Li GF, Zhang CX, Wen J, Huang ZW, Li H. Orthodontic-surgical treatment of an Angle Class II malocclusion patient with mandibular hypoplasia and missing maxillary first molars: A case report. World J Clin Cases 2022; 10(33): 12278-12288 [PMID: 36483832 DOI: 10.12998/wjcc.v10.i33.12278]
Corresponding Author of This Article
Huang Li, PhD, Professor, Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhongyang Road, Xuanwu District, Nanjing 210000, Jiangsu Province, China. lihuang76@nju.edu.cn
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 26, 2022; 10(33): 12278-12288 Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12278
Orthodontic-surgical treatment of an Angle Class II malocclusion patient with mandibular hypoplasia and missing maxillary first molars: A case report
Gui-Feng Li, Cai-Xia Zhang, Juan Wen, Zi-Wei Huang, Huang Li
Gui-Feng Li, Cai-Xia Zhang, Juan Wen, Zi-Wei Huang, Huang Li, Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
Author contributions: Li G and Zhang C contributed to manuscript writing and editing, and data collection; Wen J contributed to data analysis; Huang Z contributed to data collection; Li H contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported bythe Natural Science Foundation of Jiangsu, No. SBK2021021787; and Nanjing Key Project Foundation, No. ZKX20048.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huang Li, PhD, Professor, Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhongyang Road, Xuanwu District, Nanjing 210000, Jiangsu Province, China. lihuang76@nju.edu.cn
Received: June 15, 2022 Peer-review started: June 15, 2022 First decision: June 27, 2022 Revised: July 23, 2022 Accepted: October 12, 2022 Article in press: October 12, 2022 Published online: November 26, 2022 Processing time: 161 Days and 0.4 Hours
Abstract
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.
Core Tip: In this case report, we describe a combined surgical/orthodontic diagnosis and treatment of an Angle Class II division 1 malocclusion with a severely retruded mandible and a vertical growth pattern and discuss the pros and cons of this approach. The patient’s chief concerns were her retrognathic mandible, difficulty with lip closure, and two missing maxillary first molars. These problems were satisfactorily relieved through comprehensive orthodontic treatment by closing the spaces of missing maxillary first molars through forward movement of the maxillary second molars and retracting the proclined mandibular incisors, and orthognathic surgery for maxillary impaction, mandibular advancement, and genioplasty. After the combined treatment, her retrognathic mandible was more forward, and the patient could close her lips effortlessly. And the genioplasty assisted in achieving a harmonious profile.
