Surgical Orthodontic Treatment of Severe Skeletal Class II with Vertical Maxillary Excess.

ABSTRACT

This paper describes an adult male patient who presented with a severe skeletal class II deformity with severe gummy smile. The case was managed with a combination of presurgical orthodontic treatment followed by a double jaw orthognathic surgery and then another phase of orthodontic treatment for final occlusal detailing. Extraction of the upper fives and lower first premolars was done during the presurgical orthodontic phase of treatment to decompensate upper and lower incisors and to give room for surgical setback of the maxillary anterior segment. Double jaw surgery was performed bilateral sagittal split ramus osteotomy (BSSO) for 6mm mandibular advancement combined with Le Fort I maxillary osteotomy with 8mm impaction of the maxilla. Although the anteroposterior discrepancy and the facial convexity were so severe, highly acceptable results were obtained, both esthetically as well as occlusally.