Treatment of a severe class II subdivision malocclusion following failed bimaxillary anterior segment osteotomy: a case report

Abstract

Background: Orthognathic surgery without a well-coordinated orthodontic plan can compromise aesthetic and functional outcomes, potentially necessitating complex orthodontic retreatment. Case presentation: This case report presents a 28-year-old female with residual extraction spaces and upper incisor proclination following a failed bimaxillary anterior segment osteotomy. Clinical examination revealed a convex profile, Class I skeletal base relationship, hyperdivergent facial pattern, full-cusp Class II subdivision on the left side, excessive overjet, and significant lower dental midline deviation. Treatment involved digitally planned straight-wire lingual appliances combined with miniscrew anchorage to distalize the entire upper arch and lower right quadrant, while mesializing the lower left quadrant. This approach successfully corrected the malocclusion, achieving a solid Class I relationship, normal overbite and overjet, and a harmonious profile. Conclusions: This case highlights the effective management of complex malocclusions arising from suboptimal orthognathic surgery through a combination of miniscrew-assisted distalization and mesialization techniques, aided by digital planning and lingual appliances.