Sequential treatment of a severe Class 11 Division 1 malocclusion in a child: a case report

Early treatment of protrusive anterior upper teeth and establishment of proper overbite and overjet can create favourable conditions for mandibular growth and may help the patient achieve an improved facial profile without tooth extraction. This case report describes the sequential orthodontic management of a patient with a severe convex profile and retrognathic mandible from six to 14 years of age. A vestibular shield was used in the deciduous dentition phase to address the habits of mouth breathing and lower lip biting. A customised fixed lingual appliance was employed to close incisor gaps and the “2 × 4” technique was applied to establish proper overjet and overbite. During the permanent dentition phase, non-extraction fixed orthodontic treatment with mini screws was performed. Ultimately, both occlusion and facial profile were significantly improved. Twelve-month post-treatment records showed stable results and good facial harmony. Keywords: Class II malocclusion; Mouth breathing; Retrognathic mandible, Overjet, Overbite.