Orthodontic Retreatment For An Adult With Skeletal Class ⅱ Malocclusion

This case report presents the orthodontic retreatment of an adult female with skeletal Class II malocclusion, excessive overjet, and severe occlusal disharmony after previous premolar extractions without space. A novel molar correction approach achieved ideal occlusion in 32 months. A 23-year-old female presented with a chief complaint of lip protrusion and dissatisfaction with previous orthodontic treatment. Clinical examination revealed skeletal Class II malocclusion (ANB=6.3°), mandibular retrognathism (SNB=74.0°), Class II molar and canine relationships, severe overjet and labially inclined upper incisors. The mandibular midline was deviated left, with missing #14, 24, 34, and 44. Due to refusal of surgery, the orthodontic plan involved extraction of all third molars, miniscrew-assisted maxillary molar distalization, arch expansion, anterior teeth retraction and a maxillary anterior inclined guide plate for mandibular advancement. Finally, functional occlusion and improved profile were obtained. Challenges in this case included labial inclination of the upper incisors, excessive overjet, and distal molar-canine relationships. With premolars already extracted, the treatment focused on sagittal correction via maxillary molar distalization and mandibular advancement. A light-force system with nickel-titanium archwires and coil springs was used for molar distalization, supported by mini-implant anchorage and reserve-curve archwire for torque control. A resin bevel guide plate facilitated mandibular advancement, promoting temporomandibular adaptation while posterior vertical control ensured stable occlusion. Successful orthodontic reetreatment was attained in a skeletal Class II adult with mandibular retrusion and severe occlusal disharmony. Precise vertical and sagittal control was the key.