Surgical Management of Relative Chin Prominence in Class II Malocclusions

Area of Science:

• Orthognathic Surgery
• Maxillofacial Surgery
• Dental Surgery

Background:

• Relative chin prominence is a common esthetic challenge in Class II malocclusions, particularly deep bite and Division 2 patterns.
• Despite mandibular retrusion, soft tissue and rotation can create a prominent chin, complicating surgical planning.
• No standardized protocols exist for managing this specific esthetic paradox.

Purpose of the Study:

• To systematically review and summarize surgical approaches for managing relative chin prominence in Class II malocclusions.
• To identify and compare different surgical techniques reported in the literature.

Main Methods:

• A scoping review was conducted following PRISMA-ScR guidelines.
• Searched five databases (1975-2025) for studies on Class II malocclusion, chin prominence, and orthognathic surgery.
• Independent screening by two reviewers, with third-party resolution for disagreements.

Main Results:

• Eleven studies involving 116 patients were included.
• Six surgical techniques were identified: TMSO, anterior subapical osteotomy, distraction osteogenesis, MACR, clockwise bimaxillary rotation, and BSSO with setback genioplasty.
• Clockwise bimaxillary rotation was most frequent, showing favorable outcomes but with limited evidence.

Conclusions:

• No definitive gold standard exists for managing relative chin prominence in Class II malocclusions.
• Clockwise bimaxillary surgery may offer favorable outcomes in select cases; techniques are individualized.
• Interdisciplinary collaboration and further prospective studies are essential for defining indications and long-term results.