Treatment Of Angle Classii Malocclusion With Maxillary Deficiency And Hypodivergence

This case demonstrates the combined efficacy of maxillary protraction and facebow therapy in a growing patient with Angle Class II malocclusion, maxillary deficiency, and a low-angle facial profile. Maxillary protraction effectively addresses midfacial skeletal hypoplasia and sagittal concavity secondary to maxillary retrusion. Concurrent facebow application enables distal molar movement via directional force systems, correcting the characteristic molar distal relationship of Class II malocclusion and restoring functional occlusion with sagittal harmony. Early intervention during growth exploits growth potential to advance the maxilla while restraining mandibular protrusion, optimizing craniofacial morphology. An 11-year-old female presented with dental crowding. Clinical findings included a deep overbite (Grade II), deep overjet (Grade III), and bilateral distal canine/molar relationships. Cephalometric analysis confirmed maxillary retrusion (SNA: 83.12°, Ptm-A: 38.84 mm) and a low-angle pattern (FMA: 16.69°). Treatment comprised two phases: Phase I (maxillary expansion with protraction to advance the maxilla) and Phase II (facebow therapy for molar distalization, anterior retraction, and alignment), achieving normal overbite, overjet, and neutral occlusion. Maxillary protraction enhanced maxillary advancement (SNA: 83.12°→84.17°; Ptm-A: 38.84→41.77 mm) and induced clockwise mandibular rotation, improving midfacial projection. The facebow created space via molar distalization, reduced anterior proclination, and established molar neutrality. Combined maxillary protraction and facebow therapy provides new insights for treating growing patients with Angle Class II malocclusion and maxillary deficiency, addressing skeletal discrepancies and occlusal dysfunction while improving aesthetics and stability.