Contemporary Class II Division 2 nonextraction adult treatment

Achieving ideal results when treating a difficult malocclusion is a challenge that orthodontists frequently encounter. Maintaining those results is sometimes more challenging than the correction itself. As specialists in orthodontics, we should be able to apply bone physiology concepts during the diagnosis and treatment planning process and predict how bone will react after biomechanical stimuli. Understanding bone physiology and the biology of tissue response during orthodontic tooth movement should allow us to develop the proper mechanical design and consequently the therapeutic procedures necessary to achieve the expected tooth position and bone architecture. Surgically facilitated orthodontic therapy uses basic bone biology and physiologic bone turnover procedures as well as basic orthodontic biomechanical principles to correct dental malocclusions in the shortest, safest, and most conservative manner. The correction of such malocclusions with this approach is expected to be functional and stable.


  • Decortication procedures can make orthodontic treatment faster and more efficient.

  • Decortication procedures enhance stability when used in orthodontic treatment.

  • Less root resorption was observed in orthodontic patients treated with decortication.

  • Keratinized gingivae increase after a decortication procedure.

  • Decortication could be useful in managing mild-to-moderate skeletal discrepancies.

The patient was a 39-year-old white woman with an unremarkable medical history who came with a chief complaint of discomfort in her right temporomandibular joint and a desire to improve her smile. She had a symmetrical face and a Class II Division 2 smile. Her profile was convex, with a 90° nasolabial angle and a skeletal mandibular deficiency. Intraorally, the upper midline was coincident to the face, but the lower midline deviated by 5 mm to her right side; an overjet of 6 mm was present. She had a Class I molar relationship in both sides, a Class I canine relationship in the left side, and a full-step Class II canine relationship in the right side. The mandibular right second premolar was congenitally missing ( Figs 1 and 2 ). The initial full-mouth radiograph showed an adequate bone level and all third molars ( Fig 3 ). The pretreatment cephalometric radiograph and the corresponding cephalometric tracing ( Fig 3 ) confirmed a skeletal Class II malocclusion with an ANB of 7° and a Wits appraisal of 6 mm ( Table ). The maxillary incisors were in good positions to the face and the cranial base. The mandibular incisors were anteriorly proclined. The diagnosis was a Class II Division 2 malocclusion with a skeletal mandibular deficiency, temporomandibular joint symptoms in the right side, lower midline deviation of 5 mm to patient’s right side, congenitally missing mandibular right second premolar, generalized dental rotations, and poor submental support.

Fig 1
Pretreatment photographs.

Fig 2
Pretreatment dental casts.

Fig 3
Pretreatment lateral cephalogram, cephalometric tracing, and full-mouth radiographs.

Dec 12, 2018 | Posted by in Orthodontics | Comments Off on Contemporary Class II Division 2 nonextraction adult treatment
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