Alternative nonsurgical strategies to treat complex orthodontic problems

Patients whose vertical discrepancies are best corrected with both orthodontics and surgery can be placed into two distinct categories. The first category is the group of patients who have short posterior facial heights in conjunction with excessive anterior facial heights. The second category is the group of patients who have the opposite problem, i.e., excessive posterior facial heights and decreased anterior facial heights. Both of these types of malocclusions can best be treated with a combination of orthodontics and surgery. Alternative treatment for these "outer limits" patients require a thorough differential diagnosis, selection of appropriate force systems, and an understanding that nonsurgical treatment will result in compromises. Although these compromises must be accepted these patients can expect treatment results that are esthetically pleasing, highly acceptable for the teeth and supporting tissues, functional, and reasonably stable if a careful differential diagnosis is followed with treatment that uses precise space management with sequential directional force application.