Orthognathic Management of a High Angle Class II Division I Malocclusion Using a Passive Ligation System: A Case Report

Abstract

BACKGROUND Severe high angle Class II Division 1 malocclusion with vertical maxillary excess can be treat- ed in several ways in growing patients. Early orthodontic treatment with vertical control may decrease the maloc- clusion as well as improve the appearance. In severe cas- es involving adults, orthognathic surgery often is the opti- mal solution. Presenting case: A 21 year old cadet officer from Malaysian National Armed Forces Defense Univer- sity (UPNM) presented with a severe high angle skeletal Class II Division I Malocclusion complicated by bimaxil- lary protrusion, an increased overjet of 12 mm, increased overbite, severe dental crowding and absence of the 25 & 35. There was no obvious skeletal asymmetry. The lips were incompetent at rest. Investigations: Complete Or- thodontic records were taken, including study models, clinical photographs, dental panoramic tomogram and lateral cephalograms in occlusion. Surgical planning was carried out using digital software Opal Imaging® 2.1. Clinical Management: Orthodontic preparations included de-crowding, leveling and alignment, de-compensation of incisors and arch coordination using the Damon® 3MX self-ligating system. Orthognathic surgery was carried out after the pre-surgical orthodontics was satisfactory done. The maxilla was brought 4mm forwards and subject- ed to differential impaction (anterior 2mm and posterior 4mm). The mandible was brought forward by 8 mm and downwards by 6mm. The patient also had an advance- ment genioplasty of the chin, which improved his profile remarkably. The fixed appliances were removed 6 months post-surgery after detailing the occlusion. The total treat- ment time was 28 months. Discussion: This cadet officer has since passed his course and is now proudly serving the nation of the Malaysian Armed Forces. He is being reviewed periodically for post-treatment stability.