Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 50

Special Section: Class II Corrections
Case Report

How would you treat this malocclusion?
Pretreatment
Case S.L., 14 years, 7 months
A video of this case can be found at www.
pcsortho.org/pcso-bulletin/
A 14-year, 7-month-old Asian female patient
presented to the University of the Pacific
Orthodontic Clinic with the chief complaint
of her crooked teeth. During the initial
examination, she reported a finger-sucking
habit since infancy and a tongue-thrusting
habit for years. The patient was not taking
any medication.
Diagnosis and Etiology
Extraoral and Intraoral Findings
The initial soft-tissue analysis indicates a
convex profile, increased lower facial height,
mentalis strain, and no obvious asymmetry.
The clinical photographs and digital casts
show the following: (1) Class II, division 1
malocclusion with a full-cusp Class II on the
right and end-on Class II on the left, (2) mild
crowding (<3 mm) of the maxillary and mandibular arches, (3) moderate curve of Spee,
(4) overjet of 9 mm and anterior open from
canine to canine with an overbite of zero to
−5 mm, and (5) mandibular dental midline
discrepancy (off to patient's right by 3 mm;
Figures 1 and 2).
Radiographic Findings
The pretreatment panoramic radiograph
shows relatively short rami and sufficient
alveolar bone support in the maxillary and
mandibular arches. All third molars are
present, with the maxillary ones tipped
mesially. Cephalometric analysis indicates (1)
a Class II skeletal pattern with a protrusive
maxilla and a retrusive mandible (SNA, 85.3°;
SNB, 76.8°; ANB, 8.5°), (2) a steep mandibular
plane angle (FH-MP, 32.9°; SN-MP, 43.2°), (3)
proclined maxillary incisors (U1-SN, 117.5°; U1NA, 7.9 mm) and mandibular incisors (IMPA,
100.0°; L1-NB, 11.0 mm), (4) protrusive maxillary and lower lips (Upper lip to E-plane, 0.4
mm, Lower lip to E-plane, 3.1 mm), and (5)

50	

Figure 1. Pretreatment facial and intraoral photographs (14 years, 7 months)

Figure 2. Pretreatment digital study casts

PCSO Bulletin    Summer 2020


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Pacific Coast Society of Orthodontists Bulletin Summer 2020

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