Correction of Class II Division 2 Deepbite Malocclusion with Non-extraction Therapy

Class II malocclusion is among the common malocclusions that is faced in orthodontic practice. Early diagnosis and proper management can avoid the unnecessary extractions and even orthognathic surgeries that might be needed in some cases. Monobloc (anterior bite plane) appliance can be used in such case to treat the growing skeletal malocclusion. Further treatment refinement is done using Class II elastics, which shows desirable mandibular growth leading to non-extraction correction of skeletal and dental Class II malocclusion.


INTRODUCTION
Class II malocclusion is among the common malocclusions that is faced in orthodontic practice. Early diagnosis and proper management can avoid the unnecessary extractions and even orthognathic surgeries that might be needed in some cases. Monobloc (anterior bite plane) appliance can be used in such case to treat the growing skeletal malocclusion. Further treatment refinement is done using Class II elastics, which shows desirable mandibular growth leading to non-extraction correction of skeletal and dental Class II malocclusion.

CASE HISTORY
A 13 years and 7 months old female patient whose chief complaint in her own words was "I don't like the way my upper teeth are" was presented to the Department of Orthodontics, Peoples Dental College and Hospital. The patient's medical history was noncontributory and her dental history included routine dental check-ups. Other findings and history were unremarkable and perverse habits were not present.

CLINICAL EXAMINATION
Extra-oral examination of the patient showed symmetric and leptoprosopic facial type on frontal view. The profile view revealed prominent chin, convex profile, prominent upper lip, deep labio-mental sulcus, average nasolabial angle, and competent lip.
Temporomandibular joint examinations confirmed normal joints and maximum inter-incisal opening was acceptable with no deviation. No joint noises were perceptible in excursive movements of the mandible.
Orthodontically the patient presented with Angle's Class II Division 2 malocclusion. Complete traumatic deep bite with 2 mm overjet and flared upper lateral incisors was noted. There was mild lower anterior crowding (2 mm) and mild upper anterior crowding (1.5 mm); and a moderate curve of Spee in both arches. The soft tissue was within normal limits ( Figure 1).  (Table I). Panoramic evaluation revealed permanent dentition with all permanent teeth present.

CEPHALOMETRIC EVALUATION
The periodontal condition was within normal limits ( Figure 3).

TREATMENT
After reviewing the diagnostic records and patient history; non-extraction orthodontic correction with Y-axis 54 57 58.6 OJN preadjusted edgewise appliance technique was initiated, expecting that growth of the mandible would contribute to achieve a Class I molar and canine relationship.
The upper arch was initially banded on the first molars and bonded from second premolar to second premolar with standard Roth prescribed 0.018 pre-adjusted edgewise brackets, with arch wire progression starting from 0.012 NiTi. Mono-block (anterior bite plane) was fabricated and inserted which helped in advancement of mandible. It also acted as anterior bite plate for correction of deep bite. After 1 month lower arch was also bonded and banded.
Class II elastics were used during the treatment and Class I molar and canine relationships were achieved with excellent patient cooperation. After 22 months of active therapy followed by 6 months of active retention period, debonding was done and impressions were made for retainers.

RETENTION
Clear retainer was placed in maxillary arch and fixed lingual retainer was placed in the mandibular arch. The patient was instructed to wear them full time for 1 year, at night for an additional year, and to return for periodic evaluation until completion of growth.

RESULTS ACHIEVED
Post-treatment facial photographs are shown in Figure 4.
A Class I molar and canine relationship were obtained.
The overbite and overjet were corrected; and maxillary and mandibular crowding was eliminated. The final cephalometric radiograph is shown in Figure 5.