Orthodontic Surgical Approach of severe skeletal hyper divergent Class II malocclusion treated by Lefort I osteotomy, BSSO and Genioplasty

Abstract

Abstract: Class II skeletal base with vertical maxillary excess (VME) and skeletal mandibular deficiency presents a combination of several problems about function, psychology, and esthetics. The optimal treatment plan generally includes a harmonized orthodontic-surgical approach through superior repositioning (Vertical maxillary impaction) using Le-Fort I osteotomy, mandibular advancement, and genioplasty. A 23-year-old woman with severe skeletal Class II malocclusion, convex profile, and gummy smile was referred to our department. Skeletally, she presented with vertical maxillary excess, mandibular deficiency along with a hyperdivergent growth pattern. Dentally, Class II molar, and canine relationships increased overjet and overbite with proclined upper (U1-SN: 118o) and lower incisors (L1-MP: 97o). Maxillary impaction was planned to correct the gummy smile, and mandibular advancement to improve the convex profile and correct the mandibular deficiency. In adjunct, genioplasty was also planned to correct the chin deficiency. The decompensation phase involved correction of the proclination and crowding of the upper incisors by extraction of the upper first premolars and decrowding, uprighting, and retracting the lower incisors by using the molar extraction space thus increasing the overjet. Bi-jaw surgery which included a Le-fort I osteotomy for vertical maxillary impaction (4mm), bilateral sagittal split osteotomy (BSSO) for mandibular advancement (5mm), and genioplasty was done to correct the skeletal and dental Class II. This case report describes a multidisciplinary approach in the successful management of a patient with VME and mandibular advancement to achieve superior function, stability, facial esthetics, and an ideal occlusion.