Treatment of a hyperdivergent adult Class II subdivision malocclusion using customized 3D-printed lingual appliances,...

Adult patients increasingly seek invisible, nonsurgical solutions for complex skeletal Class II malocclusion with bimaxillary protrusion, hyperdivergent pattern, and gummy smile. Managing these cases with full aesthetic demands while maintaining vertical control remains challenging. This case report describes the nonextraction treatment of a 32-year-old woman with skeletal Class II due to mandibular retrusion, bimaxillary incisor proclination, increased lower facial height, unilateral Class II subdivision, midline deviation, and excessive gingival display. She was treated with a premolar-preserving, nonsurgical approach using fully customized 3D-printed titanium lingual brackets and third-molar extraction. Maxillary en-masse distalization with palatal mini-implants, a mandibular buccal-shelf mini-implant, unilateral Class II elastics, and staged interproximal enamel reduction enabled space creation, asymmetric control, and anterior retraction. After 25 months, bilateral Class I relationships, normalized overjet and overbite, reduced gingival display, and improved lip position were achieved, with cephalometrics showing substantial incisor retraction and good vertical control. Root parallelism, alveolar support, and occlusal relationships were stable at 1-year follow-up. Fully customized 3D-printed lingual brackets supported by skeletal anchorage and conservative enamel reduction can offer an aesthetic, nonsurgical camouflage option for selected hyperdivergent skeletal Class II adults unwilling to undergo premolar extraction or orthognathic surgery.