{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:52:49Z","timestamp":1791305569816,"version":"4.3.1"},"reference-count":12,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>This case report discusses the genetic influence and treatment of class III malocclusion in identical twin sisters, in their early 20s, who presented with mandibular prognathism. Both exhibited concave profiles with hypodivergent growth patterns, but Sister A had a more pronounced concavity. Diagnosis revealed skeletal class III malocclusion with mandibular prognathism and negative overjet (9\u2009mm in Sister A, 6\u2009mm in Sister B). Treatment involved pre-surgical orthodontics, bilateral sagittal split osteotomy (BSSO) with mandibular setbacks (7\u2009mm for Sister A, 5\u2009mm for Sister B), followed by post-surgical orthodontics and retention. Both sisters achieved improved facial aesthetics, class I occlusion and functional stability. However, Sister B experienced transient paraesthesia and a bad split, leading to temporary splinting of the second molar. The case highlights the genetic basis of mandibular prognathism, the effectiveness of BSSO and the importance of meticulous surgical planning and interdisciplinary management for optimal long-term results.<\/jats:p>","DOI":"10.1136\/bcr-2025-266018","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:05:12Z","timestamp":1791302712000},"page":"e266018","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical and orthodontic management of class III malocclusion in monozygotic twins using bilateral sagittal split osteotomy"],"prefix":"10.1136","volume":"19","author":[{"given":"Tanu","family":"Sharma","sequence":"first","affiliation":[{"name":"Orthodontics and Dentofacial Orthopaedics, ITS Dental College Hospital and Research Centre, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruti","family":"Sharma","sequence":"additional","affiliation":[{"name":"Orthodontics and Dentofacial Orthopaedics, ITS The Education Group, Greater Noida, UP, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anshul","family":"Singla","sequence":"additional","affiliation":[{"name":"Orthodontics and Dentofacial Orthopaedics, ITS The Education Group, Greater Noida, UP, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrita","family":"Puri","sequence":"additional","affiliation":[{"name":"Orthodontics and Dentofacial Orthopaedics, ITS The Education Group, Greater Noida, UP, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2026100609050697000_19.10.e266018.1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/j.1601-6343.2010.01485.x","article-title":"Genes, genetics, and Class III malocclusion","volume":"13","author":"Xue","year":"2010","journal-title":"Orthod Craniofac Res"},{"key":"2026100609050697000_19.10.e266018.2","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1007\/s00784-020-03731-5","article-title":"Genetic factors contributing to skeletal class III malocclusion: a systematic review and meta-analysis","volume":"25","author":"Dehesa-Santos","year":"2021","journal-title":"Clin Oral Invest"},{"key":"2026100609050697000_19.10.e266018.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-5406(98)70287-2"},{"key":"2026100609050697000_19.10.e266018.4","doi-asserted-by":"crossref","first-page":"e422","DOI":"10.1097\/SCS.0000000000003627","article-title":"Genetic Factors Involved in Mandibular Prognathism","volume":"28","author":"Doraczynska-Kowalik","year":"2017","journal-title":"J Craniofac Surg"},{"key":"2026100609050697000_19.10.e266018.5","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ijscr.2019.09.027","article-title":"Two middle-aged cases of deep overbite without molar support treated by orthognathic surgery","volume":"63","author":"Akizuki","year":"2019","journal-title":"Int J Surg Case Rep"},{"key":"2026100609050697000_19.10.e266018.6","doi-asserted-by":"crossref","first-page":"107219","DOI":"10.1016\/j.ijscr.2022.107219","article-title":"Orthognathic correction and corticobasal implant-supported prostheses as a treatment modality for partial edentulism with mandibular prognathism","volume":"95","author":"Ahmad","year":"2022","journal-title":"Int J Surg Case Rep"},{"key":"2026100609050697000_19.10.e266018.7","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1055\/s-0033-1357111","article-title":"Bilateral sagittal split osteotomy","volume":"27","author":"Monson","year":"2013","journal-title":"Semin Plast Surg"},{"key":"2026100609050697000_19.10.e266018.8","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1597\/1545-1569_2000_037_0551_csomsa_2.0.co_2","article-title":"Comparative study of mandibular stability after sagittal split osteotomies: biocortical versus monocortical osteosynthesis","volume":"37","author":"Fujioka","year":"2000","journal-title":"Cleft Palate Craniofac J"},{"key":"2026100609050697000_19.10.e266018.9","doi-asserted-by":"crossref","first-page":"4947","DOI":"10.1007\/s00784-022-04463-4","article-title":"Three-dimensional assessment of facial asymmetry in Class III subjects. Part 1: a retrospective study evaluating postsurgical outcomes","volume":"26","author":"Ajmera","year":"2022","journal-title":"Clin Oral Investig"},{"key":"2026100609050697000_19.10.e266018.10","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s10006-011-0287-4","article-title":"Risk factors and prevention of bad splits during sagittal split osteotomy","volume":"16","author":"Chrcanovic","year":"2012","journal-title":"Oral Maxillofac Surg"},{"key":"2026100609050697000_19.10.e266018.11","doi-asserted-by":"crossref","unstructured":"Afifah N , Maulina T , Yuza AT . Management of A Bad Split Complication: A Systematic Review. 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