Clinical case: compensatory treatment of a skeletal class II patient with miniplates

Abstract

Skeletal class II patients are a great challenge, and surgical treatment may be necessary in many cases. We present the case of a Class II patient with a gummy smile, who does not want surgical orthodontics, so the treatment will be carried out with a temporary bone anchoring device, in this case miniplates. Objective: to use 4 miniplates to impact the maxilla, intrude and distalize the mandible so that it autorotes while maintaining dental class I of the patient. Method: treatment with miniplates and appliances lasted 9 months. It is also proposed to perform a geniplasty, so that the miniplates are removed at the time of performing the chin advancement surgery under general anesthesia. The orthodontic appliances were removed 2 months later. Results: A change in the height of the gummy smile, a change in the profile and an improvement in the lip closure, as well as parallelization of the occlusal plane are observed. Conclusions: Being a skeletal class II patient, the therapeutic approach should consider orthognathic surgery if the patient would like conventional orthodontic treatment without the use of miniplates. In this case, maxillary impaction, mandibular counterclockwise rotation, decreased facial height, and correct dental positioning were achieved. However, we must emphasize that under no circumstances does the orthodontic or orthopedic use of miniplates replace or change the treatment planning of orthognathic surgery.