Ortho-surgical Management of Severe Skeletal Class II Div 2 Malocclusion in Adult

Skeletal Class II malocclusion is attributed to maxillary prognathism, mandibular retrognathism or combination of both. In adolescent cases, the treatment includes growth modulation with headgear or myofunctional appliances. However in adults, optimum esthetic and functional efficacy can be achieved by orthodontic-surgical combination. This case report describes a 21 years old post-pubertal male with severe skeletal Class II discrepancy with normal maxilla and retrognathic mandible. The case was treated with bilateral sagittal split osteotomy (BSSO) with mandibular advancement approach. Straight profile, pleasing esthetics, bilateral Class I molar and canine relationship, normal overjet and overbite were achieved because of a combined ortho-surgical approach.

However in adults, esthetics is the major concern in severe Class II cases.The treatment of severe dentofacial deformities in adult patients is a challenging task for both orthodontist and oral surgeon.Treatment is difficult because of the skeletal and facial disharmony, absence of jaw growth and a tendency to relapse. 5 Critical diagnosis and ortho-surgical combination treatment approach is to be relied on for gaining optimum esthetic harmony and functional efficiency.Furthermore, acceptance of facial appearance is the prime important factor in determining social relationship. 6

Case Report
This case report describe a 21 years old male patient who reported to Orthodontic Department of Chatrapati Shahu Maharaj Sikshan Sanstha Dental College, Aurangabad, Maharashtra, India with the complain of irregularly placed teeth in upper front region of jaw.Both the treatment options were explained to the patient.

Extraorally
As esthetics was the main concern, second treatment alternative was selected as this would preserve the integrity of the existing profile while reducing the severity of the mandibular retrognathism.

Treatment protocol
Maxillary arch was bandied and bonded using 0.022" MBT prescription and .0.012 Niti wire was placed.After leveling and alignment of the upper arch, anterior

Treatment results
Excellent facial and occlusal results were achieved.
Significant improvement of the facial profile was , the patient exhibited square face with convex profile, competent lips and deep mentolabial sulcus.Intraorally, patient presented with Class II molar and canine relation with retroclined central incisors, deep bite and scissor bite with 24.Arches exhibited moderate crowding with deep curve of Spee.

Figure 12 :
Figure 12: Post-treatment extra-oral photographs appreciated.Intraorally, bilateral Class I molar and canine relation was achieved with normal overjet and overbite relation.Deep mentolabial sulcus was corrected and chin lengthening was achieved.Mandibular retrognathism was improved from ANB 6º to 3º.The patient was satisfied with the treatment results.DISCUSSION Class II malocclusion can be corrected depending on growth status and severity of the case.In adults, correction is done by orthodontic alone (camouflage) or orthodontic-orthognathic combination.Orthognathic surgery is indicated when dental discrepancy cannot be corrected by orthodontic treatment alone or when facial esthetic is compromised.Many adults cases exhibiting severe skeletal Class II Div 1 with mandibular retrognathism treated successfully with BSSO followed by mandibular advancement have been reported.7,8However, case reports of surgical management of severe skeletal Class II Div 2 are rare.In the present case, an adult of severe skeletal Class II Div 2 malocclusion was treated with orthodontic-orthognathic combination.The treatment was focused to relieve crowding, correct skeletal antero-posterior discrepancy and improve facial esthetics.Post-treatment result showed improved facial esthetics and dental occlusion.Convex facial profile and deep mentolabial sulcus were corrected and anterior vertical facial height was increased.OJN Daokar ST, Agrawal G, Chaudhari C, Yamyar S: Ortho-surgical Management of Severe Skeletal Class II Div 2 Malocclusion in Adult

Table 2 : Linear measurements on cephalogram
Daokar ST, Agrawal G, Chaudhari C, Yamyar S: Ortho-surgical Management of Severe Skeletal Class II Div 2 Malocclusion in Adult