Class II Division 2 subdivision: Left Malocclusion, Anterior Deep bite and TMD

This case report was presented by Dr Ivan Toshio Maruo. Patient was 24-year-old male, seeking for correction of Class II Division 2 subdivision left, anterior deep overbite, dental midline deviation and crowding. His chief complaints were clicking and pain in his TMJs. The main objective of the treatment plan was enhancing skeletal bases balance (brachyfacial and Class I skeletal pattern) and facial esthetics. Treatment commenced with asymmetric headgear. Then, when the left Class II was corrected, 0.022 x 0.028-in edgewise standard brackets were bonded on the remaining maxillary teeth until the correction of the midline deviation and aligning/leveling of maxillary incisors. In the next step, 0.022 x 0.028-in edgewise standard brackets were bonded on the mandibular teeth to align and level them, to intrude incisors and canines and to correct the midline shift. Finally, as maxillary lateral incisors had size difference, they were reshaped with composite resin after brackets removal. Fixed mandibular canine-to-canine lingual arch and Hawley maxillary removable appliance were used as fixed retainers. The patient reported no longer TMD, and a new MRI was taken to assess case progress.