Class II malocclusion treatment with a customized dual force distalizer.

Intraoral distalizers associated with skeletal anchorage provide the major benefit of promoting molar distalization with minimum anchorage loss and patient cooperation. This case report presents the treatment of a 17-year-old female with Class II Division 2 malocclusion, maxillary dentoalveolar protrusion, mild mandibular retrusion, increased overjet, deepbite, and lip incompetence. The treatment plan involved initial maxillary molar distalization with a customized version of the skeletally anchored dual force distalizer (DFD). The customized DFD used smaller mini-implants and included a fixed anterior biteplane. The device applied simultaneous forces from the buccal and palatal sides directly to the molars using nickel-titanium coil springs and allowed orthodontic mechanics in the mandibular teeth. An overcorrected Class I molar relationship was obtained after 6 months. After the distalization phase, retraction mechanics began with retraction loops and using a modified transpalatal bar reinforced with the mini-implants as anchorage. Moreover, the finishing phase was performed with multiloop edgewise archwires and intermaxillary elastics to enable an individualized control of each tooth. Total treatment time comprised 2 years 4 months, and significant improvements regarding the facial and occlusal perspectives were noticed. Similarly, these favorable changes remained stable during the 2-year follow-up period. The customized version of the skeletally anchored DFD followed by fixed appliances showed effectiveness and stability in Class II malocclusion treatment.

Extreme skeletal open bite correction with vertical elastics.

Severe skeletal open bites may be ideally treated with a combined surgical-orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.