Bella Smile ↗Case report · Fixed appliances (braces)
Gummy Smile and 100% Deep Bite and Full Cusp Class II
12-year old female presents full cusp Class II with a gummy smile.
- Patient
- Child (under 12), female
- Classification
- Class II div 2
- Active treatment
- 22 months
- Published
- September 9, 2026
Presentation
Chief complaint. " I would like a second opinion. One doctor says I need to take teeth out and the other surgery."
Diagnosis. She presents with a full-cusp Class II Division 2 malocclusion, a 5 mm overjet, and a 100% impinging deep overbite. She has a convex facial profile with an obtuse nasolabial angle and a retrognathic mandible, contributing to the underlying skeletal Class II relationship. The maxillary incisors are retroclined, while the mandibular incisors are well positioned. She demonstrates a hypodivergent skeletal pattern with decreased lower facial height, consistent with her severe deep-bite presentation. CVM CS3
Records
Before — Intraoral Photos
After — Intraoral Photos
Before — Smile Facial Photos
After — Smile Facial Photos
Before — Profile view
After — Profile view
Before — Lateral Panoramic Radiograph
After — Lateral Panoramic Radiograph
Before — Panoramic Radiograph
After — Panoramic RadiographMeasurements
| Measure | Norm | Pre | Post |
|---|---|---|---|
| SNA | 82 | 84 | 83 |
| SNB | 80 | 75 | 76 |
| ANB | 2 | 9 | 7 |
| Wits | 0 | 5 | 1 |
| SN-MP | 32 | 25 | 27 |
| U1-SN | 102 | 89 | 100 |
| L1-MP | 90 | 98 | 105 |
| Overjet (mm) | 2–3 | 5 | 2 |
| Overbite (mm) | 2–3 | 5 | 2 |
Treatment
Objectives. Level and align both arches, intrude the upper incisors. advance the lower jaw to maximize growth.
Plan. Band the maxillary first molars (U6s) and bond all remaining teeth 7–7. Use 022 MBT Unitek brackets. Procline the maxillary incisors to improve their inclination and help correct the Class II Division 2 incisor relationship. Progress through the archwire sequence until a .019 × .025 stainless steel wire is in place. Cinched back the mandibular archwire before Forsus placement to reinforce anchorage and minimize unwanted lower incisor proclination. Place Forsus appliances bilaterally to advance the mandibular dentition and correct the Class II relationship. Maintain the Forsus for approximately 6–8 months, or as needed to achieve adequate sagittal correction. Continue detailing and finishing to obtain an ideal Class I relationship, overjet, overbite, and arch coordination.
Appliances and materials
- Braces — 022 MBT unitek
- Forsus — Class II corrector
Outcome
We successfully leveled and aligned both arches and corrected the deep overbite and increased overjet, resulting in a significantly improved Class II relationship and overall occlusion. Although her initial CVM assessment suggested CS3 with remaining mandibular growth potential, she demonstrated less mandibular growth than anticipated during treatment, suggesting that she may have been further along in her growth trajectory than initially estimated. As part of the Class II correction, the mandibular incisors proclined and finished somewhat more proclined than their pretreatment position. Overall, we achieved a well-aligned dentition with substantially improved overjet, overbite, and occlusal relationships, resulting in a pleasing functional and esthetic outcome.
Retention
- Fixed U2-2 permanent retainer
- Fixed U3-3 permanent retainer
- Invisalign Vivera retainers to be worn at night
Case reports are shared with patient authorisation. Individual results vary.