Staged Biomechanical Treatment For Adolescent Mandibular Deviation

This case presents the entire orthodontic treatment process of a 14-year-old female patient with mandibular deviation, emphasizing staged biomechanical strategies in the correction of complex malocclusion deformities. The patient complained of facial asymmetry affecting her appearance. Clinical examination revealed midlines misalignment (upper midline 0.5mm right shift, lower midline 3mm left shift), bilateral molar/canine distal relationships, right premolars scissors bite, II°overbite/overjet, asymmetric maxillary arch, and a right-low/left-high occlusal plane. Low-angle skeletal Class I, the mental point deviated to the left and was consistent with the lower midline. Non-extraction orthodontic treatment was adopted: First, upper brackets were bonded to align the upper teeth, coordinating the symmetry of the upper dental arch. Meanwhile, a mandibular positioning occlusal splint was worn to adjust the mandibular position while aligning the upper teeth. Then, a plane guide was worn to open the bite, and then lower brackets were bonded to align and level the lower teeth. Asymmetric traction was performed when changing to stainless steel wire to further correct the mandibular deviation. After 16 months, facial symmetry and dental issues was improved. The treatment core includes staged mechanical design and adaptive TMJ management. The protocol focuses on functional occlusion rather than absolute bone symmetry, recognizing growth limitations in late adolescent cases. This case validates the efficacy of non-surgical treatment for adolescent mandibular deviation, achieving both functional and aesthetic goals. It emphasized early treatment of mandibular deviation focuses on eliminating occlusal interference.