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case report _ orthodontic I associated with a lower rate of and need for or- thodontic treatment. The study at the University ofGreifswald,Germany,foundthat20.3%ofthe symptoms were genetically determined, 44.3 % were exogenous and 35.3 % were not precisely defined. Based on these results, the assumption that 80 % of malocclusions can be resolved by prevention and better oral hygiene is very ques- tionable (Hensel, DGKFO opinion, 2001). The varying findings and remarks illustrate the difficulty of clear classification of malocclu- sion. Nonetheless, the demands of the patient have priority and he expects a symptom-based therapy with stable treatment results. This means that in malocclusion cases that cannot be resolved by functional orthodontics solely, or- thodontic–surgical planning can be done before any treatment is attempted by pure dentoalveo- lar compensatory intervention. Compensatory dentoalveolar procedures could prevent a surgi- caloperation.Atthesametime,patientsmayrun the risk of protracted treatment without any long-lasting benefit. The decision for or against orthopaedic surgery requires interdisciplinary agreement and reliable treatment goals must be defined in advance (Figs. 2a & b). _Target group for orthopaedic surgery Nowadays, adults make up the majority of patients in the orthodontic practice. They are generally motivated by high socio-cultural de- mands and the desire for perfect teeth. In adults who have an obvious discrepancy between their maxilla and mandible, it must be clarified whether the deformities are dentoalveolar or skeletal. Owing to the limitations of conventional or- thodontic treatment, skeletal discrepancies can rarely be entirely resolved. In those cases, com- bined orthodontic–surgical treatment is neces- sary. During growth, it is mostly possible to treat malocclusions successfully without surgery by purely orthodontic treatment using removable appliances or brackets. Children and young people for whom func- tional orthodontic treatment has not led to the desired result are treated surgically after the growth period. Early surgery always carries the risk of unexpected growth pattern or unilateral abnormal hyperplasia and can affect the results of the operation. Figs. 2a & b_Significant changes between the initial assessment of latero-gnathia in 2007 (a) and the beginning of combined orthodontic–surgical treatment in 2011 (b; 19-year-old patient). Fig. 3a_Side view of a 19-year-old patient: latero-gnathia is visible in the lower lip area. Fig. 3b_Frontal view: latero-gnathia to the right and the resulting deviation is clearly visible. Figs. 4a–c_Orthodontic, prepared pre-op diagnostic radiology (orthopantomograph, cephalometric radiograph and antero-posterior projection) of the now 20-year-old patient. I 27cosmeticdentistry 2_2012 Fig. 2a Fig. 3a Fig. 3b Fig. 4a Fig. 4b Fig. 4c Fig. 2b