitations and ethical considerations. Materials and Methods: A literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for studies published between 2015 and 2026. Thirty-nine studies met the inclusion criteria.Results: AI applications span five principal domains: preoperative planning and simulation; aes-thetic analysis and attractiveness quantification; large language model–based patient counseling; intraoperative guidance and augmented reality; and postoperative outcome evaluation. Reported model accuracies ranged from 82% to 97%. Large language mod-els performed comparably or superiorly to expert surgeons in structured counseling eval-uations. Conclusion: AI offers substantial promise for enhancing precision and reproducibility in rhinoplasty, but algorithmic bias, limited dataset diversity, absence of prospective validation, and unresolved ethical concerns currently restrict widespread clinical adoption. AI should be regarded as a powerful adjunct to, rather than a replacement for, surgical expertise. Keywords: Artificial intelligence; Rhinoplasty; Machine learning; Deep learning; Large language model; Surgical simulation; Outcome prediction; Facial plastic surgery. 

Introduction: Precise transfer of implant positions is critical for the success of full-arch rehabilitations. Photogrammetry-based workflows aim to mitigate the cumulative stitching errors common in intraoral scanning (IOS), though performance varies across different systems and protocols. To evaluate the accuracy (trueness and precision) of photogrammetry for edentulous complete-arch implant capture compared to IOS and conventional impressions. Materials and Methods: PubMed, Web of Science, Scopus, and Embase were searched for publications from 2010 through 2025; the final search was run on January 15, 2026. Forty-eight studies (11 clinical/in vivo and 37 in vitro) assessing photogrammetry in full-arch scenarios (≥4 implants) were included. Primary outcomes were linear, angular, and 3D deviations. Risk of bias was assessed with QUADAS-2 or setting-specific modifications, and certainty was assessed by outcome domain using GRADE. Owing to methodological heterogeneity, a qualitative synthesis and risk-of-bias-stratified robustness analysis were performed. Results: Forty-eight studies were included. Overall risk of bias was low in 3 studies (6.3%), raised some concerns in 37 (77.1%), and was high in 8 (16.7%). The seven formal GRADE outcome domains were rated moderate (n = 1), low (n = 3), or very low certainty (n = 3). The only moderate-certainty domain—clinical precision of photogrammetry versus IOS—was based on correlated endpoints from one 19-participant cross-over study, which reported lower mean 3D spatial-fit deviation with photogrammetry (7 ± 5 μm) than IOS (61 ± 54 μm). Laboratory trueness and precision findings were mixed and protocol-dependent. Conclusion: Photogrammetry may provide a precision advantage in selected complete-arch workflows, but the evidence does not establish consistent clinical superiority over IOS or conventional impressions. Confidence is limited by the predominance of studies with methodological concerns, indirect laboratory evidence, protocol heterogeneity, and reliance on single studies for several outcome claims. Device- and protocol-specific verification remains necessary pending independent clinical comparisons linked to prosthesis-level outcomes.Keywords: Photogrammetry; Dental implants; Dental impression technique; Edentulous mouth; Dental prosthesis; Implant-supported.

Introduction: Nomograms are effective statistical tools that may be integrated into medical practice to calculate treatment outcomes, diagnose diseases, and guide treatment decisions based on patient-specific variables. The current study aimed to develop a novel nomogram to stratify patients with oral epithelial dysplasia (OED) into different risk groups based on their clinic-pathological data. Materials and Methods: Clinico-pathological data of all cases of OED reported during a twelve-year period were retrospectively retrieved. The presence of malignant transformation (MT) among them was confirmed from the departmental cancer registry. Bivariate regression analyses and multivariate logistic regression were used to analyze the risk factors and the role of multiple independent variables, respectively. A p-value < 0.05 was considered statistically significant. An OED nomogram was constructed from the above data. Results: A novel OED nomogram was constructed using three variables - induration, texture, and clinical type. The Receiver operating characteristic (ROC) curve demonstrated an area under the curve (AUC) of 0.753, indicating fair predictive potential. MTR of our study population was 9.8%. Conclusion: The OED nomogram serves as a valuable tool for predicting MT in OED patients. Its application in dental science for stratifying patient risk enables clinicians to plan treatment and follow-up visits efficiently. Keywords: Nomogram; Oral cancer; Oral epithelial dysplasia; Oral potentially malignant disorders.

Introduction: This pilot study aimed to evaluate the uptake of the radiopharmaceutical 99mTc in the mandibular condyles and cervical vertebrae on bone scintigraphy and to assess the correlation between inter-condylar metabolic disparities and longitudinal soft-tissue changes in patients presenting with progressive mandibular deviation. Materials and Methods: This prospective longitudinal pilot study enrolled patients referred to orthodontic and oral and maxillofacial surgery clinics with suspected condylar hyperactivity and mandibular deviation. Bone scintigraphy was performed at baseline to assess 99mTc-MDP uptake in both mandibular condyles normalized against the first cervical vertebra (C1). Standardized facial photographs were obtained at baseline and after a 6-month prospective follow-up period to evaluate soft-tissue asymmetry changes. Results: Over the 6-month observation period, the most pronounced soft-tissue variations were observed in An.b (mean: 62.40 ± 33.69) and Gn.a (mean: 38.59 ± 34.41). Bivariate Pearson correlation analysis revealed a statistically significant, strong negative correlation between inter-condylar 99mTc uptake differences (L−R) and changes in pog.oc (r = -0.821, 95% CI: [-0.96, -0.26], p = 0.012). Non-significant moderate-to-strong correlations with inter-condylar uptake differences were noted for Gn.b (r = -0.643, p = 0.086), ph.b (r = 0.607, p = 0.110), and pog.b (r = 0.571, p = 0.139). Conclusion: Preliminary findings suggest that quantitative 99m Tc bone scintigraphy demonstrated preliminary correlations with specific regional soft-tissue changes. Given the small sample size and lack of diagnostic validation against a reference standard, these findings reflect exploratory associations rather than predictive capability. Larger prospective studies are required to clarify the clinical utility of semi-quantitative scintigraphy in asymmetry management. Keywords: Mandibular condyle; Condylar hyperactivity; Bone scintigraphy; Technetium 99mTc medronate; Facial asymmetry.

Introduction: Traumatic dental injuries (TDIs) are common among school-aged children and often require immediate and appropriate first-aid management to improve treatment outcomes. However, evidence regarding children’s knowledge and intended responses to TDIs in Iran remains limited. This study aimed to assess the knowledge and self-reported practice of Iranian elementary school students regarding the emergency management of TDIs and to identify associated factors. Materials and Methods: A descriptive-analytical cross-sectional study was conducted among 487 students aged 10–13 years from four public elementary schools in Tehran, Iran. Participants completed a structured self-administered questionnaire comprising demographic characteristics, 10 knowledge items, and 5 scenario-based self-reported practice items related to TDI management. Knowledge and practice scores were converted to percentages, with higher scores indicating better performance. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and multiple linear regression analysis. Results: The mean age of participants was 10.73 ± 0.85 years, and 57.1% were female. The mean knowledge score was 64.83 ± 9.54, while the mean self-reported practice score was 80.89 ± 16.30. Although most students recognized the importance of seeking immediate dental care after tooth mobility (82.1%), only 6.6% knew that an avulsed permanent tooth could be replanted. Knowledge regarding the critical extra-alveolar time and appropriate storage media for avulsed teeth was also low. Only 4.5% of participants selected immediate replantation as the correct management of an avulsed tooth, and 17.7% identified milk as an appropriate storage medium. Regression analysis showed that knowledge scores were positively associated with previous TDI training (β = 0.15, p = 0.001) and negatively associated with age (β = −0.10, p = 0.03). Self-reported practice scores were associated with gender (β = 0.19, p < 0.001), while an unexpected inverse association was observed with previous training (β = −0.15, p = 0.001). Conclusion: Elementary school students demonstrated inadequate knowledge regarding the emergency management of TDIs, particularly tooth avulsion. School-based educational interventions are needed to improve emergency preparedness and evidence-based responses to dental trauma. Keywords: Tooth injuries; Knowledge; Practice; Students; Child; Adolescent.

Introduction: This study aimed to evaluate the influence of different access cavity designs (conservative versus traditional) and the impact of thermocycling and load cycling on the fracture resistance of endodontically treated molars. Materials and Methods: In this in vitro investigation, sixty extracted human molars were selected and allocated into six groups based on access cavity design and subsequent thermocycling (1000 cycles between 5 °C and 55 °C) and load cycling (200,000 axial cycles at 80 N) protocols. Root canal treatment was performed on all specimens using standardized endodontic procedures. Fracture resistance was subsequently assessed using a universal testing machine. Results: The mean fracture resistance of the teeth with conservative access cavity preparation was significantly higher than that of traditional preparation (P = 0.044). Furthermore, the application of thermocycling and load cycling significantly reduced fracture resistance across all tested groups (P < 0.05). Conclusion: These findings underscore the critical roles of access cavity design and simulated functional aging conditions in determining the long-term structural durability of endodontically treated teeth. Keywords: Root canal therapy; Fracture resistance; Load cycling; Thermocycling; Access cavity Preparation. 

Introduction: This study aimed to investigate the effect of adding 10-MDP monomer to resin-modified glass ionomer on its compressive strength and microhardness. Materials and Methods: In this experimental study, an acetonic stock solution of 10-MDP was diluted with RMGI liquid to achieve final 10 MDP concentrations of 0%, 5%, 10%, and 15% (w/v). According to ISO 9917-1, compressive strength was evaluated on cylindrical samples with 4*6 mm dimensions (n = 7) by a universal testing machine with a crosshead speed of 1mm/min and a force of 5KN. For hardness measurement, cylindrical samples with dimensions of (2 * 4mm) were prepared for each group (n = 7), and the Vickers hardness test was performed. Data were analyzed by one-way ANOVA, and Tukey’s test (α = 0.05). Results: There was no significant difference between the groups in terms of compressive strength. The hardness in the RMGI + 10% 10-MDP group was significantly higher than all the studied groups and the control group has a significantly higher average hardness than the RMGI + 15% 10-MDP group. Conclusion: The addition of 10% (w/v) of 10-MDP to the resin-modified glass ionomer significantly improves its hardness, without affecting its compressive strength. Keywords: Resin modified glass ionomer; 10-MDP monomer; Compressive strength; microhardness.

Introduction: Stress is an important factor affecting education and clinical practice of dental students. The purpose of the present study was to assess stress levels of dental students using the validated PSS-14 questionnaire in Iran. Materials and Methods: A cross-sectional study was conducted in 2024 using stratified non-random sampling method on Iranian undergraduate dental students. Following ethical clearance, the concurrent validity of the DASS-21 and the PSS-14 questionnaires was assessed on a sample of dental students. The Persian version of the PSS-14 questionnaire in addition to demographic characteristics, history of COVID-19 vaccination status and systemic disease in student/family member was used for data collection electronically. Data was analyzed using SPSS ver. 26.0, descriptive and analytical analysis performed (p < 0.05). Results: In the first phase, 211 subjects responded and the concurrent validity was confirmed (r = 0.621, p < 0.001). In the second phase, 420 students replied 53.1% were female (n = 223) and 46.9% were male (n = 197), with a mean age of 23.5 (SD = 2.7) years. The mean stress score of the respondents was 26.7± 8.1 out of 56 (female: 43.14 (SD = 7.90) and male: 38.18 (SD = 7.54). There was a significant association between stress level and being female (B = -0.344, p = 0.000), having lower Grade Point Average (GPA) (B = -0.136, p = 0.008), having systemic disease in students’ family (B = 0.158, p = 0.001), and studying in Type I universities (B = -0.105, p = 0.036).  Conclusion: PSS-14 and DASS-21 questionnaires exhibited high concurrent validity. In the post-COVID-19 era, stress levels were modest among dental students in Iran. There is a need for stress management training, especially for high-risk students. Keywords: COVID-19; Students; Dental; Pandemics; Stress disorders; Post-traumatic.

Introduction: Oral squamous cell carcinoma is an uncommon and potentially aggressive malignant tumor arising from Oral epithelial remnants. Identification of molecular alterations involved in Oral squamous cell carcinoma may contribute to the discovery of reliable diagnostic and prognostic biomarkers and potential therapeutic targets. PRKAR1A encodes the regulatory subunit type I-alpha of protein kinase A (PKA) and may play an important role in cellular signaling and tumor development. This study aimed to evaluate PRKAR1A gene expression in peripheral blood samples from patients with Oral squamous cell carcinoma compared with healthy individuals and to investigate its association with clinicopathological characteristics of the disease. Materials and Methods: In this case-control study, peripheral venous blood samples were collected from 30 patients with histopathologically confirmed Oral squamous cell carcinoma and 30 healthy individuals matched for age and sex. Total RNA was extracted from blood samples using the Viva 2-Step RNA extraction method. Following reverse transcription, quantitative real-time polymerase chain reaction (qRT-PCR) was performed to determine PRKAR1A mRNA expression. GAPDH was used as the internal reference gene, and relative gene expression was calculated using the 2^−ΔΔCt method. Statistical analyses were selected according to the distribution and type of the variables. Independent-samples t-test or Mann–Whitney U test was used for comparison between the two study groups, as appropriate. Associations between PRKAR1A expression and clinicopathological characteristics were evaluated using appropriate parametric and non-parametric tests. Results: PRKAR1A mRNA expression was significantly lower in peripheral blood samples from patients with Oral squamous cell carcinoma compared with healthy controls (P < 0.05). Reduced PRKAR1A expression was also associated with more advanced tumor stage, poorer histological grade, and the presence of metastasis (P < 0.05). Conclusion: The findings suggest that reduced PRKAR1A expression in peripheral blood may be associated with Oral squamous cell carcinoma and with clinicopathological indicators of tumor progression. PRKAR1A may have potential as a molecular biomarker of Oral squamous cell carcinoma. However, the relatively small sample size and absence of HPV assessment should be considered when interpreting these findings. Larger, adequately powered studies are required to validate the diagnostic and prognostic value of PRKAR1A in Oral squamous cell carcinoma. Keywords: PRKAR1A; Oral squamous cell carcinoma; Gene expression; PKA signaling.

This clinical report describes the prosthetic rehabilitation of a patient following a maxillary resection performed to treat Mucoepidermoid Carcinoma. Following hemi maxillectomy and total resolution of the tumor, implant placement was digitally planned to use the dual-scan technique, and implants were surgically inserted with the aid of a printed acrylic surgical guide. After successful osseointegration, a removable implant-supported overdenture retained by stud attachments was fabricated to improve prosthetic stability and minimize rotational and translational displacement under functional loading. Keywords: Maxillary defect; Implant-supported overdenture; Prosthetically driven implant insertion; Maxillofacial prosthesis.

Persistent post-treatment apical periodontitis may remain after root canal treatment when microbial control is incomplete or orthograde retreatment is impractical. This four-case series describes endodontic microsurgery performed with magnification, root-end resection, ultrasonic retro-preparation, and calcium silicate-based retrograde materials, and places the cases in the context of a focused narrative review. Preoperative cone-beam computed tomography was used for surgical planning. The cases involved symptomatic or suppurative lesions in previously treated teeth for which existing crowns, posts, or prior retreatment limited further orthograde management. At 4–6 months, all patients were clinically asymptomatic and the available periapical radiographs showed early favorable healing. No standardized postoperative pain scores were collected. A focused narrative search of PubMed/MEDLINE, Crossref metadata, and journal websites identified nine recent case reports or small series (26 patients/cases) published from 2022 through August 2026. The reports included conventional, guided, navigated, and bone-lid approaches, together with case-based microbiologic and histologic findings; reported clinical outcomes were generally favorable but heterogeneous. The cases in this report are distinct from the 2023 case published by Soesilo et al.; no text or figures from that report were reused. Because this is a small uncontrolled series with short follow-up and nonstandardized outcome assessment, the findings are preliminary. Endodontic microsurgery can be considered a tooth-preserving option in carefully selected cases when nonsurgical retreatment is not feasible, but longer prospective follow-up with standardized clinical and radiographic outcomes is required. Keywords: Apicoectomy; Cone-beam computed tomography; Endodontic microsurgery; Post-treatment apical periodontitis; Root-end filling.

Multiple primary malignancies (MPMNs) pose a diagnostic challenge, particularly when a second primary tumor is mistaken for metastasis or a benign lesion related to a known malignancy. This case report highlights the clinical consequences of delayed diagnosis in a patient who developed a second primary squamous cell carcinoma (SCC) of the tongue in the setting of colon adenocarcinoma. A 74-year-old female with a history of colon adenocarcinoma presented with a persistent ulcerative lesion on the left lateral border of the tongue. The lesion was initially managed with topical corticosteroids under the presumptive diagnosis of aphthous ulceration or localized inflammation. Over seven months, the lesion progressively worsened. Incisional biopsy eventually revealed poorly differentiated squamous cell carcinoma. Subsequent PET/CT imaging demonstrated ipsilateral cervical lymph node involvement, consistent with advanced disease. Owing to progression of the malignancy and the patient’s deteriorating systemic condition, definitive surgical treatment could not be performed, and the patient subsequently died. This case demonstrates the critical risk of diagnostic overshadowing and emphasizes the necessity of a strict clinical protocol: any persistent or non-healing oral mucosal ulceration exceeding 2 weeks in oncology patients must mandate an immediate diagnostic biopsy rather than prolonged empirical treatment. Keywords: Multiple primary malignancies; Squamous cell carcinoma; Tongue; Oral cancer; Delayed diagnosis; Colon adenocarcinoma.

Isolated plasmacytoma relapse of multiple myeloma (MM) is uncommon and portends a poor prognosis; mandibular involvement is exceptionally rare, and its clinical presentation in the post-autologous stem cell transplantation (ASCT) setting, particularly in patients with prior bisphosphonate exposure, can closely mimic medication-related osteonecrosis of the jaw (MRONJ), creating a critical diagnostic pitfall. A 62-year-old male with MM in sustained remission following ASCT and lenalidomide maintenance presented with a seven-month history of a non-healing extraction socket and progressive exophytic mandibular mass. Prior zoledronic acid therapy led to an initial diagnosis of MRONJ, delaying biopsy. Clinical examination revealed a 4×3 cm firm mass with lingual bone exposure; contrast-enhanced CT demonstrated osteolytic cortical destruction with inferior alveolar canal invasion and indeterminate incidental vertebral lytic foci. Incisional biopsy confirmed sheets of atypical plasma cells with eccentric nuclei and prominent mitotic activity, consistent with plasmacytoma. Comprehensive systemic workup, including bone marrow biopsy and serum protein electrophoresis, confirmed the absence of systemic MM relapse. The patient was treated with external beam radiotherapy (40 Gy in 20 fractions), achieving significant lesion regression. Focal residual bone exposure (<1 cm) attributed to combined bisphosphonate-radiation osteonecrosis was managed conservatively. The patient reported functional recovery and maintained acceptable quality of life at the three-month follow-up, with no evidence of local recurrence or systemic relapse. This case highlights that persistent oral lesions in MM patients must not be reflexively attributed to MRONJ without histopathological verification, especially when lesions fail to resolve following bisphosphonate cessation. Multidisciplinary surveillance at the oncology–dentistry interface is essential to avoid diagnostic delay in this vulnerable population. Keywords: Multiple myeloma; Plasmacytoma; Mandibular neoplasms; Stem cell transplantation; Case report.

Multidisciplinary team conferences (MDTC) significantly improve outcomes in complex malignancies such as head and neck squamous cell carcinoma (HNSCC). However, diagnostic delays in early-stage oral malignancies remain a substantial obstacle to optimal prognosis. A 28-year-old male with a history of substance use presented with persistent, severe tongue pain previously misdiagnosed as oral lichen planus and treated empirically for four months without symptom relief. Clinical and histopathological reassessment confirmed a poorly differentiated squamous cell carcinoma (SCC) on the dorsal tongue. The patient underwent oncologic surgical resection, neck dissection, and adjuvant chemoradiotherapy. Post-treatment recovery was characterized by severe functional limitations, psychological distress, and substance relapse. Comprehensive multidisciplinary rehabilitation—encompassing oral medicine specialists, head and neck oncologists, speech therapists, nutritionists, prosthodontists, and psychiatric support—facilitated long-term functional recovery, addiction cessation, and a disease-free state at the 2-year follow-up. This case highlights the vital role of oral medicine specialists within the MDTC framework, particularly in accurate differential diagnosis, reducing diagnostic delay, managing oral complications during cancer therapy, and orchestrating comprehensive long-term supportive care. Keywords: Head and neck neoplasms; Squamous cell carcinoma; Diagnostic delay; Multidisciplinary care team; Oral medicine.

Severe supraeruption of maxillary molars following loss of opposing mandibular teeth can critically reduce interarch space and compromise implant-prosthetic rehabilitation. When extrusion is extensive, orthodontic intrusion or prosthetic reduction may be impractical. Posterior maxillary segmental osteotomy (PMSO), classically indicated in orthognathic surgery, can be repurposed as a pre-prosthetic intervention to restore vertical dimension and occlusal harmony. Two patients presenting with missing mandibular posterior teeth and marked supraeruption of opposing maxillary molars exhibited interarch space of <5 mm. After clinical and radiographic evaluation, PMSO was planned to reposition the extruded maxillary posterior segment. Osteotomy lines were executed under local anesthesia, and the segment was repositioned using a prefabricated surgical stent for guidance and stabilization. Simultaneous placement of endosseous implants was performed in the mandibular posterior region. Patients were followed radiographically and clinically to assess bony union, implant osseointegration, pulpal vitality, and segment stability. Both cases demonstrated satisfactory repositioning of the maxillary segment with immediate restoration of interarch space adequate for prosthetic rehabilitation. Follow-up imaging confirmed successful bony union and implant osseointegration. No postoperative complications, including segmental necrosis, relapse, or pulpal injury, were observed. Definitive prosthetic rehabilitation was completed after three months with stable occlusal relationships and improved function. PMSO can serve as a predictable pre-prosthetic surgical option for immediate correction of severe dentoalveolar extrusion when conventional orthodontic or prosthetic methods are not feasible. This approach facilitates restoration of interarch space and enables successful implant-supported rehabilitation with favorable functional outcomes. Keywords: Posterior maxillary osteotomy; Dentoalveolar extrusion; Interarch space.

This case report aimed to present non-surgical treatment of an adult patient with anterior openbite (AOB), skeletal class II malocclusion, and hyperdivergent facial pattern via molar intrusion using Temporary Anchorage Devices (TAD). Upper right first molar and upper left first premolar were extracted in order to relieve crowding. Full-arch maxillary and mandibular fixed appliances were placed. After alignment and leveling, miniscrews were inserted between the second premolars and molars on both right and left sides of the upper and lower arches. Elastomeric chains were passed under the 0.019×0.025-inches wire to the miniscrews in order to apply intrusive force. Counterclockwise rotation of the mandible led to chin advancement, reduction in facial height, and to some degree relief of lip strain resulting in improvement in facial profile. This case report presented a successful treatment of an adult patient with AOB due to the counterclockwise rotation of the mandible in response to molar intrusion.  Keywords: Openbite; Miniscrew; Class II malocclusion; Hyperdivergent; Chin deficiency. 

Abstract: The surgery-first approach (SFA) to orthognathic treatment has emerged as a compelling alternative to conventional protocols, offering immediate skeletal correction without prolonged presurgical orthodontics. A key biological advantage is the regional acceleratory phenomenon (RAP), a post-surgical response that accelerates orthodontic tooth movement and reduces overall treatment duration significantly. The present case involved a patient presenting with a concave facial profile, retrusive upper lip, reverse overjet and overbite of 3 mm, proclined maxillary incisors, retroclined mandibular incisors as dental compensation, Class I molar relationship, maxillary arch spacing, mild mandibular anterior crowding, and congenitally absent maxillary lateral incisors. This constellation of findings, combined with the patient's desire for early aesthetic improvement and the anticipated benefit of RAP-driven accelerated tooth movement, guided the decision toward SFA as the most appropriate patient-centred strategy. Le Fort I maxillary advancement was performed, followed by expedited postoperative orthodontics. Canine substitution addressed the congenitally missing lateral incisors and restored smile harmony. Treatment was completed in seven months, substantially shorter than conventional protocols. At the 24-month follow-up, Class I occlusion with ideal overjet and overbite was maintained, facial profile improvement remained stable, and functional outcomes were consistent. Keywords: Canine substitution; Class III malocclusion; Maxillary retrognathism; Orthognathic surgery; Surgery-first approach