Managing of an adult skeletal CLASS II deep bite: The role of orthodontics and surgery

Aim: skeletal class II may often represent an overlooked diagnostic challenge for many orthodontists. This case report aims to describe the necessity of a combined orthodontic and orthognathic surgical approach to a skeletal class II deep bite adult patient to achieve the best possible results. Methods: the patient came to our attention expressing aesthetic as well as functional concerns and was later diagnosed as a skeletal class II deep bite. Orthodontic treatment alone, by restoring the considerably reduced anteroinferior vertical dimension to the appropriate height, would only worsen the existing condition. Thus, the combination of orthodontic treatment and orthognathic surgery was deemed the most suitable treatment alternative. Following pre-surgical orthodontics, sagittal split mandibular ramus osteotomy was performed to advance and post-rotate the mandible. Results: the combined treatment approach led to the desirable results, both in terms of aesthetics and function. By revising the nasolabial and mentolabial angles a more suitable chin position was obtained, also resulting in the nasolabial folds minimized appearance. Function too appeared to be improved through masticatory muscles Electromyography (EMG) as well as on a clinical level. Conclusions: in adult patients presenting severe dentofacial deformities, a combined orthodontic and orthognathic surgical approach must be considered, as it frequently turns out to be the most successful treatment option in both aesthetic and functional terms.