Maxillary Constriction With Skeletal Class II Malocclusion - A Comprehensive Treatment Approach. - Maxillary Constriction With Skeletal Class II Malocclusion - A Comprehensive Treatment Approach. - Open Access Pub

This case report reiterates the fact that a bilateral posterior crossbite with severe skeletal class II malocclusion in the growth period could be effectively treated by a comprehensive approach with a rapid palatal expansion appliance followed by fixed appliance therapy. A 14-year-old boy presented with a severe skeletal Class II malocclusion with an orthognathic maxilla, retrognathic mandible and a high mandibular plane angle with an Angles’ Class II division 1 subdivision malocclusion with maxillary constriction, increased overjet, deep bite and severe crowding of maxillary and mandibular incisors. A banded rapid palatal expansion appliance was initially given to correct the bilateral posterior cross bite and subsequently maxillary and mandibular first premolars were extracted and Roths’ Pre adjusted edgewise appliance therapy (0.022 x 0.28-inch slot) was strapped up to correct the severe tooth size-arch length discrepancy. The patient’s soft tissue profile and dentofacial esthetics improved dramatically with increased self-confidence and enthused self-esteem. DOI 10.14302/issn.2473-1005.jdoi-16-1159 Growth period of an individual is an ideal period for the treatment of desired orthopaedic effects of skeletal jaw discrepancies. It has been reported that a deficiency in maxillary arch width is associated with Class II malocclusion.Skeletal maxillary constriction treated with rapid palatal expansion appliance has been widely reported in literature, however, other possible indications of this technique have also been proposed in addition to its prime objective of correction of posterior cross bite.1,2 Haas3 opined that all Class II division 1 and Class division 2 patients present mandibular functional retrusion and that with Class II division 1 group the retrusion was due to constriction of maxillary dental arch, especially between the canines. It has been reported that skeletal Class II malocclusion with retrognathic mandible have benefited immensely with spontaneous forward positioning of the mandible facilitated by the widening of the constricted maxilla.4, 5 This case report illustrates the treatment of a skeletal Class II malocclusion with an orthognathic maxilla and retrognathic mandible with Angles’ Class II division 1 subdivision malocclusion with maxillary constriction and severe maxillary and mandibular tooth size-arch length discrepancy. Initial treatment with rapid palatal expansion appliance to correct the maxillary constriction to promote spontaneous forward positioning of the mandible and subsequent orthodontic treatment with fixed