Orthodontic-surgical treatment of an Angle Class Ⅱ malocclusion patient with mandibular hypoplasia and missing maxillary first molars: A case report

BACKGROUND Adult patients presenting with Angle Class II division 1 malocclusions that have a strong skeletal etiology can be challenging for clinicians,particularly if accompanied by retrognathia of the mandible and a dolichofacial growth pattern.CASE SUMMARY In this case report,we describe the successful orthodontic and surgical management of a 20-year-old woman with an Angle Class II malocclusion with a severe anteroposterior skeletal discrepancy characterized by mandibular deficiency.She had incompetent lips,dental and skeletal Class II malocclusion,high mandibular plane angle,mild mandibular crowding,and two missing maxillary first molars.The treatment plan comprised:(1)Extraction of two mandibular second premolars to decompensate and retract mandibular incisors;(2)pre-surgical alignment,leveling,and space closure of the teeth in both arches,and protraction of the second maxillary molars to close the maxillary space;(3)surgical treatment including a LeFort I osteotomy for maxillary retraction and rotation,a bilateral sagittal split osteotomy for mandibular advancement and rotation,and a genioplasty for correctting the skeletal deformities;and(4)post-surgical correction of the malocclusion.CONCLUSION The patient’s facial esthetics was significantly improved and a desirable occlusion was achieved after 16 mo treatment.Follow-up records after 2 years showed stable esthetics and function.