Class II Malocclusion with 14.0 mm Overjet Treated with Maxillary Second Molar Extractions and Bone Screws

A 15-year-old male presented with flared maxillary central incisors. Skeletal Class I relationship (SNA, 84.5˚; SNB, 80.5˚; ANB, 4.0˚) was associated with a full-cusp Class II molar relationship. Dental analysis revealed flared maxillary central incisors (U1-NA, 12.0 mm; U1-SN, 128.0˚) with an excessive overjet of 14.0 mm. Facial convexity was within normal limits, but lips were markedly protrusive (4.0/5.0 mm to the E-line). The Discrepancy Index was 22. Maxillary second molars (U7s) were extracted to provide space for retracting the whole maxillary dentition (from UR6 to UL6) to correct the Class II malocclusion. Skeletal anchorage was provided by two bone screws: bilateral infrazygomatic crest (IZC) bone screws. Maxillary anterior bite turbos and Class II elastics were applied for the purpose of overbite and overjet reduction. Nineteen months of active treatment resulted in a satisfactory facial profile and dental alignment. Bilateral Class I canine and molar relationships were achieved. The excessive 14.0 mm overjet was reduced to 1.0 mm. The 7.0 mm impinging overbite was reduced to 4.0 mm. Protrusive lips were treated from 4.0/5.0 mm to 2.0/2.0 mm to the E-line (Table 1). A full-cusp Class II malocclusion with 14.0 mm of overjet, flared U1s, 100% overbite, and periodontal impingement was treated with extraction of both U7s followed by retraction of the entire maxillary dentition with bilateral IZC anchorage. Anterior bite turbos and Class II elastics resulted in a pleasing facial profile without orthognathic surgery while preserving as much of the dentition as possible.