Multidisciplinary Management Of Skeletal Mandibular Retrusion With Open Bite.

Introduction: This case demonstrates the efficacy of combined orthodontic-orthognathic treatment in addressing skeletal Class II malocclusion with mandibular retrusion, anterior open bite, and temporomandibular joint (TMJ) disorders. The multidisciplinary approach ensured functional and aesthetic rehabilitation. Case description: Case Presentation: A 19-year-old female presented with chief complaints of dental protrusion and malocclusion. Clinical examination revealed a convex profile, mandibular retrusion, anterior open bite, dental crowding, and bilateral TMJ absorption. Preoperative imaging confirmed thin alveolar bone, short anterior tooth roots, and narrowed airway volume (19,379 mm³). Treatment Plan & Outcomes: Pre-surgical orthodontics: Fixed expansion (maxillary width increased by 3 mm), alignment, and decompensation. Orthognathic surgery: Bilateral sagittal split osteotomy (BSSO) with mandibular advancement, genioplasty, and counterclockwise rotation. Adjunctive procedures: TMJ monitoring, fluoridation, and functional training. Post-treatment results showed significant improvements: Occlusion: Class I molar relationship, resolved open bite, and tight intercuspation. Aesthetics: Enhanced facial profile and increased airway volume (25,481 mm³). Radiographic findings: Parallel tooth roots, normalized TMJ space, and no root resorption. Discussion: 1. Skeletal Class II high-angle cases require orthognathic surgery for optimal functional and aesthetic outcomes. 2. TMJ monitoring is critical due to high risks of joint degeneration. 3. Thin alveolar bone necessitates careful torque control to prevent root resorption. Conclusion/clinical significance: Integrated orthodontic-surgical intervention successfully corrected complex dentofacial deformities, improving occlusion, airway function, and patient satisfaction.