Class II anomalies: a coordinated approach to the management of skeletal, dental, and soft tissue problems

Osteotomies to set back the anterior part of the maxilla or the whole maxilla (Le Fort I) can be done to reduce the anteroposterior discrepancy in class II anomalies. Predictable and stable results can be expected. Transverse discrepancies may be treated either by orthodontic means or by combined surgical-orthodontic means or by combined surgical-orthodontic methods, depending on the age of the patient, the axial inclination of the teeth, and the width of the apical base. Surgical expansion alone works well in the anterior maxillary osteotomy. Surgical expansion on the whole maxillary arch by additional palatal splitting in Le Fort I osteotomies gives excellent results, provided the gaps are filled with autogenous bone grafts. Mandibular segmental osteotomies or body osteotomies to advance portions of the mandible also provide stable results. Advancement procedures carried out in the rami show a tendency for relapse that can be compensated by overcorrection and orthodontic treatment.