A new look at the treatment of Class II Division 2 malocclusions

This case report illustrates a treatment option for managing a skeletal Class II relationship with a Class II Division 2 malocclusion and impinging overbite. The patient's maxillary first premolars were extracted during unsuccessful orthodontic treatment at age 15. These extractions and the retraction of the maxillary anterior teeth during space closure worsened the facial profile deficiency caused by the original facial skeletal Class II discrepancies. During the retreatment described here, the second premolars were moved into the place of the previously extracted first premolars. The opened spaces at the second premolars were then restored with implant-supported restorations. Lingual brackets were used to correct the severe overbite. This approach created sufficient overjet to correct the Class II skeletal relationship with bisagittal mandibular advancement osteotomy. Reconstruction of the skeletal and occlusal relationships resulted in a more desirable facial profile for this patient.