Management of severe Class II division 1 malocclusion: a case report

To describe the two-phase treatment of a preadolescent boy with a severe skeletal Class II division 1 malocclusion with vertical maxillary excess and spaced upper incisors.

Treatment involved an orthopaedic phase using high-pull headgear and a maxillary intrusion splint followed by non-extraction orthodontic treatment with a pre-adjusted edgewise appliance. The case was assessed at the start of treatment (T1), at the end of orthopaedic treatment (T2), at the end of orthodontic treatment (T3) and 2 years after debanding (T4).

At T2 the Class II molar occlusion was corrected to a Class I molar relationship and the overjet and overbite were considerably reduced. A lower lip trap was relieved and a normal mentolabial sulcus obtained. The cephalometric changes at T2 revealed a 4 degree reduction in the ANB angle but no change in the SNA angle. At T3, the inclination of the upper central incisors, the overjet and overbite were normal and the spaces between the upper anterior teeth were closed. At T4, the Class I molar and canine relationships, reduced overjet, reduced overbite and intercuspation were maintained. The curve of Spee deepened slightly.

A severe skeletal Class II division 1 malocclusion with vertical maxillary excess may be successfully treated in two phases with an initial orthopaedic appliance in the form of high-pull head gear and a maxillary intrusion splint followed by fixed appliances.