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Abstract

This case report illustrates a combined orthodontic-orthognathic surgical treatment option for correction of Class II division 2 malocclusion. A 31-year-old female patient, presenting a chief complaint of gummy smile and backward position of anterior teeth, came to seek for treatment. She had skeletal Class II with hypodivergent facial type and mild asymmetric face. Intraoral examination revealed a severe deep bite with 13 mm overbite. The pre-surgical orthodontic treatment consisted of proclination of the maxillary incisors and increased in overjet to provide space for surgical advancement of mandible; the mandibular curve of Spee was partially leveled and maintained some parts of deep overbite. The surgeries included the 2-pieces LeFort I to torque upper anterior teeth further, bilateral sagittal split osteotomies and genioplasty. During surgery, the increased overjet has guided the body of mandible forward, and the remaining deep overbite created clockwise rotation of distal segment, moved pre existing strong chin forward and downward to a proper position and also increased the lower facial height. The post-operative orthodontic treatment continued to correct the remaining deep bite and detail the results. The maintenance of a deep bite prior to surgical correction with optimal setback and/or vertical lengthening genioplasty could be the treatment strategies of the hypoplastic mandible with a strong chin. The treatment had successfully improved the smile arc, the masticatory functions and favorable dental alignment of the patient. The vertical control during the post-surgical tooth movement is an important factor to maintain the ideal results of surgical outcome.

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