• Etsuko Kondo.
• kortho@tkd.att.ne.jp
• World J Orthod. 2007 Jan 1;8(3):261-76.

AimThe treatment of an adult patient with a skeletal Class II Division 1 malocclusion, retrognathic mandible with downward and backward rotation, anterior open bite, and temporomandibular disorders is presented. Treatment objectives included establishing a stable occlusion with normal respiration, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment.Subject And MethodsThe patient was a Japanese adult female, who had previously been advised to have orthognathic surgery. An expansion plate was used to reshape the maxillary dentoalveolar arch. Distalization of the maxillary arch and forward movement of the mandible were achieved by reduced excessive posterior occlusal vertical dimension, through uprighting and intruding the mandibular posterior teeth, and rotating the mandible slightly upward and forward. The functional occlusal plane was reconstructed by uprighting and intruding the mandibular posterior teeth with a full-bracket appliance, combined with a maxillary expansion plate and short Class II elastics. Myofunctional therapy and masticatory and cervical muscle training involved chewing gum exercises and neck-muscle massage.ResultsThe excessive posterior vertical occlusal dimension was significantly reduced, creating a small clearance between the posterior maxilla and mandible. The occlusal interferences in the posterior area were eliminated by the expansion of the maxillary dentoalveolar arch. As a result, the mandible moved forward, creating a more favorable jaw relationship. Distal movement of the maxillary arch was also achieved. The functional occlusal plane was reconstructed and a normal overjet and overbite were created. Adequate tongue space for normal respiration was established during the early stage of treatment. A stable occlusion with adequate posterior support and anterior guidance was established in a treatment time of 25 months, without orthognathic surgery, extraction, or headgear; this result was maintained at more than 1 year 8 months posttreatment.

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