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Case Report
ABSTRACT
Correction of skeletal deformities in adult patients with orthodontics is limited. Orthognathic
surgery is the best option for cases when camouflage treatment is questionable and growth
modulation is not possible. This case report illustrates the benefit of the team approach
in correcting vertical maxillary excess along with class II skeletal deformity. A cosmetic
correction was achieved by superior repositioning of maxilla with LeFort I osteotomy and
augmentation genioplasty, along with orthodontic treatment. The patients facial appearance
was markedly improved along with functional and stable occlusion.
INTRODUCTION
CASE REPORT
The present case report is about a 20-yearold female patient who came to the
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Balachander, et al.: Surgical correction of class II skeletal malocclusion
Diagnosis
Angle class I malocclusion on a class II skeletal base
between orthognathic maxilla and retrognathic
mandible with vertical growth pattern and increase
lower anterior facial height, with over jet of 4 mm and
over bite of 5 mm and lower anterior crowding.
Treatment objectives
To obtain class I skeletal base, to level and align the
teeth, to obtain the ideal over jet and over bite, to
maintain class1 molar and canine relation, improvement
of soft-tissue profile.
Treatment plan
Phase I
Phase II
Treatment progress
The case was started with pre adjusted edgewise appliance
using 0.022 slot MBT prescription. Upper and lower
premolars were extracted as planned for pre surgical
orthodontics. 0.016 initial nickel-titanium (Ni-Ti) arch
wires were placed for alignment followed by 0.016 0.022
Ni-Ti and 0.017 0.025 Ni-Ti wires. Retraction was done
on 0.019 0.025 stainless steel (ss) wire. 0.021 0.025 ss
wires were placed for 2 months to achieve proper torque.
Anterior superior repositioning of 5 mm was done along
with advancement genioplasty [Figure 5]. The patient was
put on settling elastics post surgically.
Treatment results
The total treatment duration was 18 months with
10 months of pre-surgical orthodontics and 8 months of
post-surgical management. Outcome of the treatment
was a significant improvement in the patients smile and
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Balachander, et al.: Surgical correction of class II skeletal malocclusion
DISCUSSION
There are certain limitations how far a tooth can be
moved and these become important when the problem
is of severe skeletal deformity.[5] The essential steps in
pre-surgical orthodontics are to align the arches and
make them compatible to establish the antero-posterior
and vertical position of the incisors. The extraction of
first premolars aided in the correction of the upper
incisor proclination and alignment and leveling the
cuve of spee in the lower arch.
CONCLUSION
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Balachander, et al.: Surgical correction of class II skeletal malocclusion
Normal
PrePostsurgical surgical
822
802
2
81
75
6
80
79
1
22
25
102
90
30
32
111
95
23
26
104
91
1.
131
12
2-3
2-3
111
10
3
4
130
4
3
2
3.
25
32
47-52
57-65
62-65
48-56
715
34
42
52
70
58
55
67
27
34
50
68
60
54
70
5.
2
90-110
12
83
4
108
REFERENCES
2.
4.
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