Camouflage Treatment of a Severe Hyperdivergent Class II Malocclusion by Posterior Interproximal Tooth Reduction and...

Orthognathic surgery is the main treatment option to improve aesthetics and function in severe skeletal discrepancy. Orthodontic camouflage could be considered a treatment option when the patient refuses surgery. However, camouflage treatment can be challenging since it requires an acceptable compromise between achieving a stable occlusion and satisfying the patient's aesthetic expectations. This case report highlights an uncommon camouflage treatment of a severe hyperdivergent skeletal Class II malocclusion using posterior interproximal enamel reduction (IPR) and clear aligners. A 15-year-old female presented with a severe skeletal Class II relationship and severe facial hyperdivergency, a cusp-to-cusp Class II dental relationship, moderate anterior open-bite, and maxillary constriction. Orthognathic surgery was considered the main treatment option; however, the patient refused surgical procedures. Thus, a camouflage treatment was planned with the aim to (1) improve the sagittal, vertical, and transverse occlusal discrepancies, (2) enhance smile aesthetics, avoiding deterioration of lower-third facial aesthetics. The treatment plan included upper and lower posterior IPR and control of upper posterior intrusion, using clear aligners and Class II elastics. Posterior IPR was preliminarily calculated considering posterior Bolton's discrepancy and inserted into the dental VTO before proceeding with the digital setup. After 26 months of nonsurgical orthodontic treatment, normal occlusion was achieved, and the smile aesthetic was improved without deteriorating the facial profile. Residual mandibular growth has significantly contributed to the correction of the malocclusion. This case suggests that the combination of clear aligners, appropriate posterior IPR (based on Bolton's Index), and residual growth may represent a viable alternative in selected severe Class II patients refusing surgery.