Spacing, Protrusion, Deep Bite and Full cusp Class II

Presentation

Chief complaint. " I want to fix my teeth"

Diagnosis. Full-cusp Class II malocclusion with severe deep overbite, 8mm overjet, maxillary spacing, mandibular retrognathia, proclined maxillary incisors, lingually inclined mandibular incisors, excessive curve of Spee, and CVM Stage 3.

Why I chose this approach

My goal was to reduce the protrusion and excessive overjet, open the deep bite, and achieve a functional Class I relationship while taking advantage of her remaining growth. She had a full cusp Class II bite with a retrusive lower jaw, and her CVM Stage 3 assessment supported incorporating growth into the treatment plan. I chose braces to close the upper spacing, improve incisor inclination, and level the pronounced curve of Spee. Preparing and coordinating both arches created the foundation for correction with the Forsus appliance. Forsus provided a fixed method of Class II correction that reduced reliance on daily elastic wear during this phase. I used it to advance the lower dentition and improve the bite through dental changes, with favorable mandibular growth also contributing to the result. Her lower incisors were initially inclined inward, which made their forward movement a useful component of the planned correction. At the same time, closing the upper spaces allowed us to bring the protrusive upper incisors back into a more favorable position. This combination of braces, Forsus, and growth helped reduce the overjet from 8 mm to 2 mm, correct the deep bite, and establish a Class I occlusion with a more balanced profile.

Measurements

Cephalometric values before and after treatment
Measure	Norm	Pre	Post
SNA	82	78	77
SNB	80	74	75
ANB	2	4	2
Wits	0	5	0
SN-MP	32	30	37
U1-SN	102	112	105
L1-MP	90	84	96
Overjet (mm)	2–3	8	2
Overbite (mm)	2–3	4	2

Treatment

Objectives. Close maxillary spacing, use Forsus to posture the mandible forward and produce dentoalveolar changes to improve the Class II relationship, reduce overjet and protrusion, level and align both arches, coordinate the midlines, and improve the facial profile.

Plan. Band the upper first molars and bond 7–7. Level and align both arches, then use the Forsus appliance as the Class II corrector to advance the lower dentition and improve the Class II relationship.

Appliances and materials

Metal Braces — 022 MBT
Class II Forsus
Class II elastics

Outcome

We successfully leveled and aligned both arches and corrected the Class II malocclusion to a Class I relationship. Treatment was completed with an ideal 2 mm overjet and 2 mm overbite, with well-coordinated dental midlines. The mandibular incisors were well controlled and maintained in an ideal position. Favorable forward mandibular growth contributed to the Class II correction, with skeletal improvement demonstrated by the Wits appraisal and ANB angle. Her facial profile became more balanced, with improved facial esthetics both at rest and on smiling. Overall, treatment achieved a well-coordinated Class I occlusion, ideal overjet and overbite, improved skeletal relationship, and enhanced facial and smile esthetics.

Retention

Fixed U2-2 permanent retainer
Fixed L3-3 permanent retainer
Invisalign Vivera retainers to be worn at night